CSF disorders Flashcards
What is hydrocephalus?
Increase in CSF volume and increase in ventricle size
By which two mechanisms does hydrocephalus occur?
Increased production
Decreased absorption
What are the two types of hydrocephalus?
Communicating
Non-comm/obstructive
Describe comm hydrocephalus
No blockage
Impaired resorption of CSF at the arachnoid granulations
Describe non-comm hydrocephalus
Obstruction preventing CSF flow
Which ventricles are dilated in comm hydrocephalus?
All
Which ventricles are dilated in non-comm hydrocephalus
Those before the obstruction
Where is the most common site of obstruction in obstructive hydrocephalus?
Cerebral aqueduct
How does hydrocephalus present?
Features of raised ICP
Irritability
Sunsetting
How does chronic hydrocephalus present?
Progressive deterioration of higher neurological function
Persistent headache
What does CT show in hydrocephalus?
Enlarged ventricles
What does LP show in hydrocephalus?
Sike u shouldn’t do an LP in hydrocephalus in case u cause coning
Which infants are ultrasounded for hydrocephalus?
Large, tense, bulging anterior fontanelle
How is hydrocephalus managed?
Shunting
Third ventriculostomy
Describe the ventriculo-peritoneal shunt
Catheter inserted into ventricle to drain CSF to peritoneum
Note ventriculoatrial can also be used if needed
Describe third ventriculostomy
Hole made in the floor of the third ventricle to give an alternative route for CSF to enter SA space
What is normal pressure hydrocephalus?
When CSF has normal pressure (duh) but ventricles are still enlarged
What is the triad of normal pressure hydrocephalus symptoms?
Ataxia/apraxic gait
Incontinence
Memory problems
What does CT show on NPH?
Big ventricles
What does LP show in NPH?
Normal pressure (shock, horror)
Describe the LP tap test in NPH
Drain 30mls of CSF and see if the symptoms improve - mainly the ataxia
How is NPH managed?
Shunting
Who is most commonly affected by IIH?
Overweight females 15-45 who are on the pill
How does IIH present?
Raised ICP features
What does examination show in IIH?
Papilloedema on fundoscopy
Enlarged blind spot
How is IIH investigated?
MRI or CT to rule out other causes
LP shows increased pressure
How is IIH managed?
Lose weight (if approp)
Acetazolamide
Repeated therapeutic lumbar puncture
What should be monitored in IIH?
Visual fields
What is the most common cause of intracranial hypotension?
Following LP
What are the clinical features of intracranial hypotension?
Neck stiffness
Nausea
Whooshing sound in ear
Headache relieved on lying down
How is intracranial hypotension managed?
Caffeine and rehydration
Bed rest
Analgesia
