Abnormalities with CSF

Question 1

What is cerebral perfusion pressure?

Answer 1

Defined as mean arterial pressure - intracranial pressure

Determines blood flow into the brain

Question 2

What are three ways increased ICP can damage the brain?

Answer 2

Brain tissue damage via compression

Blood flow can be compromised causing a stroke or compression hemorrhage

Brain can herniate

Question 3

What is a subfalcine herniation?

Answer 3

Herniation into the interval between the falx cerebri and corpus callosum

Seldom causes specific symptoms

Question 4

What is an uncal herniation?

Answer 4

Uncus of the temporal lobe is displaced through the tentorial notch

Compression of ipsilateral crus cerebri - contralateral motor weakness

Compression of contralateral crus - ipsilateral motor weakness

Decreased consciousness, ipsilateral pupillary dilation

Question 5

What is pressure coning?

Answer 5

A cone of cerebellar tissue may descend into the foramen magnum, squeezing the medulla

Severely decreased consciousness, change in vitals (medulla)

Question 6

What is the most common cause of subarachnoid hemorrhage?

Answer 6

Rupture of aneurysm - berry in CoW

May also occur from leakage of arteriovenous malformations or angiomas

Question 7

What are the cardinal symptoms of subarachnoid hemorrhage?

Answer 7

Sudden onset of a severe headache

Stiff neck (nuchal rigidity)

Altered level of consciousness

Question 8

How can a hemorrhage involving meninges/sinuses be caused in infants?

Answer 8

Breech, excessive molding of head

Tearing of bridging veins or rupture of a venous sinus

Shearing force that tears the attachments of the falx cerebri from the tentorium cerebelli

Question 9

What indicates the presence of a basal fracture?

Answer 9

Leakage of CSF or bleeding from the auditory canal

Should always be viewed as a serious clinical sign

Question 10

Why do fractures of the skull increase the risk of meningeal bleeding?

Answer 10

Meningeal vessels are also distributed to bone

Question 11

Describe and epidural hematoma.

Answer 11

Dura is separated from the bone, causes a lens shaped hematoma

Can result in brain herniation

Can be followed by a period of normalcy, before a subsequent decompensation

Question 12

Describe a subdural hemorrhage

Answer 12

Bleeding into the dubdural space between the dura and arachnoid membranes

Crescent-shaped hematoma

Most commonly occur from anterior-posterior displacement of the brain, more common in the elderly

Question 13

What is a concussion?

Answer 13

transient disruption of brain funnction; can involve a temporary alteration of consciousness

referred to as a mil traumatic brain injury

produces damage in the white matter underlying the prefrontal cortex

Question 14

What is chronic traumatic encephalopathy?

Answer 14

Caused by repeated head trauma or repeated TBIs

Charachterized by memory loss, paranoia, depression and ataxia

Question 15

What are the two general types of hydrocephalus?

Answer 15

Non-communicating - obstructive

Communicating - non obstructive

Question 16

Describe Non-communicating hydrocephalus

Answer 16

Fluid flow out of one or more of the ventricles is blocked

Occurs from blockage or stenosis anywhere in the system

Usually a complication of another disorder (brain tumor)

If possible, shunt from the lateral ventricle to the peritoneal cavity (under the skin)

Question 17

What can cause aqueductal stenosis/hydrocephalus in infants?

Answer 17

IF their mothers were infected with mumps or rubella virus

Question 18

What happens to the head in newborns with non-communicating hydrocephalus?

Answer 18

Head enlarges

Question 19

Describe Communicating hydrocephalus.

Answer 19

CSF is freely communicating, but either too much CSF produced, or not enough removed

All ventricles will be enlarged and the head will swell enormously

In adults, associated with increased ICP and damage to the brain

Treatment - medications to reduce production or surgically destroying some of the choroid plexus

Question 20

What is idiopathic intracranial hypertension (pseudotumor cerebri)?

Answer 20

Increased ICP with no apparent cause on imaging

Causes severe daily pulsatile headaches

Visual distrubances

Question 21

What are the risk factors for IIH?

Answer 21

Females

Tetracycline antibiotics

Obesity

Vitamin A excess

Estrogen birth control

Question 22

What is the treatment for IIH?

Answer 22

Initial: Lumbar Puncture, Drugs to reduce CSF production

Chronic: Lose weight

Question 23

What is Normal Pressure hydrocephalus?

Answer 23

Communicating hydrocephalus without an associated increase in ICP

Occurs in elderly adults

Treatment is to place a shunt in ventricles

Question 24

What are the three cardinal features of NPH?

Answer 24

Gait difficulty

Cognitive disturbance

Urinary incontinence