CSF disorders

Question 1

What is hydrocephalus?

Answer 1

Increase in CSF volume and increase in ventricle size

Question 2

By which two mechanisms does hydrocephalus occur?

Answer 2

Increased production

Decreased absorption

Question 3

What are the two types of hydrocephalus?

Answer 3

Communicating

Non-comm/obstructive

Question 4

Describe comm hydrocephalus

Answer 4

No blockage

Impaired resorption of CSF at the arachnoid granulations

Question 5

Describe non-comm hydrocephalus

Answer 5

Obstruction preventing CSF flow

Question 6

Which ventricles are dilated in comm hydrocephalus?

Answer 6

All

Question 7

Which ventricles are dilated in non-comm hydrocephalus

Answer 7

Those before the obstruction

Question 8

Where is the most common site of obstruction in obstructive hydrocephalus?

Answer 8

Cerebral aqueduct

Question 9

How does hydrocephalus present?

Answer 9

Features of raised ICP
Irritability
Sunsetting

Question 10

How does chronic hydrocephalus present?

Answer 10

Progressive deterioration of higher neurological function

Persistent headache

Question 11

What does CT show in hydrocephalus?

Answer 11

Enlarged ventricles

Question 12

What does LP show in hydrocephalus?

Answer 12

Sike u shouldn’t do an LP in hydrocephalus in case u cause coning

Question 13

Which infants are ultrasounded for hydrocephalus?

Answer 13

Large, tense, bulging anterior fontanelle

Question 14

How is hydrocephalus managed?

Answer 14

Shunting

Third ventriculostomy

Question 15

Describe the ventriculo-peritoneal shunt

Answer 15

Catheter inserted into ventricle to drain CSF to peritoneum

Note ventriculoatrial can also be used if needed

Question 16

Describe third ventriculostomy

Answer 16

Hole made in the floor of the third ventricle to give an alternative route for CSF to enter SA space

Question 17

What is normal pressure hydrocephalus?

Answer 17

When CSF has normal pressure (duh) but ventricles are still enlarged

Question 18

What is the triad of normal pressure hydrocephalus symptoms?

Answer 18

Ataxia/apraxic gait
Incontinence
Memory problems

Question 19

What does CT show on NPH?

Answer 19

Big ventricles

Question 20

What does LP show in NPH?

Answer 20

Normal pressure (shock, horror)

Question 21

Describe the LP tap test in NPH

Answer 21

Drain 30mls of CSF and see if the symptoms improve - mainly the ataxia

Question 22

How is NPH managed?

Answer 22

Shunting

Question 23

Who is most commonly affected by IIH?

Answer 23

Overweight females 15-45 who are on the pill

Question 24

How does IIH present?

Answer 24

Raised ICP features

Question 25

What does examination show in IIH?

Answer 25

Papilloedema on fundoscopy

Enlarged blind spot

Question 26

How is IIH investigated?

Answer 26

MRI or CT to rule out other causes

LP shows increased pressure

Question 27

How is IIH managed?

Answer 27

Lose weight (if approp)
Acetazolamide
Repeated therapeutic lumbar puncture

Question 28

What should be monitored in IIH?

Answer 28

Visual fields

Question 29

What is the most common cause of intracranial hypotension?

Answer 29

Following LP

Question 30

What are the clinical features of intracranial hypotension?

Answer 30

Neck stiffness
Nausea
Whooshing sound in ear
Headache relieved on lying down

Question 31

How is intracranial hypotension managed?

Answer 31

Caffeine and rehydration
Bed rest
Analgesia