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Neurology System > CSF and Hydrocephalus > Flashcards

CSF and Hydrocephalus Flashcards

1
Q

What does CSF bathe?

A

Brain and spinal cord

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2
Q

Where is CSF found?

A

Subarachnoid space

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3
Q

What is the main role of CSF?

A

Shock absorber

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4
Q

Describe the ventricular anatomy

A 
Lateral ventricles
Interventricular foramen 
3rd ventricle 
Cerebral aqueduct 
4th Ventricle
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5
Q

Where is the choroid plexus found?

A

Mostly on floor of lateral ventricles

Some in roof of 3rd and 4th

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6
Q

Describe the flow of CSF

A
  1. Lateral ventricles
  2. Foramina of Munro
  3. 3rd Ventricle
  4. Aqueduct of Sylvius
  5. 4th Ventricle
  6. Foramen of Magendie (medial, x1) & Foramen of Luschka (lateral, x2)
  7. Subarachnoid spaces
  8. Arachnoid granulations (reabsorbed here)
  9. Dural venous sinuses
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7
Q

Is CSF production passive or active?

A

Active

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8
Q

Is CSF reabsorption passive or active?

A

Passive

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9
Q

What is hydrocephalus?

A

General condition whereby there is excess CSF within the intracranial space

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10
Q

Is normal CSF production or absorption usually affected in hydrocephalus?

A

Absorption

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11
Q

What is the result of abnormal CSF absorption?

A

Ventricular system dilatation

Raised ICP

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12
Q

What are potential causes of congenital hydrocephalus?

A

Chiari malformation
Aqueductal stenosis
Dandy-Walker malformation

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13
Q

What are causes of acquired hydrocephalus?

A 
Meningitis 
Post-haemorrhagic 
Neoplasm: benign or malignant 
Post op 
Cerebellar stroke 
Post traumatic
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14
Q

What are signs and symptoms of hydrocephalus in infants?

A 
Cranial enlargement 
Splaying of cranial sutures 
Irritable
Poor feeding 
Frontanelles full and bulging 
Engorged scalp veins (venous scalp distension) 
Abducens palsy 
Perinauds syndrome  (upwards glaze, convergent nystagmus, eyelid retraction)
Exaggerated reflexes 
Respiratory problems
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15
Q

Are there any RBC in the CSF?

A

No

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16
Q

What are some other roles of CSF?

A

Fills in the gaps between the brain and the skull
Immunological role
Removal of some waste products

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17
Q

CSF distribution between brain and spinal cord

A

50:50

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18
Q

Where is CSF produced?

A

In the choroid plexus

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19
Q

Is there commonly an overproduction of CSF?

A

No commonly a problem with the reabsorption of CSF

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20
Q

What are the signs and symptoms of hydrocephalus in older children and adults?

A 
May be asymptomatic 
Increased ICP - measured with a monitor 
Headaches - worse in the morning or on coughing 
Papilloedema 
Visual disturbances 
Gait abnormality 
Loss of upgaze or CN VI palsy 
Impaired consciousness
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21
Q

What will imaging show in hydrocephalus?

A

Dilation of the temporal horns of the LV
3rd ventricle will become ballooned
Lateral ventricle size increases
Peripheral sulci effaced (pushing of gyri together)

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22
Q

What is the medical Rx for hydrocephalus?

A

Acetazolamide

Reduces CSF production from the choroid plexus

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23
Q

What is the surgical Rx for hydrocephalus?

A

External ventricular drain (EDV)
CSF diversion
Eliminating obstruction

24
Q

What is a long term solution for hydrocephalus?

A

Shunts

25
Q

What is the management for hydrocephalus in an emergency situation?

A

EVD

26
Q

What is the most commonly used shunt?

A

Ventriculo-peritoneal

27
Q

What are the types of shunts?

A 
¥	Ventriculo-peritoneal (VP shunt)
-	Most used 
¥	Ventriculo-pleural
¥	Ventriculo-atrial
-	Can be considered in cases of peritoneal failure 
¥	Ventriculo-subarachnoid
28
Q

When can a ventriculo-atrial shunt be considered?

A

Can be considered in cases of peritoneal failure

29
Q

What are the potential complications of shunts?

