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Pathophysiology > CSF > Flashcards

CSF Flashcards

1
Q

ml/min?

A

0.3ml/min

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2
Q

absorption of CSF?

A

arachnoid villi (granulations)

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3
Q

Is the production of CSF pressure dependent?

A

no, only if so high, cerebral flow is reduced.

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4
Q

Is the resorption of CSF pressure dependent?

A

yes.

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5
Q

how much CSF does a newborn have?

A

5ml

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6
Q

how much CSF does a newborn produce per day?

A

25ml

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7
Q

What is normal Na and K in CSF?

A

Na: 138. K: 2.8

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8
Q

what is normal pH in CSF compared to plasma?

A

7.33 jmf 7.41

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9
Q

normal pO2 in CSF compared to arterial plasma?

A

43 compared to 104.

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10
Q

glucose level in CSF compared to plasma?

A

60 vs 90. obs higher in plasma.

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11
Q

total protein level in CSF compared to plasma?

A

35mg/dl c
vs 7000mg/dl.

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12
Q

Normal number of mononuklear or lymphocytes in CSF?

A

0-5 lymphocytes or monocytes.

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13
Q

normal no of polyleukocytes in CSF?

A

0

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14
Q

what is the best test for CSF?

A

Beta transferrin (Beta tracer)

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15
Q

What is the best bilddiagnostik to localize a fistula?

A

CT cisternography

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16
Q

How is a CT cisternography performed?

A

kolla upp!

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17
Q

When to suspect csf fistulae?

A
  • rhinorrea after trauma
  • otorrhea after trauma
  • recurrent meningitis.
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18
Q

Kom ihåg rörande spontana CSF fistuale

A
  • oftast äldre än 30 år.
  • smygfiser, misstas ofta för rhinit.
    ! Pneumocephalus är OVANLIGT
  • titta efter infektion i paranasala sinus.
  • kan vara associerat med empty sellae
  • kan vara associerat med tumörer, inkl pituitary adenoma and meningioma.
    !!!- persisterande rest av craniopharyngeala kanalen
  • Ibland associerat till ökat ICP o hcph.
  • ibland associerat till agenesi av cribriform plate eller middle fossa.
  • AVM association - jag vet ej hur.
  • spännande! DEHISCENCE OF THE FOOTPLATE of stapes which can produce rhinorrea via the eustachian tube.
  • dehischence belov foramen rotundum.
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19
Q

signs of spinal CSF fistulae

A

postural HA+neck stiffness+neck tenderness

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20
Q

Risk for CSF fistulae after trauma?

A

5-10%, increase if leak persist more than 7 days.

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21
Q

what is the most common pathogen in spinal CSF fistulae infections?

A

pneumococc 83%

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22
Q

Age differences in CSF fistulae infection

A

Better prognosis, (less than 10-50% mortality) than for pneumococcal meningitis w/o fistulae. Probably because these patients are younger.
BUT worse progrnosis in children.

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23
Q

What taste has CSF rhinorrea?

A

SALTY p 400

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24
Q

What special patient groups might have B transferrin w/o CSF leak?

A

newborns and liver diseased.

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25
Q

what other source than CSF produce betatransferrin?

A

vitrous fluid of the eye

26
Q

How often is pneumocephalus presented on CT scan after CSF leak?

A

20%

27
Q

How is a cisternogram performed to find a CSF leak?

A
  1. intrathecal injection of radionucleotide.
  2. scintigram OR
  3. injection of radiopaque and then CT scan
28
Q

How many % of pt w CSF leak have anosmia?

A

5%

29
Q

what is a pseudo-CSF rhinorrhea?

A

nasal hypersecretion from imbalanced autonomic regulation after skull base surgery. Ipsilateral to the surgery site.

30
Q

What structure is most often involved in pseudo-rhinorrea?

A

the greater superficial petrosal nerve injuries. Due to imbalancing autonomic regulation.

31
Q

What autonomic disturbances often accompanies pseudo-rhinorrea?

A
  • loss of lacrimation ipsilaterally.
  • facial flushing
  • nasal “stuffiness”
32
Q

How often is a water soluble contrast CT cisternography needed to localize a CSF fistulae?

A

10%

33
Q

What to ask and look for in a CT to detect SCF leak?

A
  • ask for thin CORONAL cuts through anterior fossa and back to sella turcica. W/WO contrast
  • Look for:
    Pneumocephalus
    Fractures
    Skull base defects
    Hcph
    Obstructive neoplasms

Contrast - abnormal enhancement of adjacent brain parenchyma possibly due to inflammation.

34
Q

What is the role of MRI in finding CSF leak

A

R/O p-fossa mass
Tumor
Empty sella
* T2W1 fast spin w fat suppression might be used to try and see CSF flow direction.

35
Q

When is CT cisternography indicated to find CSF leakage site?

