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CSF And Hydrocephalus Flashcards

1
Q

What and where is the CSF?

A

Fluid around brain and spinal cord

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2
Q

What is the function of the CSF?

A

helps provide homeostasis and mechanical protection/buoyancy

Remove brain metabolites

Endocrine mechanism in transporting hormones

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3
Q

What is the primary producer of CSF?

A

Choroid plexus by ependymal cells

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4
Q

Where is the choroid plexus found?

A

Lateral ventricle (65%)

Third ventricle

Fourth ventricle

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5
Q

What is the choroid plexus?

A

Villous folds lined by epithelium w/ a central core of highly vascularized connective tissue

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6
Q

What overlies the villi of the choroid plexus?

A

Specialized layer of ependymal cells - choroidal epithelium

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7
Q

What meningeal layer surrounds the ependymal cells?

A

Pia mater

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8
Q

What should the normal composition of CSF be?

A

Clear and colorless

Few cells and low protein

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9
Q

How does it differ from plasma?

A

Quantitatively

Same qualitatively

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10
Q

How do you test the CSF composition?

A

Lumbar puncture between L4 and L5

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11
Q

What is higher in CSF than in plasma?

A

Mg

CL

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12
Q

What is lower in CSF than in plasma?

A 
K 
Ca
HCO3 
Protein 
Glucose
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13
Q

What is the flow of CSF thru the ventricles? I

A

Lateral —>

Interventricular foramina of Monroe—> 3

3rd -> cerebral aqueduct of Sylvius-> 4th

4th-> foramina of Luschka and foramen of magendie —> subarachnoid space

Subarachnoid-> granulations -> dural venous sinuses

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14
Q

Where are the foramina of luschka and the foramen of magendie

A

Luschka - 2 lateral apertures

Magendie - medial aperture

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15
Q

What is CSF re-absorbed by? Where does it drain to?

A

Re-absorbed by arachnoid granulation

Drains to dural venous sinuses

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16
Q

Where is the lateral ventricle at?

At what level will you see the lateral ventricle on a CT?

A

In telencephalon;

Cerebral cortex area

17
Q

At what level, will you see the third ventricle?

A

Level of thalami

18
Q

At what level will you see the fourth ventricle?

A

At the level of the PONS

19
Q

What is hydrocephalus?

A

Increase amts. of ICP and ventricular dilation due to an excessive amt. of CSF accumulation in ventricles &/or subarachnoid spaces

20
Q

What can hydrocephalus be due to?

A

Congenital or acquired things

21
Q

What are examples of what can cause hydrocephalus? Non-comm. or comm.?

A

Overproduction of CSF - commun.

Under-absorption of CSF - commun.

Obstruction of outflow - non comm.

22
Q

What is aqueductal stenosis?

Caused by?

Where will CSF accumulate?

A

Non-communicating hydrocephalus

Narrowing/obstruction of cerebral aqueduct

Fluid accumulates in 3rd and lateral ventricles

23
Q

What are the causes of aqueductal stenosis?

A

Congenital (x-linked) (most common cause)

Pineal tumor

Previous meningitis that led to scarring (or other infection)

Inflammation from intrauterine infection

24
Q

What is normal pressure hydrocephalus?

A

Failure of CSF to drain properly leading to enlarged ventricles and cortical atrophy

communicating hydrocephalus (no obstructions)

25
Q

What can cause normal pressure hydrocephalus?

A

Increased CSF viscosity
Altered elasticity of ventricular walls
Impaired CSF absorption

26
Q

What is the TRIAD assoc. w/ Normal Pressure Hydrocephalus?

A

Cognitive impairment/confusion
Unsteady, magnetic gait
Urinary in continence

Wacky, wobbly, wet

27
Q

What ventricles are enlarged with normal pressure hydrocephalus?

A

All of them

28
Q

What is Dandy-walker malformation?

A

Congenital brain malformation where the fourth ventricle outlet is obstructed and enlarged

Non-communicated hydrocephalus (obstructed)

29
Q

What happens bc of the 4th ventricle enlargement in the Dandy Walker Malformation?

A

Hypoplasia of the cerebellum - specifically partial or complete agenesis of vermis

Cyst in the 4th ventricle causes cerebellum to not develop (no space for it)

30
Q

When does the Dandy-Walker malformation occur in embryo?

A

Weeks 13-18

31
Q

What is Chiari 2?

A

Non communicating hydrocephalus (obstructive)

Caused by downward displacement of inferior cerebellar veins and tonsil thru the foramen magnum closing off 4th ventricle.

32
Q

What is Chiari 2 associated with?

A

Lumbosacral myelomeningocele

33
Q

What is the difference between Chiari II and the Dandy-Walker malformation?

A

Chiari II - will have cerebellum

Dandy-Walker- agenesis of vermis and no cerebellum

34
Q

Where does fluid accumulate in Chiari II?

A

Above the 4th ventricle

35
Q

What are the treatments for hydrocephalus?

A

Most common = shunt to drain fluid to another part of body with valve keeping the fluid flowing in the right direction and at correct speed

Will need for the rest of life

36
Q

Where will ventricles generally be enlarged for a non-communicating case of hydrocephalus

A

Proximal to obstruction

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