CSF DISTURBANCES Flashcards

1
Q

the 1 ,500-g brain, which has a water content of approximately ___________ percent, weighs only 50 g when suspended in CSF, so the brain virtually floats in its CSF

A

80

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2
Q

In the adult, the average intracranial volume is 1,700
mL; the volume of the brain is from ___________
CSF volume ranges from _______ (mean: 104 mL),
and that of blood is approximately ________

A

1 ,200 to 1,400 mL,

70 to 160 mL

150 mL.

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3
Q

the CSF occupies somewhat less than

_______ percent of the intracranial and intraspinal spaces

A

10

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4
Q

the distance between the caudate
nuclei at the anterior horns gradually widens by approximately
__________, and the width of the third ventricle
increases from _________

A

1 . 0 to 1 .5 Cm

3 to 6 mm by age 60 years

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5
Q

They established that the average rate
of CSF formation is 21 to 22 mL/h (0.35 mL /min), or
approximately__________ thus the volume of CSF as a
whole is renewed __________

A

500 mL / d;

4 or 5 times daily.

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6
Q

T OR F

Ionized
compounds, such as hexoses and amino acids, being
relatively insoluble in lipids, enter the CSF slowly unless
facilitated by a membrane transport system.

A

Ionized
compounds, such as hexoses and amino acids, being
relatively insoluble in lipids, enter the CSF slowly unless
facilitated by a membrane transport system.

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7
Q

What are the components of the BBB

A
  1. endothelium of the choroidal and brain capillaries
  2. plasma membrane and adventitia (Rouget cells) of these vessels
  3. pericapillary foot processes of astrocytes
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8
Q

________________ help drive the fluid

centrifugally from the ventricular system.

A

Arterial

pulsations of the choroid plexuses

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9
Q

pacchionian granulations or bodies

A

microscopic excrescences of arachnoid
membrane that penetrate the dura and protrude into
the superior sagittal sinus and other venous structures

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10
Q

In the recumbent position, ICP and, consequently, CSF
pressure are normally about ___________
(1 mm Hg equals 13.7 mm H20), with an upper limit of
normal that is higher in children than in adults

A

8 mm Hg or 110 mm H20

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11
Q

T or F

increased venous pressure exerts no
immediate effect on CSF pressure by increasing the volume
of blood in the cerebral veins, venules, and dural
sinuses.

A

F

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12
Q

The
normal curve begins its steep ascent at an ICP of approximately
__________. After this point, small increments in
intracranial volume result in marked elevations in ICP.

A

25 mm Hg

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13
Q

The numerical difference between ICP and mean

BP within the cerebral vessels is termed ________

A

cerebral perfusion

pressure (CPP).

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14
Q

Of the 3 ICP waveforms, which has a clinical significance, , B or C?

A

A

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15
Q

___________coincide with an increase in intracranial
blood volume, presumably as a result of a temporary
failure of cerebrovascular autoregulation

A

plateau waves

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16
Q

In a normal adult reclining with the
head and trunk elevated to 45 degrees, the ICP is in the
range of ________

A

2 to 5 mm Hg

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17
Q

As a rule, patients with normal BP retain normal
mental alertness with ICP of _______ unless
there is concurrent shift of brain tissue

A

25 to 40 mm Hg

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18
Q

Only when ICP exceeds________ does cerebral
blood flow diminish to a degree that results in loss of
consciousness

A

40 to 50 mm Hg

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19
Q

the brain shift and herniation that causes
the pupil to dilate on the side of a mass lesion generally
occurs at an ICP of________

A

28 to 34 mm Hg

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20
Q

Indications for ICP monitoring

A

with severe traumatic brain injury if they are
over 40 years of age, and have a Glasgow Coma Score
below 9

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21
Q

to ventricular enlargement because of failure of development

of the brain, a state known as ______

A

colpocephaly

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22
Q

T or F

that the ventricle closest to the obstruction enlarges the
most;

A

T

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23
Q

The rarely encountered radiologic picture of enlarged
subarachnoid spaces over and between the cerebral hemispheres,
coupled with modest enlargement of the lateral
ventricles has been referred to as _________