A
  • No site id on coronal plane thin slice CT
  • The patient is actively leaking (otherwise difficult to trace w CT cisternography)
  • Multiple bony fragments found and which is causing trouble is unknown.
  • A bony defect seen on plain CT does not have associated changes of abnormal enhancement of adjacent brain parenchyma.
36
Q

What vaccine is indicated after posttraumatic suspected SCF leak or postoperative?

A

pneumococcal vaccine. ( age 2-65yo)

37
Q

non-surgical rek. in CSF leak

A
  • Lower ICP
  • Bed rest - can be discussed.
  • Avoid straining - stool pills! No blown nose
  • Acetazolamide 4x/d. 250mg (reduce CSF production)
  • Modest fluid restriction but cautious after transsphenoidal due to possible DI. (1500/d)
38
Q

2nd step rek. CSF leak

A
  1. rule out obstructive hcph.
  • LP to H/A or normal pressure.
    OR
  • percutaneous lumbar continous drainage.
    -Head elevation 10-15 degree.
    -Chamber at shoulder.
    -15-20cc 1/h.
39
Q

Indication surgical treatment CSF leak

A

*persisting more than 2 weeks although non-surgical interventions.
*spontaneous leaks
* delayed onset following trauma/surgery
*leaks complicated by meningitis.

40
Q

MNEMONICS for intracranial hypotension findings

A

SEEPS-
S- sagging brain
E- enhancement of pachymeninges
E- Engorged veins
P- pituitary hyperemia
S- subdural fluid

41
Q

treatment of “spontaneous” intracranial hypotension

A

Blood patch. mejority do well.

42
Q

Pathophysiology of spontaneous intracranial hypotension

A

USUALLY connected to spontaneous CSF leak.
sometimes only “too little CSF production”

43
Q

How can spontanoeus CSF leaks occur?

A

*Spinal Diverticulae usually thoracic spine. sometimes cervicothoracic junction.
*Lumbosacral perineural cysts
*Degenerative disc disease
*osteophytes
*bony spurs.

44
Q

Underlying causes to spontaneous CSF leaks associated to spontaneous intracranial hypotension?

A

suspected “weak meninges” possibly associated to connective tissue diseases such as Marfan and Ehler Danlos.

45
Q

Is there any connection between spontaneous intracranial hypotension and cranial SCF leaks?

A

No. No connection has been found.

46
Q

What is the reason for orthostatic H/A in intracranial hypotension?

A

Descent of the brain causing strain on pain sensitive structures intracranially.

47
Q

Recommendation when meeting a patient w new sudden onset of orthostatic H/A?

A

Brain MRI with contrast - SEEPS? Suspicion of intracranial hypotension.

48
Q

what is the subdural fluid collection in spontaneous intracranial hypotension?

A

its seen in 50% of cases. 2X more often hygroma vs blood. only occasionally need intervention.

49
Q

what is the subdural fluid collection in spontaneous intracranial hypotension?

A

its seen in 50% of cases. 2X more often hygroma vs blood. only occasionally need intervention.

50
Q

Causes of blindness from hcph

A
  • occlusioon of PCA by downward herniation
  • chronic papilloedema causing injury to optic nerve and optic disc.
  • dilatation of 3rd ventricle and compression of optic chiasm
51
Q

What does DESH stand for?

A

disproportionately enlarged subarachnoid space hydrochephalus

52
Q

What defines DESH on MRI?

A

*Enlarged Subarachnoid spaces in the Sylvian fissure and basal cistern and
*lessening of the subarachnoidal space over the convexity.

53
Q

Callosal angle in NPH - what are the angles and why does it occur?

A

mindre eller = 90 grader.
On coronal MRI perpendicular to AC-PC line, passing through the posterior comissure.

  • due to upward bowing and thinning
54
Q

where is CSF produced?

A
  • choroid plexus
  • ependymal lining of ventricles
  • dural sleeves of spinal nerve roots.
55
Q

What three types of slit ventricle syndrome are there?

A
  1. Intermittent shunt occlusion
  2. Total malfunction
  3. Venous hypertension with normal shunt function

(De flesta med slit ventricles på CT har inget slit ventricle syndrome)

56
Q

What happens with time in intermittent shunt occlusion slit ventricle syndrome?

A

the ventricles develop low compliance and a minimal dilatation result in high pressure and symtoms.

Jag tycker att detta verkar konstigt rent fysiskt.

57
Q

total shunt malfunction in slit ventricles

A

When the ventricles cannot expand at all, either due to subependymal gliosis or due to Laplace law

58
Q

Describe laplace law

A

It says that it takes higher pressure to expand a smaller container as opposed to a larger.

59
Q

What is a slit ventricle syndrome with venous hypertension w normal shunt function?

A

p 441 - “It may occur in certain conditions like Crouzons, from partial venous occlusions. Usually subsides by adulthood

60
Q

Explain slit ventricle syndrome with venous hypertension w normal shunt function?

A

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Pathophysiology (11 decks)

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