A 
Over drainage
Under drainage 
Blockage 
Infection 
Disconnection 
Seizures 
Distal end problems
30
Q

What can over drainage of shunts cause?

A

Low pressure headaches

subdural haematoma

31
Q

What is endoscopic 3rd ventriculostomy?

A

Endoscopic third ventriculostomy (ETV) is a surgical procedure for treatment of hydrocephalus in which an opening is created in the floor of the third ventricle using an endoscope placed within the ventricular system through a burr hole. This allows the cerebrospinal fluid to flow directly to the basal cisterns, bypassing the obstruction.

32
Q

Where does ETV create a fistula?

A

Between 3rd ventricle and subarachnoid spaces/ basal cisterns

33
Q

What does ETV only work for?

A

non-communicating hydrocephalus

34
Q

What is communicating hydrocephalus?

A

Communicating hydrocephalus, also known as non-obstructive hydrocephalus, is caused by impaired cerebrospinal fluid reabsorption in the absence of any CSF-flow obstruction between the ventricles and subarachnoid space.

35
Q

What is normal pressure hydrocpehalus?

A

type of brain malfunction caused by expansion of the lateral cerebral ventricles

36
Q

What is the classic triad in NPH?

A

Dementia
Gait disturbance
Urinary incontinence

37
Q

What age is typical for NPH?

A

> 60

38
Q

What is the Rx for NPH?

A

Insertion of a shunt

39
Q

What is shown in NPH on MRI/CT?

A

Communicating hydrocephalus

40
Q

What is idiopathic intracranial hypertension?

A

Raised ICP without obvious cause

41
Q

What is the typical patient for idiopathic intracranial hypertension?

A

Young obese female

42
Q

What is the typical presentation of idiopathic intracranial hypertension?

A

Headaches
Visual disturbances
Papilloedema

43
Q

What will happen to idiopathic intracranial hypertension patients without treatment?

A

Will go blind

44
Q

What is the treatment for idiopathic intracranial hypertension?

A

Loos weight
Medical - Acetazolamide
VP of LP shunt

45
Q

What are the indications for LP?

A

¥ Obtain CSF for analysis
¥ Rule out bacterial or viral infection
¥ Measure for blood breakdown products (SAH)
¥ Measure protein load
¥ Measurement of pressure (intracranial pressure (ICP))
¥ CSF drainage for raised pressure
¥ Diagnostic test for Normal Pressure Hydrocephalus

46
Q

What are the contraindications for LP?

A

} Unstable patient with cardiovascular or respiratory instability
} Localized skin/soft tissue infection over puncture site
} Evidence of unstable bleeding disorder
◦ Platelets < 50,000 or clotting factor deficiency

47
Q

What are the pre LP checks?

A

¥ Awake & conscious patient
¥ No focal neurological deficit (6th nerve palsy)
¥ CT/MRI: rule out intracranial mass lesion
¥ Ensure patient not on anticoagulants

¥ Verbal consent

48
Q

Describe the positioning for LP

A

Correct positioning
Fetal position - knees up and neck flexed
Pillow between the knees
Between L4/L5

49
Q

Describe the technique for LP

A 
Aseptic 
Local anaesthetic administered
Spinal needle angled towards umbilicus 
Aim for space 
Going through ligamentum flavum (1st pop)
2nd pop - dura 
Check for SF 
Measure pressure 
Obtain samples 
Withdraw needle 
Dress the area
50
Q

What are the risks of LP?

A 
Bleeding 
Infection 
Nerve root injury 
Retroperitoneal/ intra-abdominal injury 
Brainstem
51
Q

What is post-LP care?

A

Bed rest for 2-4 hours
Warn patients about low pressure headaches
Stop if patient is developing neurological deficit or becoming unconscious

52
Q

What is typical CSF in meningitis?

A

Cloudy
Turbid
WBC - mostly polomorphs

53
Q

When can a bloody CSF sample be a sign of?

A

Traumatic tap

following SAH

54
Q

What is a traumatic tap?

A

When the needle has been inserted into an epidural vein

55
Q

What causes xanthochromic?

A

Yellow CSF due to blood breakdown products

56
Q

When is xanthochromic seen?

A

In SAH

57
Q

When is spectrophotometry positive?

A

After 12 hrs

If it persists for 12 weeks

Neurology System (35 decks)

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