A

external hydrocephalus

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24
Q

The only reported
examples of overproduction of CSF are ___________________, but even in this circumstance, there
is usually an associated ventricular obstruction, either
of the third or fourth ventricle or of one lateral ventricle

A

papillomas of

the choroid plexus

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25
The cranial bones fuse by the ______________; for the head to enlarge, the tension hydrocephalus must develop before this time
end of the third year
26
In Dandy Walker, because of bossing of the occiput from | enlargement of the posterior fossa, the head is __________
dolichocephalic
27
cause the child's head to move forward and backward or side-to-side constantly or intermittently at about 2 to 3 Hz. This is caused by a suprachiasmatic arachnoid cyst or by third ventricular enlargement,
"bobble head" syndrome
28
Gait associated with NPH pts
Most often, there is unsteadiness and impairment of balance and shortening of the step length, with the greatest difficulty being encountered on stairs and curbs
29
In NPH, what is this state called: the steps become shorter, with more frequent shuffling and falls; eventually standing and sitting and even turning over in bed become impossible.
"hydrocephalic | astasia-abasia. "
30
What kind of incontinence among pts with NPH? the patient is indifferent to his lapses of continence, and bowel control becomes similarly disordered
"frontal lobe incontinence,"
31
presumed cause of NPH
aymptomatic fibrosing meningitis decompensated congenital aqueductal stenosis
32
In pts with NPH, lateral ventricular span at the level of the anterior horns has been in excess of approximately _________________
40 mm
33
amount of CSF to be drained in NPH for clinical improvement
20-30cc
34
more definitive tx for NPH
insert a lumbar drain for up to 3 d, removing approximately 50 mL of CSF daily in order to observe the response in gait and mentation.
35
predictors of success for the tx of NPH
1. enlargement of the ventricles in comparison to the degree of cortical atrophy, 2. CSF pressures above 150 mm H20, and 3. improvement after spinal puncture,
36
how to overcome orthostatic HA in pts after shunting
Orthostatic headaches can be overcome by raising the opening pressure of the shunt valve.
37
in the tx of NPH, The incidence of catheter blockage is reduced by ______________where there is no choroid plexus.
placing it in the anterior hom | of the ventricle (usually the right side is used),
38
Cx of VP shunts
Peritoneal pseudocysts | "slit ventricle" syndrome
39
In most shunted patients with slit ventricle syndrome, the ICP in the upright position is diminished to
30 mm H20
40
Tx of slit ventricle syndrome
the most effective measure has been the placement of an antisiphon device, which prevents valve flow when the patient stands
41
giving ________________orally daily, shunting can be avoided in both adult normal-pressure, and infantile hydrocephalus
250 to 500 mg of acetazolamide
42
components of Parinaud
abnormal papillary reaction, upper lid retraction, paralysis of convergence, skew deviation, and convergenceretraction nystagmus
43
CSF pressure in IIH
250-450 mmH20
44
Enlargement of the blind spot is the result of _____________ from the edges of the swollen disc
displacement of the retina
45
__________ increases the resistance to CSF absorption | and is the proximate mechanism underlying pseudotumor
venous | hypertension
46
what vitamin is 50 percent higher than | expected, in patients with pseudotumor
Vit A
47
Venous sinus thrombosis can be detected in most instances by careful attention to the appearance of the __________ on the Tl-weighted MRI
superior sagittal and transverse sinuses
48
systemic conditions associated with increased CSF CHON
Guillain-Barre syndrome, systemic lupus, and spinal tumors, particularly oligodendroglioma
49
other agents causing IIH
1. Tetracycline 2. Vitamin A (isotretinoin) 3.estrogens, phenothiazines, lithium, the antiarrhythmic drug arniodarone, and quinolone antibiotics
50
T or F the diagnosis of idiopathic pseudotumor cerebri should not be accepted when the CSF content is normal.
F
51
indications for | prompt treatment of raised ICP in IIH
A reduction incpreviously normal acuity to less than 20 /20 corrected, enlargement of the blind spot, or the appearance of sector field defects, usually inferonasal,
