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Neurology System > CSF and Hydrocephalus > Flashcards

CSF and Hydrocephalus Flashcards

1
Q

What does CSF bathe?

A

Brain and spinal cord

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2
Q

Where is CSF found?

A

Subarachnoid space

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3
Q

What is the main role of CSF?

A

Shock absorber

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4
Q

Describe the ventricular anatomy

A 
Lateral ventricles
Interventricular foramen 
3rd ventricle 
Cerebral aqueduct 
4th Ventricle
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5
Q

Where is the choroid plexus found?

A

Mostly on floor of lateral ventricles

Some in roof of 3rd and 4th

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6
Q

Describe the flow of CSF

A
  1. Lateral ventricles
  2. Foramina of Munro
  3. 3rd Ventricle
  4. Aqueduct of Sylvius
  5. 4th Ventricle
  6. Foramen of Magendie (medial, x1) & Foramen of Luschka (lateral, x2)
  7. Subarachnoid spaces
  8. Arachnoid granulations (reabsorbed here)
  9. Dural venous sinuses
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7
Q

Is CSF production passive or active?

A

Active

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8
Q

Is CSF reabsorption passive or active?

A

Passive

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9
Q

What is hydrocephalus?

A

General condition whereby there is excess CSF within the intracranial space

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10
Q

Is normal CSF production or absorption usually affected in hydrocephalus?

A

Absorption

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11
Q

What is the result of abnormal CSF absorption?

A

Ventricular system dilatation

Raised ICP

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12
Q

What are potential causes of congenital hydrocephalus?

A

Chiari malformation
Aqueductal stenosis
Dandy-Walker malformation

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13
Q

What are causes of acquired hydrocephalus?

A 
Meningitis 
Post-haemorrhagic 
Neoplasm: benign or malignant 
Post op 
Cerebellar stroke 
Post traumatic
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14
Q

What are signs and symptoms of hydrocephalus in infants?

A 
Cranial enlargement 
Splaying of cranial sutures 
Irritable
Poor feeding 
Frontanelles full and bulging 
Engorged scalp veins (venous scalp distension) 
Abducens palsy 
Perinauds syndrome  (upwards glaze, convergent nystagmus, eyelid retraction)
Exaggerated reflexes 
Respiratory problems
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15
Q

Are there any RBC in the CSF?

A

No

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16
Q

What are some other roles of CSF?

A

Fills in the gaps between the brain and the skull
Immunological role
Removal of some waste products

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17
Q

CSF distribution between brain and spinal cord

A

50:50

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18
Q

Where is CSF produced?

A

In the choroid plexus

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19
Q

Is there commonly an overproduction of CSF?

A

No commonly a problem with the reabsorption of CSF

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20
Q

What are the signs and symptoms of hydrocephalus in older children and adults?

A 
May be asymptomatic 
Increased ICP - measured with a monitor 
Headaches - worse in the morning or on coughing 
Papilloedema 
Visual disturbances 
Gait abnormality 
Loss of upgaze or CN VI palsy 
Impaired consciousness
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21
Q

What will imaging show in hydrocephalus?

A

Dilation of the temporal horns of the LV
3rd ventricle will become ballooned
Lateral ventricle size increases
Peripheral sulci effaced (pushing of gyri together)

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22
Q

What is the medical Rx for hydrocephalus?

A

Acetazolamide

Reduces CSF production from the choroid plexus

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23
Q

What is the surgical Rx for hydrocephalus?

A

External ventricular drain (EDV)
CSF diversion
Eliminating obstruction

24
Q

What is a long term solution for hydrocephalus?

