CSF

Question 1

What are the relative volumes of the ff:

1. Brain
2. CSF
3. Blood

Answer 1

1. 1200-1400
2. 70-160
3. 150
   TOTAL around 1700 intracranial volume

Question 2

What is the rate of formation of CSF?

Answer 2

21-22 ml/h or 500ml per day?

Question 3

What are the 3 components of the BBB?

Answer 3

1. Endothelium
2. Plasma membrane and Adventitia of vessels
3. Foot processes

Question 4

Where are arachnoid granulations most located?

Answer 4

SSS

Question 5

What is the main contributor to CSF pressure?

Answer 5

Venous pressure

Question 6

What is 1mmHg equal to in cn H20?

Answer 6

1.37

Question 7

What is the Queckenstedt test?

Answer 7

Pressure on the jugular veins should result in an increase in ICP if there NO spinal subarachnoid block

Question 8

High CO2 causes increase or decreased ICP?

Answer 8

Increased due to acidification and vasodilation of the vessels

Question 9

In the Monroe Kellie doctrine what are:

1. 3 components of the rigid structure
2. 3 contents of the rigid structure

Answer 9

1. Cranium, Vertebral canal, Inelastic dura

2. Blood, CSF, Brain

Question 10

What are the compensatory mechanisms of increased ICP?

Answer 10

CSF to vertebral canal and stretching of dura

Question 11

At what ICP does the compensatory measures start to fail with continuing increased ICP

Answer 11

25mmHg

Question 12

T or F An ICP of 40mmHg provided that the BP is normal will still result in a patient with adequate cerebral perfusion pressure?

Answer 12

T

Question 13

T or F if the block to CSF is confined to the absorptive sites adjacent to the cerebral convexities and superior sagittal sinus, the ventricles remain normal in size

Answer 13

T

Question 14

At what age do sutures fuse? Up to what age can megaminds occur?

Answer 14

3 years old

5 years old

Question 15

What composes the syndrome of pseudotumor cerebri AKA normal pressure hydrocephalus?

REMEMBER: IT IS A SYNDROME NOT A DISEASE

Answer 15

1. Headache
2. Papilledema
3. MINIMAL focal neurologic signs
4. NORMAL CSF
5. ABSENCE of enlarged ventricles

Question 16

Who is the typical patient with pseudotumor cerebri?

Answer 16

Overweight adolescent girls with menstrual abnormalities

Question 17

What is the purported pathophysiology of pseudotumor cerebri?

Answer 17

Venous obstruction

Question 18

What drugs or substances are associated with pseudotumor cerebri?

Answer 18

1. Lead toxicity
2. Tetracycline
3. Vitamin A
4. Bear liver

Question 19

What are the treatment methods for pseudotumor cerebri in order of importance?

Answer 19

1. Serial LP
2. Acetazolamide 1-5g per day
3. Weight reduction
4. LP shunting
5. Steroids last resort

Question 20

What medication can be given to chronic headache from pseudotumor cerebri?

Answer 20

Topiramate

Question 21

What is the most effective treatment for intracranial hypotension due to lumbar tap?

Answer 21

Epidural blood patch, 75% relieved by first injection, 97% by second injection

Question 22

What are the characteristics of post LT headache?

Answer 22

1. Pressure of 60mmH20 or less
2. Orthostatic headache
3. Occasional: 6th nerve palsy
4. Occasional: Self audible bruit

Question 23

What is the most common structural cause of intracrania hypotension?

Answer 23

Leaking Tarlov cyst (meningeal diverticulum)