52
At least ____________ of patients have recovered within 6 months after treatment by repeated lumbar punctures and drainage of sufficient CSF to maintain the pressure at normal or near-normal levels (less than 200 mm Hp).
one-fourth
53
InitiaL Tx of IIH
large doses of acetazolamide at 1-5g per day
54
Other oral agents used in the tx of IIH
glycerol (15 to 60 mg four to six times daily), or | furosemide 20 to 80 mg bid
55
improvement of vision in pts with IIH after LP shunt
70%
56
Steroids dose for IIH
prednisone (40 to 60 mg/d) we have occasionally observed a gradual recession of papilledema and a lowering of CSF pressure
57
ON fenestration improvement in vision
preserved or restored vision in 80 to | 90 percent of patients
58
this syndrome phenomenon is usually attributable to a lowering of ICP by leakage of CSF through the needle track into the paravertebral muscles
INTRACRANIAL HYPOTENSION
59
T OR F, Occasionally, there will be unilateral or bilateral sixth nerve palsy or a self-audible bruit from turbulence in the intracranial venous system.
T
60
Other forms of tx for intracranial hypotension
The ingestion of large volumes of fluids, the infusion of 1,000 to 2,000 mL of 5 percent glucose, and various forms of caffeine
61
The most dependable treatment in IC hypotension is a _____________
"blood patch" (spinal epidural injection of approximately 20 mL of the patient's own blood).
62
The administration of ____________preparations or intravenous caffeine may also have a salutary, although temporary, effect on the orthostatic headache
caffeine-ergotamine
63
mechanism of spinal HA
As to mechanism, the pain is presumed to be from tugging on cerebral veins or assuming the upright position.
64
Some surveys suggest that patients with structural disorders of connective tissue are not at greater risk for spontaneous CSF leaks than others
F
65
mechanism of dural enhancement in spinal hypotension
a phenomenon attributed by Fishman and Dillon to dural venous dilatation; this finding may extend to the pachymeninges of the posterior fossa and the cervical spine.
66
MRI findings of regional arachnoiditis
The MRI shows irregularly enhru;cing roots and arachnoidal thick.ening; 􀄪yelo?I'aphy. 􀄫Iscloses loculated pockets of imagmg media
67
agents associated with regional arachnoiditis
instillation of iophendylate (Pantopaque) for myelography and corticosteroids (for pain or multiple sclerosis) and other irritative agents,
68
This condition was well known to neurologists during the period when neurosyphilis was a common disease. It occurs after years of chronic syphilitic meningitis, sometimes in conjunction with tabes dorsalis or meningomyelitis
O pticoc h i a s m atic Ara c h n o i d it i s
69
This term refers to a chronic, inflammatory thickening | of the dura
Pachym e n i n g it i s
70
Pachym e n i n g it i s occurred mainly m the cervical region (hence the name pachymeningitis cervicalis hypertrophica) and was attributed to _________
syp􀄹hilis
71
A condition associated with plasma cells proliferation that contain__________ has been reported to involve the pachymeninges
IgG-4 receptors
72
serum and CSF findings of Pachym e n i n g it i s
elevation of the IgG fraction in the serum and in CSF and infiltration of meningeal tissue by uniform plasma cells that exhibit IgG-4 markers (
73
The fibrous connective tissue of which the dura is composed may also undergo pronounced thickening in the course of a mucopolysaccharidosis, especially in cases where_________ are implicated.
fibroblasts
74
_________is clearly the consequence of | repeated contamination of the meninges by blood
Superficial siderosis
75
sites for Superficial siderosis
cerebellum, eighth cranial nerve, | and spinal cord,
76
The clinical syndrome of siderosis of the meninges | consists essentially of _____________
progressive ataxia and nerve deafness; sometimes a spastic paraparesis is added and, rarely, mental impairment, probably from hydrocephalus.
77
the iron-impregnated tissues are __________in | T2-weighted images
hypointense
78
The clinical syndrome includes dementia, seizures, stroke-like episodes, subarachnoid hemorrhage, ataxia, myelopathy, deafness, radiculopathy, and ocular amyloidosis
O c u l o l e pto m e n i n g e a l A m y l o i d o s i s