Cerebrospinal Fluid Flashcards
Cerebrospinal fluid (CSF) surrounds the brain and spinal cord and circulates within the subarachnoid space. Following statements regarding CSF is true except?
● A. Formation rate is 0.3 to 0.35 mL/min in adults and total volume is 150 mL
● B. Absorption of CSF is in arachnoid villi, choroid plexuses, and glymphatics
● C. In normal adults, lymphocytes are 0 to 5/mm3 while there are no RBCs or polymorphonuclear cells
● D. Produced only in the choroid plexus in the ventricles
● E. Normal glucose in CSF is 60 mg/dL while protein is 35 mg/dL
D. Produced only in the choroid plexus in the ventricles
What is the most accurate confirmatory test for fluid to be CSF?
● A. Halo sign
● B. Beta 2 transferrin
● C. Reservoir sign
● D. Quantitative glucose within fluid
● E. CT cisternography
B. Beta 2 transferrin
A patient presents with signs of meningitis. On CSF examination, there is increased opening pressure with turbid appearance of fluid, increased protein, decreased glucose, and few 1000 WBCs (mostly PMNs). What is the most likely diagnosis
in this patient?
● A. Viral meningitis
● B. TB meningitis
● C. Fungal meningitis
● D. Acute purulent meningitis
● E. Multiple sclerosis
D. Acute purulent meningitis
Which of the following is the cause of nontraumatic CSF fistula?
● A. Empty sella syndrome
● B. Increased ICP or hydrocephalus
● C. Infection of paranasal sinuses
● D. A persistent remnant of craniopharyngeal canal
● E. All of the above
E. All of the above
A child presents with complaint of recurrent meningitis without any identifiable cause. A diagnosis of spontaneous posterior fossa fistula is made. Which of the following is a possible site of egress of CSF in this patient?
● A. Facial canal which can fistulize into the middle ear
● B. Petromastoid canal: along the path of arterial supply to the mucosa of mastoid air cells
● C. Hyrtl’s fissure also known as tympanomeningeal fissure which links posterior fossa to hypotympanum
● D. Anomaly of labyrinthine in Mundini dysplasia
● E. All of the above
E. All of the above
Pneumococcal meningitis is the most common pathogen in CSF fistula meningitis. Meningitis most commonly occurs in which type of CSF fistula?
● A. Fistula following a neurosurgical procedure
● B. Posttraumatic fistula
● C. Spontaneous fistula
● D. Fistula due to basal skull fracture
● E. All of the above
C. Spontaneous fistula
What is investigation of choice to determine the site of CSF fistula?
● A. CT of brain with and without contrast
● B. Water-soluble, contrast CT cisternography
● C. MRI with and without contrast
● D. MRI only without contrast
● E. Radionuclide cisternography
B. Water-soluble, contrast CT cisternography
Following statements are true regarding treatment of CSF fistula except?
● A. Prophylactic antibiotics are recommended while there is no rule of pneumococcal vaccine
● B. Conservative treatment includes bed rest, acetazolamide, avoidance from straining, and modest fluid restriction
● C. Serial LPs or continuous lumbar drainage with head of bed elevation
● D. Waiting for 2 weeks before surgical treatment for post-traumatic fistula that does not settle with conservative therapy
● E. Spontaneous leaks usually requires surgery
A. Prophylactic antibiotics are recommended while there is no rule of pneumococcal vaccine
A patient has spontaneous intracranial hypotension (SIH) with low CSF pressure and orthostatic hypotension in the absence of antecedent trauma or dural puncture. Following are characteristics finding on imaging except?
● A. Sagging brain
● B. Pachy-meningeal enhancement
● C. Engorged veins
● D. Pituitary hyperemia
● E. Subdural space absence
E. Subdural space absence
In SIH, there is usually a spontaneous CSF leak which can occur due to spinal diverticula, underlying weakness of meninges as in some connective tissue disorder such as Ehlers and Marfan syndrome and CSF leak because of dural injury due to degenerative disk, osteophyte, or bony spurs. What is the study of
choice for diagnosing and localizing intermittent leaks?
● A. CT myelogram with iodinated contrast
● B. MRI with intrathecal gadolinium
● C. Radioisotope cisternography
● D. Spinal MRI
● E. CT of brain
A. CT myelogram with iodinated contrast
