CSF

Question 1

What is the normal volume of CSF per day?

Answer 1

500mls

Question 2

What is CSF produced by?

Answer 2

Ependymal cells in the choroid plexus

Question 3

What is the CSF absorbed by?

Answer 3

Arachnoid granulations in the dural venous sinus

Question 4

Where is the lumbar cistern?

Answer 4

Between L2 and S2

Question 5

What is the normal value for ICP?

Answer 5

10mmHg

Question 6

What level is a lumbar puncture performed?

Answer 6

L3/4

Question 7

What are all the functions of the CSF?

Answer 7

Neutral buoyancy
Provides a buffer, absorbing and dissipating the energy
Clearing waste, accommodating to changes in intracranial volume
Provide micronutrients to cerebral tissue e.g. Vit C, Thyroxine

Question 8

What is the amount of RBCs normally present in the CSF?

Answer 8

NO RBCs

Question 9

The rate of CSF production is dependent on the cerebral perfusion and ICP TRUE/FALSE

Answer 9

FALSE

CSF production continues independently of cerebral perfusion and ICP

Question 10

TRUE/FALSE CSF Production decreases in the elderly

Answer 10

TRUE

Question 11

How does the CSF move from the lateral ventricles to the third ventricle?

Answer 11

Foramina of Munro

Question 12

How does the CSF move from the third ventricle to the fourth ventricle?

Answer 12

Through central aqueduct of Sylvia

Question 13

How does the CSF move from the fourth ventricle to the SAS?

Answer 13

Foramina of Luschka and Magendie

Question 14

Name 6 CSF pathologies

Answer 14

Hydrocephalus
Spontaneous intracranial hypertension
Syringomyelia
Intracranial arachnoid cysts
Dandy walker cysts
Spinal arachnoid webs

Question 15

What are 4 CNS pathologies?

Answer 15

Cerebral oedema
Benign intracranial hypertension
Spinal dural arteriovenous fistulae
Syringomyelia (& Cord Oedema)

Question 16

What are the 3 reasons that there would be increased CSF?

Answer 16

Overproduction at source
Inhibition of reabsorption
Obstruction to the flow of CSF

Question 17

What would be evident from CSF for narcolepsy?

Answer 17

Low or undetectable levels of CSF orexin/hypocretin

Question 18

What would be the CSF findings if someone has idiopathic intracranial hypertension?

Answer 18

High opening pressure

Question 19

What is Xanthochromia present in?

Answer 19

Present in the CSF if the patient has Creutzfelt-Jakob syndrome

Question 20

Oligoclonal bands found in the CSF indicate which disease?

Answer 20

Multiple Sclerosis

Question 21

Which condition on CSF has an increase in phosphorylated tau protein and decrease in B-amyloid?

Answer 21

Alzheimer’s

Question 22

What is hydrocephalus?

Answer 22

Accumulation of excessive CSF within the ventricular system of the brain

Question 23

What is a common cause of non-communicating hydrocephalus?

Answer 23

Aqueduct stensosi

Question 24

What causes communicating hydrocephalus?

Answer 24

When arachnoid granule absorption defects

Question 25

What age does the suture typically close?

Answer 25

2-3 years

Question 26

If hydrocephalus occurs before closure of the cranial suture then what occurs?

Answer 26

Cranial enlargement

Question 27

If hydrocephalus occurs after the closure of the cranial suture then what occurs?

Answer 27

Expansion of ventricles and increase in ICP

Question 28

What causes cerebral atrophy?

Answer 28

Dementia

Question 29

Who is central aqueduct stenosis most common in?

Answer 29

Children

Question 30

What do these signs point to as a clinical condition? - Unusually large head - Thin and shiny scalp with easily visible veins - Bulging or tense fontanelles - Downward looking eyes "sunsetting" - Failure to thrive - If congenital picked up during an US

Answer 30

Hydrocephalus

Question 31

What is the treatment for hydrocephalus?

Answer 31

Ventricular Peritoneal Shunt

Question 32

How is the risk of infection reduced when inserting a ventricular peritoneal shunt?

Answer 32

Antibiotic or silver impregnated shunts | Use iodine +++

Question 33

What are the 4 steps in the development of normal pressure hydrocephalus?

Answer 33

1-Drainage of CSF blocked 2-Collagen disorders 3-Dural Diverticula 4-Trauma

Question 34

Aside from idiopathic what is the other cause of normal pressure hydrocephalus?

Answer 34

Post-inflammatory | e.g. SAH,Meningitis, Trauma and craniotomy

Question 35

What is the triad that normal pressure hydrocephalus presents with?

Answer 35

Ataxia Memory decline/reversible dementia Incontinence

Question 36

What are the 4 causes of spontaneous intracranial hypotension?

Answer 36

1-Idiopathic 2-Collagen disorder 3-Dural diverticula 4-Trauma

Question 37

What is Syringomyelia?

Answer 37

Cystic enlargement of the spinal cord

Question 38

What is the mean age of presentation fo Syringomyelia?

Answer 38

30

Question 39

What is the commonest cause of syringomyelia?

Answer 39

Arnold-Chiiari II malformation

Question 40

Expansion of spinal canal interferes with the fibres of the anterior white commissure of spinothalamic tract. Therefore what is affected?

Answer 40

Pain, Temperature , Crude Touch

Question 41

Why is hyperhydrosis a feature of early stage syringomyelia?

Answer 41

Hyperactivity in pre-ganglionic neurones

Question 42

What is the treatment of syringomyelia if it is caused by chair malformation?

Answer 42

Posterior fossa decompression

Question 43

What is the degree of difficult in operating on syringomyelia proportional to?

Answer 43

The extent of intramural fibrosis | Collapse of the syrinx cavity

Question 44

Name two conditions where there is Hydrocephalus ex vacuo?

Answer 44

Alzheimer's disease | Picks disease