CSF Disorders Flashcards
you shouldn’t drain more than __ml of CSF in a lumbar puncture
30
upper limit of normal for CSF pressure?
15mmHg
a CSF pressure of >__mmHg is abnormally high
20
average CSF pressure is __mmHg
10
how much CSF is made and absorbed per day?
a pint
a pint
what drug is very effective at reducing ICP
acetazolamide
absorption of CSF is driven by….
ICP
physical functions of CSF?
buoyancy
accompanies physical changes in the head
weight of the brain is…
1.5kg
fluid trapped in spinal cord is called…
syringomyelia
a child with hydrocephalus from birth’s phenotype is..
an unusually large head
thin shiny scalp with visible veins
bulging fontanelle
downward looking eyes
babies with hydrocephalus will have what problems?
poor feeding irritability vomiting sleepiness muscle stiffness and spasm in lower limbs
2 types of hydrocephalus?
obstructive
communicating
why do you get papilloedema?
optic nerve is an extension of the CNS and has meninges around it thus contains CSF
acquired causes of paediatric hydrocephalus?
haemorrhage
infection ie post meningitis
trauma
tumour
a child with congenital hydrocephalus will have it for life T or F
T
how can subarachnoid haemorrhages cause hydrocephalus?
the blood blocks up the arachnoid granulations
shunt complications?
overdrainage underdrainage = blockage infection seizures intracerebral haemorrhage
symptoms of a blocked shunt?
headache
vomiting
lack of upgaze in adults
papilloedema
Ix and Tx of a blocked shunt
CSF sample to microbiology
CT head
name the triad that presents in normal pressure hydrocephalus?
ataxia
memory decline
incontinence
(basically get dementia)
causes of NPH
idiopathic SAH (subarachnoid haemorrhage) meningitis trauma craniotomy
what does the ataxia in NPH present like?
a broad based, shuffling gait
Ix of NPH
CT/MRI
tracer diffusion studies
ICP measurement
tap test lumbar puncture
Tx of NPH
VP shunt
who gets IIH?
young overweight females
what conditions are associated with IIH?
obesity sleep aponoea hypothyroid addisons lupus
symptoms of IIH
headaches
visual field loss from papilloedema
signs of IIH ?
papilloedema
constricted visual fields
loss of visual acuity
LP pressure of someone with IIH would be…
> 25mmHg (HIGH)
IIH is normal on imaging T or F
T
Tx of IIH
treat underlying cause diuretics lumbar puncture VP/LP (lumbar-peritoneal) shunt weight loss
LP shunt complications
blockage
infection
nerve root irritation
subdural haemorrhage
what is an orthostatic headache?
a headache present on standing up that is relieved when lying down
symptoms of SIH
orthostatic headaches neck/upper back/arm pain visual field defects dizziness muffled hearing
in IIH the ventricles are normal size T or F
T
causes of SIH
idiopathic
collagen disorders
dural diverticula (looks really thick)
trauma
“fat girl off school for years with headaches and has papilloedema” could be…
IIH
SIH Tx
conservative
surgery
drug Tx of mild IIH
acetazolamide
diuretic
SIH Ix
MRI
lumbar puncture
syringomyelia classic presentation?
sensory loss - cant feel pain loss of limb reflexes involuntary movements muscle wasting clawed hands
in a patient with persisting spine and limb symptoms ___ should always be considered
syringomyelia
early features of syringomyelia?
hyperhidrosis
hindbrain hernias are a form of…
syringomyelia
main symptoms of a hindbrain hernia
headaches following valsalva
visual disturbances
ear disturbance
sometimes papilloedema
sleep apnoea is a common problem in those with…
hindbrain hernias
syringomyelia Tx
open up CSF channels via craniovertebral decompression
drain syrinx cavity
lower CSF pressure
where can CSF fluid be diverted to if there is too much in the subarachnoid space?
pleural cavity
peritoneal cavity
