CSF Circulation Disorders

Question 1

What is the upper limit of normal of CSF pressure?

Answer 1

15mm Hg or 20cm CSF

Question 2

How much CSF is produced each day?

Answer 2

500ml

Question 3

What drug reduces the production of CSF?

Answer 3

Acetazolamide

Question 4

Where does CSF absorption take place?

Answer 4

Arachnoid granulations

Question 5

Give some functions of CSF

Answer 5

Brain buoyancy
Provides nutrition
Clears waste products

Question 6

Give some signs of hydrocephalus seen at birth

Answer 6

Unusually large head
Thin/shiny scalp
Bulging fontanelle
Downward looking eyes

Question 7

What imaging can be done to look for congenital hydrocephalus?

Answer 7

Antenatal ultrasound

Question 8

What is the main treatment for hydrocephalus?

Answer 8

Ventriculoperitoneal shunting

Question 9

Give some complications of shunting

Answer 9

Overdrainage
Underdrainage
Infection
Seizures

Question 10

Give some symptoms of a blocked shunt

Answer 10

Headache and vomiting
Sunset eyes (kids)
No upgaze (adults)

Question 11

What should be done in the event of a blocked shunt?

Answer 11

CT head

Surgery - shunt replacement

Question 12

What is an alternative treatment to shunting in hydrocephalus?

Answer 12

Endoscopic ventriculostomy (ETV)

Question 13

What is the main advantage of ETV over shunting?

Answer 13

Less likely to need replaced

Question 14

What occurs in normal pressure hydrocephalus?

Answer 14

Enlarged cerebral ventricles with normal ICP

Question 15

What triad of symptoms is seen in normal pressure hydrocephalus?

Answer 15

Ataxia (shuffling/broad-based gait)
Memory decline
Incontinence

Question 16

How is normal pressure hydrocephalus mainly diagnosed?

Answer 16

Clincially
CT
Lumbar tap test

Question 17

What treatment options are available for normal pressure hydrocephalus?

Answer 17

Lumbar drain

Shunt (mainly VP)

Question 18

Patients with idiopathic intracranial hypertension tend to be obese/underweight and male/female

Answer 18

Obese and female

Question 19

What are the main symptoms of IIH?

Answer 19

Headaches

Visual loss

Question 20

What is the main sign of IIH?

Answer 20

Papilloedema

Question 21

In IIH, CSF pressure is above what?

Answer 21

> 25cm CSF

Question 22

What are the main treatments for IIH?

Answer 22

Diuretics
LP/VP shunts
Weight loss

Question 23

Give some symptoms of spontaneous intracranial hypotension

Answer 23

Orthostatic headaches
Neck/arm pain
Diplopia
Dizziness
Galactorrhoea

Question 24

How is spontaneous intracranial hypertension treated?

Answer 24

Conservatively (bed rest/fluids/analgesia)

Question 25

What investigations are done in spontaneous intracranial hypertension?

Answer 25

MRI | Lumbar puncture

Question 26

What occurs in syringomyelia?

Answer 26

Cyst forms in the spinal cord

Question 27

Syringomyelia commonly occurs in which patients?

Answer 27

Spinal trauma patients

Question 28

How does syringomyelia present?

Answer 28

``` Sensory loss Small muscle wasting Clawed hands Loss of upper limb reflexes Increased lower limb reflexes ```

Question 29

What is an early stage feature of syringomyelia?

Answer 29

Hyperhidrosis

Question 30

What are some common presentations of hindbrain hernias?

Answer 30

Headaches following straining/coughing Visual disturbances Dizziness Deafness

Question 31

How is syringomyelia treated?

Answer 31

Open up obstructed CSF channels | Drain syrinx cavity

Question 32

What is the main way to open up an obstructed CSF cannel?

Answer 32

Craniovertebral decompression