CNS practical 2

Question 1

where do you do lumbar punctures in children

Answer 1

lower than L4/5 because the end of the spinal chord is less well defined

Question 2

how do you distinguish between an epidural and subdural haemorrhage

Answer 2

epidural - between the skull and the dura - arteries are damaged - shift of midline
subdural - between dura and arachnoid - slower vein bleeding

Question 3

what structure is affected in meningitis

Answer 3

meninges

Question 4

what is shown on a CSF sample to show bacterial meningitis

Answer 4

see bacteria, low on glucose, high in protein

if not it is viral - never know what type so treat as a normal viral infection

Question 5

how does CSF composition differ from blood

Answer 5

less protein
lower glucose, ca, k, pH and cells
higher cl and mg

Question 6

2 types of hydrocephalus

Answer 6

communicating - child

non-communicating - adult

Question 7

causes of communicating hydrocephalus

Answer 7

block in csf absorption or csf flow over the brain surface,
meningitis 
head injury 
congenital 
sub arachnoid haemorrhage

Question 8

causes of non-communicating hydrocephalus

Answer 8

not all ventricles are enlarged
aqueduct stenosis
ventricular tumours
paraventricular tumours

Question 9

main symptoms of communicating hydrocephalus

Answer 9

increased head circumference
irritability
loss of upwards gaze

Question 10

main symptom of non-communicating hydrocephalus

Answer 10

increased pressure in head
headache
drowsy
blackouts

Question 11

how is hydrocephalus treated

Answer 11

remove cause
papilloma for tumour
divert csf - shunt in neonate
open alternative pathway eg ventriculostomy