25
What is the management for hydrocephalus in an emergency situation?
EVD
26
What is the most commonly used shunt?
Ventriculo-peritoneal
27
What are the types of shunts?
``` ¥ Ventriculo-peritoneal (VP shunt) - Most used ¥ Ventriculo-pleural ¥ Ventriculo-atrial - Can be considered in cases of peritoneal failure ¥ Ventriculo-subarachnoid ```
28
When can a ventriculo-atrial shunt be considered?
Can be considered in cases of peritoneal failure
29
What are the potential complications of shunts?
``` Over drainage Under drainage Blockage Infection Disconnection Seizures Distal end problems ```
30
What can over drainage of shunts cause?
Low pressure headaches | subdural haematoma
31
What is endoscopic 3rd ventriculostomy?
Endoscopic third ventriculostomy (ETV) is a surgical procedure for treatment of hydrocephalus in which an opening is created in the floor of the third ventricle using an endoscope placed within the ventricular system through a burr hole. This allows the cerebrospinal fluid to flow directly to the basal cisterns, bypassing the obstruction.
32
Where does ETV create a fistula?
Between 3rd ventricle and subarachnoid spaces/ basal cisterns
33
What does ETV only work for?
non-communicating hydrocephalus
34
What is communicating hydrocephalus?
Communicating hydrocephalus, also known as non-obstructive hydrocephalus, is caused by impaired cerebrospinal fluid reabsorption in the absence of any CSF-flow obstruction between the ventricles and subarachnoid space.
35
What is normal pressure hydrocpehalus?
type of brain malfunction caused by expansion of the lateral cerebral ventricles
36
What is the classic triad in NPH?
Dementia Gait disturbance Urinary incontinence
37
What age is typical for NPH?
>60
38
What is the Rx for NPH?
Insertion of a shunt
39
What is shown in NPH on MRI/CT?
Communicating hydrocephalus
40
What is idiopathic intracranial hypertension?
Raised ICP without obvious cause
41
What is the typical patient for idiopathic intracranial hypertension?
Young obese female
42
What is the typical presentation of idiopathic intracranial hypertension?
Headaches Visual disturbances Papilloedema
43
What will happen to idiopathic intracranial hypertension patients without treatment?
Will go blind
44
What is the treatment for idiopathic intracranial hypertension?
Loos weight Medical - Acetazolamide VP of LP shunt
45
What are the indications for LP?
¥ Obtain CSF for analysis ¥ Rule out bacterial or viral infection ¥ Measure for blood breakdown products (SAH) ¥ Measure protein load ¥ Measurement of pressure (intracranial pressure (ICP)) ¥ CSF drainage for raised pressure ¥ Diagnostic test for Normal Pressure Hydrocephalus
46
What are the contraindications for LP?
} Unstable patient with cardiovascular or respiratory instability } Localized skin/soft tissue infection over puncture site } Evidence of unstable bleeding disorder ◦ Platelets < 50,000 or clotting factor deficiency
47
What are the pre LP checks?
¥ Awake & conscious patient ¥ No focal neurological deficit (6th nerve palsy) ¥ CT/MRI: rule out intracranial mass lesion ¥ Ensure patient not on anticoagulants ¥ Verbal consent
48
Describe the positioning for LP
Correct positioning Fetal position - knees up and neck flexed Pillow between the knees Between L4/L5
49
Describe the technique for LP
``` Aseptic Local anaesthetic administered Spinal needle angled towards umbilicus Aim for space Going through ligamentum flavum (1st pop) 2nd pop - dura Check for SF Measure pressure Obtain samples Withdraw needle Dress the area ```
50
What are the risks of LP?
``` Bleeding Infection Nerve root injury Retroperitoneal/ intra-abdominal injury Brainstem ```
51
What is post-LP care?
Bed rest for 2-4 hours Warn patients about low pressure headaches Stop if patient is developing neurological deficit or becoming unconscious
52
What is typical CSF in meningitis?
Cloudy Turbid WBC - mostly polomorphs
53
When can a bloody CSF sample be a sign of?
Traumatic tap | following SAH
54
What is a traumatic tap?
When the needle has been inserted into an epidural vein
55
What causes xanthochromic?
Yellow CSF due to blood breakdown products
56
When is xanthochromic seen?
In SAH
57
When is spectrophotometry positive?
After 12 hrs | If it persists for 12 weeks

Neurology System (35 decks)

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