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Neurology Week 3 2018/19 > 6: Hydrocephalus > Flashcards

6: Hydrocephalus Flashcards

1
Q

What is the normal CSF pressure in the subarachnoid space?

A

10 mmHg

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2
Q

Anyone with a CSF pressure greater than ___ mmHg should be suspected of having hydrocephalus.

A

15 mmHg

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3
Q

How much circulating CSF does a typical adult have at any one time?

How much CSF do you produce per day?

A

1600ml circulating at any one time

500ml produced per day

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4
Q

CSF production (increases / decreases) as you get older.

A

decreases

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5
Q

What happens if you remove too much CSF during a lumbar puncture?

A

Tonsilar herniation

Cushing’s response - hypertension, bradycardia, irregular breathing

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6
Q

What causes increased CSF pressure?

A

Blockage of ventricles

Overproduction of CSF

Impaired CSF absorption

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7
Q

Which drug decreases CSF production?

A

Acetazolamide

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8
Q

Which structures absorb CSF from the cranial cavity?

A

Arachnoid granulations

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9
Q

ICP affects CSF (production / absorption).

A

CSF absorption only, inverse relationship

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10
Q

What are the functions of CSF?

A

Maintenance of homeostasis e.g nutrition, ions

Keeps the brain buoyant - reduces pressure exerted on skull

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11
Q

What is a Chiari malformation?

What disease does it cause?

A

Congenital OR acquired tonsilar herniation of cerebellum and brainstem through the foramen magnum and into the spinal canal

Syringomyelia

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12
Q

What is syringomyelia?

Which malformation can cause it?

A

Abnormal fluid-filled cavity/ies within the spinal cord

Chiari malformation

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13
Q

How can syringomyelia cause hydrocephalus?

A

Impaired CSF flow from spinal cord to brain due to compression of central canal by syrinxes

CSF builds up and ICP increases

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14
Q

What is the physical presentation of hydrocephalus in children?

A

Abnormally large head

Thin, shiny scalp with visible veins

Bulging fontanelles

Sunset eyes

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15
Q

What eye sign can be seen in children with hydrocephalus?

A

“Sunset” eyes

Downward gaze with area of sclera visible between upper eyelid and iris

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16
Q

Which structure in the brain is compressed to cause a sunset gaze?

A

Tectal plate

17
Q

What are the neuro symptoms of paediatric hydrocephalus?

A

Sensory and motor problems

Behavioural changes - sleeping, feeding, irritability

Vomiting

18
Q

Why can hydrocephalus cause visual loss?

A

Increased CSF volume

=> Increased ICP

=> Pressure on meninges surrounding CN II

=> Papilloedema

=> Visual loss

19
Q

Acquired hydrocephalus tends to be a ___ disease.

A

resolving

20
Q

Which acute brain disease causes acquired hydrocephalus?

Why?

A

Subarachnoid haemorrhage

Arachnoid granulations are blocked with blood and can’t absorb CSF properly

21
Q

Which tube can be fitted to drain CSF from the ventricles of a patient with hydrocephalus?

A

Ventriculoperitoneal shunt

Valves only open if ICP is too high, avoiding excessive draining of CSF

22
Q

Why are shunts avoided in hydrocephalus involving tumours?

A

Tumour may be disseminated into peritoneal cavity

23
Q

What is craniosynostosis?

A

Inappropriate fusion of cranial bones caused by rapid head size changes

24
Q

What are the signs and symptoms of a blocked shunt in patients with hydrocephalus?

A

N&V

Headache

Blurred vision

“Sunsetting” - lack of upgaze

pretty much the same as hydrocephalus

25
Q

What is the gold standard investigation for hydrocephalus?

A

CT scan

26
Q

What is a more long-term option compared to a shunt for treating patients with some types of hydrocephalus?

A

Endoscopic third ventriculostomy

drilling a hole in the floor of the 3rd ventricle to let CSF drain

27
Q

What is a disease presenting as a triad of ataxia, memory decline and incontinence?

A

Normal pressure hydrocephalus

28
Q

What is normal pressure hydrocephalus?

What does it present as?

What is the investigation?

A

Enlarged cerebral ventricles with normal CSF pressure

Ataxia, memory decline and incontinence

Head scan - CT/MRI

29
Q

How is normal pressure hydrocephalus treated?

A

Shunt

30
Q

Which group of patients typically develop idiopathic intracranial hypertension?

A

Obese women

31
Q

What are the symptoms of idiopathic intracranial hypertension?

A

Headache (worse in the mornings)

Visual blurring (papilloedema due to raised ICP)

32
Q

What is the gold standard investigation for idiopathic intracranial hypertension?

A

Lumbar puncture

Only case in which you’d do an LP on someone with hypertension, because you need to see that CSF pressure is up

33
Q

How is idiopathic intracranial hypertension treated?

A

WEIGHT LOSS

Control underlying diseases

Drugs/procedures to reduce ICP

Neurology Week 3 2018/19 (10 decks)

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