CSF DISTURBANCES Flashcards
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
80
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 ________
1 ,200 to 1,400 mL,
70 to 160 mL
150 mL.
the CSF occupies somewhat less than
_______ percent of the intracranial and intraspinal spaces
10
the distance between the caudate
nuclei at the anterior horns gradually widens by approximately
__________, and the width of the third ventricle
increases from _________
1 . 0 to 1 .5 Cm
3 to 6 mm by age 60 years
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 __________
500 mL / d;
4 or 5 times daily.
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.
Ionized
compounds, such as hexoses and amino acids, being
relatively insoluble in lipids, enter the CSF slowly unless
facilitated by a membrane transport system.
What are the components of the BBB
- endothelium of the choroidal and brain capillaries
- plasma membrane and adventitia (Rouget cells) of these vessels
- pericapillary foot processes of astrocytes
________________ help drive the fluid
centrifugally from the ventricular system.
Arterial
pulsations of the choroid plexuses
pacchionian granulations or bodies
microscopic excrescences of arachnoid
membrane that penetrate the dura and protrude into
the superior sagittal sinus and other venous structures
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
8 mm Hg or 110 mm H20
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.
F
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.
25 mm Hg
The numerical difference between ICP and mean
BP within the cerebral vessels is termed ________
cerebral perfusion
pressure (CPP).
Of the 3 ICP waveforms, which has a clinical significance, , B or C?
A
___________coincide with an increase in intracranial
blood volume, presumably as a result of a temporary
failure of cerebrovascular autoregulation
plateau waves
In a normal adult reclining with the
head and trunk elevated to 45 degrees, the ICP is in the
range of ________
2 to 5 mm Hg
As a rule, patients with normal BP retain normal
mental alertness with ICP of _______ unless
there is concurrent shift of brain tissue
25 to 40 mm Hg
Only when ICP exceeds________ does cerebral
blood flow diminish to a degree that results in loss of
consciousness
40 to 50 mm Hg
the brain shift and herniation that causes
the pupil to dilate on the side of a mass lesion generally
occurs at an ICP of________
28 to 34 mm Hg
Indications for ICP monitoring
with severe traumatic brain injury if they are
over 40 years of age, and have a Glasgow Coma Score
below 9
to ventricular enlargement because of failure of development
of the brain, a state known as ______
colpocephaly
T or F
that the ventricle closest to the obstruction enlarges the
most;
T
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 _________
external hydrocephalus
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
papillomas of
the choroid plexus
The cranial
bones fuse by the ______________; for the head to
enlarge, the tension hydrocephalus must develop before
this time
end of the third year
In Dandy Walker, because of bossing of the occiput from
enlargement of the posterior fossa, the head is __________
dolichocephalic
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
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
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. “
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,”
presumed cause of NPH
aymptomatic fibrosing meningitis
decompensated congenital aqueductal stenosis
In pts with NPH, lateral ventricular span at the level of the anterior horns has been in excess of approximately _________________
40 mm
amount of CSF to be drained in NPH for clinical improvement
20-30cc
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.
predictors of success for the tx of NPH
- enlargement of the ventricles in comparison to the degree of cortical atrophy,
- CSF pressures above 150 mm H20, and
- improvement after spinal puncture,
how to overcome orthostatic HA in pts after shunting
Orthostatic headaches
can be overcome by raising the opening pressure of
the shunt valve.
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),
Cx of VP shunts
Peritoneal pseudocysts
“slit ventricle” syndrome
In most shunted
patients with slit ventricle syndrome, the ICP in the
upright position is diminished to
30 mm H20
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
giving ________________orally daily,
shunting can be avoided in both adult normal-pressure,
and infantile hydrocephalus
250 to 500 mg of acetazolamide
components of Parinaud
abnormal papillary reaction, upper lid retraction, paralysis
of convergence, skew deviation, and convergenceretraction
nystagmus
CSF pressure in IIH
250-450 mmH20
Enlargement of the blind spot is the result of
_____________ from the edges of the swollen
disc
displacement of the retina
__________ increases the resistance to CSF absorption
and is the proximate mechanism underlying pseudotumor
venous
hypertension
what vitamin is 50 percent higher than
expected, in patients with pseudotumor
Vit A
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
systemic conditions associated with increased CSF CHON
Guillain-Barre
syndrome, systemic lupus, and spinal tumors, particularly
oligodendroglioma
other agents causing IIH
- Tetracycline
- Vitamin A (isotretinoin)
3.estrogens, phenothiazines, lithium, the antiarrhythmic
drug arniodarone, and quinolone antibiotics
T or F
the diagnosis of idiopathic pseudotumor
cerebri should not be accepted when the CSF content
is normal.
F
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,
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
InitiaL Tx of IIH
large doses of acetazolamide at 1-5g per day
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
improvement of vision in pts with IIH after LP shunt
70%
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
ON fenestration improvement in vision
preserved or restored vision in 80 to
90 percent of patients
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
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
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
The most dependable treatment in IC hypotension is a _____________
“blood patch”
(spinal epidural injection of approximately 20 mL of the
patient’s own blood).
The administration of ____________preparations
or intravenous caffeine may also have a salutary,
although temporary, effect on the orthostatic headache
caffeine-ergotamine
mechanism of spinal HA
As to mechanism, the pain is presumed to be from
tugging on cerebral veins or assuming the upright
position.
Some surveys suggest that patients with structural
disorders of connective tissue are not at greater risk for
spontaneous CSF leaks than others
F
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.
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
agents associated with regional arachnoiditis
instillation of iophendylate (Pantopaque)
for myelography and corticosteroids (for pain or multiple
sclerosis) and other irritative agents,
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
This term refers to a chronic, inflammatory thickening
of the dura
Pachym e n i n g it i s
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 _________
syphilis
A condition associated with plasma cells proliferation
that contain__________ has been reported
to involve the pachymeninges
IgG-4 receptors
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 (
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
_________is clearly the consequence of
repeated contamination of the meninges by blood
Superficial siderosis
sites for Superficial siderosis
cerebellum, eighth cranial nerve,
and spinal cord,
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.
the iron-impregnated tissues are __________in
T2-weighted images
hypointense
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
