CSF, Hydrocephalus and lumbar puncture

Question 1

Function of the CSF

Answer 1

Protection - shock absorber
Immune ?

Question 2

Colour of CSF

Answer 2

Clear and colourless

Question 3

What produces CSF?

Answer 3

Choroid plexus (80%)
Interstitial space
Ependymal lining of ventricles

Question 4

How muhc CSF produced per day?

Answer 4

450ml

Question 5

How does CSF leave the 4th ventricle?

Answer 5

Through either:

Foramen of Luschka (takes csf back - front)
Foramen of Magendie (posterior)
Or down th ecentral canal or around the spinal chord

Question 6

Distinguishations in CSF for bact/viral/fungal/tb

Answer 6

Bact:
- high protein
- high white cell
- low glucose
-turbid appearance

Viral:
-high white cell (Monocytes )

Funga/Tb
-low glucose
-high WCC (monocytes)
-fibrin web appearance

Question 7

When don’t we do a lumbar puncture?

Answer 7

Raised ICP or non-communucating hydrocephalus

Question 8

Hydrocephalus - can we do a lumbar punture?

Answer 8

Only if it is communicating hydrocephalus

Question 9

What level for lumbar puncture?

Answer 9

L3/4 or L4/5

Question 10

What are the 2 types of hydrocephalus? (main)

Answer 10

communicating and non communucating

Question 11

What are th ecauses of hydrocephalus?

Answer 11

Many different causes, including:
Infective (meningitis)
Post haemorrhagic
Secondary to masses
Congenital - Chiari Type 2, myelomeningocele, primary aqueductal stenosis, Dandy Walker Malformation (atresia of Luschka and Magendie

Question 12

Congentical causes of hydrocephalus

Answer 12

Chiari Type 2 malformation, Primary aqueductal stenosis, DandyWalker Malformation

Question 13

Aquired cuases of hyderocephalus

Answer 13

Infectious, post haemorrhagic, secondary to masses

Question 14

Signs nad symptoms of hydrocephallus

Answer 14

In baby:
-increased head size
-irritable, poor feeds, vomit

In adults (2+ = fused cranium):
-papilledema
-headache (w/ nausea and vommitting)
-gait changes
-gaze palsy
-diplopia

Question 15

What is the first localising sign?

Answer 15

VI cranial nerve palsy causing diplopia

Question 16

How do we investigate hydrocephalus?

Answer 16

Baby: ultrasound

Adult (2+) : Ct - micky mouse appearance . MRI gives more precise

Question 17

How do we treat hydrocephalus?

Answer 17

Obstructive hydrocephalus:
-external ventricular drain
-permanent diversion - endoscopic third ventriculostomy

Communucating hydrocephalus:
-Ventricular peritoneal shunt (also if not suibtable to endscopic 3rd ventriulostomy)

Question 18

Is hydrocephalus an emergency?

Answer 18

yes!