Hydrocephalus & Shunt Malfunction

Question 1

What symptoms are associated with normal pressure hydrocephalus (NPH)?

Answer 1

Gait disturbances, incontinence, dementia

Question 2

A lumbar puncture is performed on a patient. The pathology report describes the CSF as xanthochromic. What does this mean?

Answer 2

The CSF is red/orange/yellow in color. This indicates that blood was within the CSF and heme has begun to be broken down to bilirubin.

Question 3

This type of congenital hydrocephalus is associated with a genetic anamoly.

Answer 3

Syndromic hydrocephalus. Non-syndromic hydrocephalus is congenital, but is not associated with gene abnormalities

Question 4

At what level should a lumbar puncture be performed?

Answer 4

Below L2 - L3/4 or L4/5

Question 5

Where is CSF produced?

Answer 5

Choroid plexus of each ventricle

Question 6

What is hydrocephalus ex-vacuo?

Answer 6

A hydrocephalus-like condition. There appears to be excess CSF, however, tissue surround the ventricles has shrunk/died and CSF filled the space

Question 7

How is hydrocephalus typically diagnosed in infants and adults?

Answer 7

Ultrasound is used to diagnose hydrocephalus in fetuses and infants. MRI is commonly used to diagnose adults

Question 8

What is the first step in treating non-communicating hydrocephalus?

Answer 8

Create a pathway for the flow of CSF to decrease pressure.

Question 9

A patient is diagnosed with hydrocephalus, but there was not an obstruction in CSF flow. What is the type?

Answer 9

Communicating hydrocephalus - patent pathways, but accumulation of CSF

Question 10

Where is most CSF found within the CNS?

Answer 10

Nearly half of CSF is within the ventricles

Question 11

Hydrocephalus results from excessive CSF in the ventricles. How is it possible for CSF to accumulate?

Answer 11

Obstruction of normal flow, poor reabsorption of CSF by arachnoid granulations, excess production of CSF by the choroid plexus (rare)

Question 12

Eyes that are fixed downward, called sun setting, may be an indication of hydrocephalus in what population?

Answer 12

Neonates

Question 13

What are the treatment options for hydrocephalus?

Answer 13

Ventricular shunt or third ventriculostomy

Question 14

Describe the production, flow, and reabsorption of CSF.

Answer 14

CSF is produced by the choroid plexus in the lateral ventricles.

From here, CSF flows through the intraventricular foramina to the third ventricle and then the cerebral aqueduct to the fourth ventricle. Each ventricle has a choroid plexus that produces more CSF. CSF exits the fourth ventricle to fill the subarachnoid space to surround the brain and spinal cord.

CSF is reabsorbed by arachnoid villi within the sagittal sinus.

Question 15

What type of spina bifida is easier to treat and does not involve neuronal elements?

Answer 15

Meningocele

Question 16

How is CSF reabsorbed?

Answer 16

By arachnoid villi

Question 17

What type of spina Bifida involves neuronal elements within the external fluid-filled cavity?

Answer 17

Myelomeningocele

Question 18

What is normal pressure hydrocephalus (NPH)?

Answer 18

There is an accumulation of CSF, however, the rate of accumulation is slow enough that tissues around the ventricles shrink to prevent an increase in pressure

Question 19

True/False. The total volume of the brain, CSF, and blood is constant within the skull.

Answer 19

True. If there is an increase in the volume of one, the volume of the others must be reduced to accommodate. A failure of this accommodation leads to hydrocephalus.

Question 20

What is the normal range for CSF pressure?

Answer 20

70-180 mmH2O

Question 21

Where do CSF obstructions most commonly occur?

Answer 21

Foramina Monro, Aqueduct of Sylvius, fourth ventricle, foramen magnum

Question 22

What is a ventriculostomy?

Answer 22

A hole is created in the floor of the third ventricle to help drain CSF

Question 23

This type of hydrocephalus results from a blockage that obstructs the flow of CSF.

Answer 23

Non-communicating hydrocephalus

Question 24

Shunts may be used to treat hydrocephalus. What are the common reasons why these devices fail?

Answer 24

Mechanical failure or infection

Question 25

True/False. CSF is composed of ions, proteins, glucose, and leukocytes.

Answer 25

False. CSF should not have leukocytes or blood, only ions, proteins, and glucose.