Lecture 3 - Spina Bifida and Hydrocephalus Flashcards Preview

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Flashcards in Lecture 3 - Spina Bifida and Hydrocephalus Deck (23):

What is Hydrocephalus?

Occurs when there is an imbalance between the production and absorption of cerebrospinal fluid (CSF)


What is the broad consequences of hydrocephalus?

If the flow of CSF is obstructed this leads to a build up of pressure on the brain, which can impact on the structure and function of the brain.

If left untreated this results in damage to the brain cells and ultimately death.


What are the three ways hydrocephalus can be classified?

1.Type: obstructive or communicating

2.Aetiology: congenital or acquired

3.Co-morbidities: present or absent


What are some common neuropathological consequences of hydrocephalus?

•Axonal destruction and white matter atrophy
•Disruption to myelination
•Thinning/stretching of callosal and projection fibres
•Atrophy of olfactory nerves and optic tract


What is the main surgical treatment for hydrocephalus?

•Usually involves insertion of a shunt
•The shunt is inserted via a burr hole through the skull and into the ventricle
•Accumulated CSF drains through the shunt to the extracranial body cavity


What are the consequences of shunt malfunctions? (hydrocephalus)

Blocked, malfunctioning or infected shunts give rise to physical and cognitive changes
•Signs may include:
–Gradual deterioration in functioning
–More severe malfunctions include: persistent headaches, vomiting, lowered arousal
•If left untreated may lead to acute illness and coma


What is an Arnold Chiari Malformation?

what is a possible consequence?

Malformation of the brainstem and cerebellum
•Structures displaced into the spinal canal
•Can obstruct flow of CSF and cause hydrocephalus


What is Spina Bifida?

A defect of neural tube closure (bottom) in early embriogenesis, occurring around the end of the first month of gestation during the neurolationphase
•It manifests as a malformation along the spinal cord
Malformations on the spinal cord can occur at any point between the cervical and lower sacral regions


What are the three forms of Spina Bifida?

–Spina bifida occulta
–Spina bifida cystica (2 forms):
–1. Meningocele
–2. Myelomeningocele


What is Spina bifida occulta?

A mild form of spina bifida,
•Vertebral arches incomplete, CNS develops normally
•May be apparent because of abnormalities in skin and tissue at the site of the malformation

Outer layer of vertebrae not completely joined. Spinal cord and covering (meninges) undamaged. Hair often at the site of defect.


What is Spina bifida Meningocele?

•Protrusion of the meninges and CSF through abnormal vertebral arches
•This protrusion forms a skin covered sac, usually in the region of the lumbosacral spine
•CNS usually otherwise intact


What is Spina bifida Myelomeningocele?

•Most common and severe form of spina bifida
•At birth, appears as an open cyst/external sac on the back
•This sac contains damaged spinal cord and nerves
•The level of the lesion is related to the severity of the impairments


90% of children with Spina bifida Myelomeningocele will have what four issues?

–Arnold Chiari Malformation
–Lower Limb Paralysis
–Bowel and Bladder Incontinence


What are the physical issues associated with Spina Bifida

•Usually weakness and paralysis of lower limbs (varies in severity)
•Child may require:
–Special braces to support muscles


What continence issues are associated with spina bifida?

•Incontinence may result from impairments in ability of nerve signals to move from brain to bowel/bladder
•Management usually involves intermittent cathedarisation
•Bowel management strategies:
–Toilet timing
–Diet monitoring


Broadly, what are the main neuropsychological deficits associated with Spina Bifida and Hydrocephalus?

•Majority of children with SB and hydrocephalus demonstrate “average” intellectual functioning

•However, most experience specific cognitive impairments

•Common deficits include:
–Attention & concentration
–Memory and Learning
–Visuo-perceptual and motor integration
–Executive skills


Why are their neuropsychological deficits in spina bifida? (neuropathology)

Cognitive deficits are directly caused by underlying neurological problems associated with SB:
–Arnold Chiari Malformation
–Cortical Dysplasias


What are some common Attention & Concentration symptoms of SB and Hydroceph?

•Poor sustained attention
•Difficulties with selective attention
•Poor focused attention & distractibility
•Reduced arousal, motivation and initiation


What are some common language symptoms of SB and Hydroceph?

•Good vocabularies, talkative
•Disorder of language usage rather than content
•Deficits in fluency, comprehension and inferential language
•Poor monitoring of logic, relevance or appropriateness
•Slow and reduced comprehension


What are some common memory & learning symptoms of SB and Hydroceph?

•Difficulty with encoding, rate of learning, delayed recall and spontaneous retrieval of information
•Recognition memory and cued recall stronger
•Encoding and retrieval deficits on visual memory tasks
•Struggle with learning abstract concepts (like mathematics)


What are some common perceptual & motor-integration symptoms of SB and Hydroceph?

•Poor at interpreting visuo-spatial information
•Impaired fine motor skills
•Slow and untidy handwriting


What are some common executive function symptoms of SB and Hydroceph?

•Poor planning and organisation
•Problem solving and reasoning difficulties
•Difficulty maintaining goal directed behaviour
•Inflexible thinking
•Concrete thinking


What are some common visuo-academic symptoms of SB and Hydroceph?

•Impaired reading comprehension
•Poor spelling
•Slow and messy handwriting
•Poor copying skills
•Difficulties with mathematical problem solving