CSF/ CSF obstruction

Question 1

Headache, papilledema, CN III palsy (pupil dilation, opthalmoplegia)

Answer 1

Hydrocephalus, either communicating or non-communicating–> symptoms the same

*CN III issues due to transtentorial (uncal) herniation

Question 2

Difference between communicating an non-communicating hydrocephalus

Answer 2

Communicating–> decreased reabsorption of CSF by arachnoid granulations = increased ICP

Non-communicating–> structural blockage of CSF circ (stenosis of aqueduct of Sylvius, aka cerebral aqueduct)

Question 3

Causes of communicating hydrocephalus (1)

Answer 3

Arachnoid scarring post-meningitis

Question 4

*Triad of normal pressure hydrocephalus

Answer 4

1. urinary incontinence (wet)
2. ataxia (wacky)
3. cognitive impairment (wild)

Question 5

Hydrocephalus ex vacuo

Answer 5

Appearance of increased CSF due to cerebral atrophy; intracranial pressure is NORMAL (so no symptoms)

Question 6

3 causes of hydrocephalus ex vacuo

Answer 6

1. Alzheimer’s
2. Pick’s dz
3. advanced HIV

Question 7

definition of pseudotumor cerebri

Answer 7

elevated ICP WITHOUT hydrocephalus

Question 8

usual demographic of pt with psuedo tumor cerebri

Answer 8

young, obese women

Question 9

Symptoms of pseudotumor cerebri

Answer 9

1. pulsatile HA, worse in morning
2. retroocular pain worsened by eye movement
3. Possible nausea/ vomiting

Question 10

worrisome complication of pseudotumor cerebri

Answer 10

vision loss

Question 11

1st step in possible psueudotumor cerebri pt

Answer 11

CT scan/ MRI to rule out other pathology–> no tumors or masses, absence of ventricular dilation

Question 12

*What confirms pseudotumor cerebri

Answer 12

LP opening pressure of over 200 mmHg in normal pt; over 250 mmHg in obese

Question 13

What three things can incite pseudotumor cerebri

Answer 13

1. Vitamin A (including food or isoretinoic topical)
2. Tetracyclines
3. Corticosteroid withdrawal

Question 14

• First line medical tx for pseudotumor cerebri

Answer 14

Acetazolimide (diuretic to drop fluids)

*weight loss is the most effective, if obese

Question 15

Where does CSF drain to from arachnoid granulations

Answer 15

superior sagittal sinus

Question 16

Final draining spot in the dural venous sinuses

Answer 16

Sigmoid sinus–> goes from there into internal jugular vein in the carotid sheath (common carotid and vagus also there)

Question 17

*7 contents of the cavernous sinus

Answer 17

1. CN III
2. CN IV
3. CN V1
4. CN V2
5. CN VI
6. postganglionic sympathetic fibers (headed to orbit)
7. Internal carotid artery