CSF, Hydrocephalus and Lumbar Puncture Flashcards
Where is CSF found?
Subarachnoid space
Where is the choroid plexus located?
Floor of lateral ventricles
What is the aetiology of hydrocephalus?
Aqueductal stenosis Dandy- Walker malformation Meningitis Post-haemorrhagic Cerebellar stroke Benign or malignant neoplasia Chiari malformation
What are the symptoms of hydrocephalus in infants?
Cranial enlargement Splaying of cranial sutures Irritable Poor feeding Engorged scalp veins Fontanelles full and bulging Exaggerated reflexes Respiratory problems Perinaud's syndrome
What are the symptoms of hydrocephalus in older children and adults?
Increased ICP Headaches worse in morning and on coughing Papilloedema Visual disturbances Gait abnormality Loss of upgaze or abducens palsy Impaired consciousness
What is the treatment for hydrocephalus ?
Acetazolamide (carbonic anhydrase inhibitor)
External ventricular drain (emergency)
CSF diversion with shunt
Endoscopic ventriculostomy
What are the complications of shunting?
Over drainage (low pressure headaches, subdural haematoma)
Under drainage
Blockage
Infection
Seizures
Disconnection
Distal end problems (abdominal hernias, cardiac arrhythmias)
What is an endoscopic ventriculostomy?
Fistula created between 3rd ventricle and subarachnoid spaces/ basal cisterns
What are the clinical features of non pressure hydrocephalus?
Dementia (potentially reversible)
Gait disturbances
Urinary incontinence
What are the clinical features of idiopathic intracranial hypertension?
Headaches and visual disturbance
What is the treatment of idiopathic intracranial hydrocephalus?
Loose weight
Acetazolamide
CSF diversion -VP or LP shunt
Optic nerve sheath fenestration
What are the indications for lumbar puncture?
Obtain CSF for analysis
Measurement of pressure
CSF drainage for raised pressure
Diagnostic test for normal pressure hydrocephalus
What is checked before a lumbar puncture?
Awake and conscious patient
No focal neurological deficit (6th nerve palsy)
CT/MRI (rule out intracranial mass lesion)
Ensure patients not on anticoagulants
What are the risks of a lumbar puncture?
Bleeding Infection Nerve root injury Retroperitoneal/ intraabdominal injury Brainstem herniation
How would CSF indicate meningitis?
Cloudy, turbid
Lots of WBC
Protein >1g/L
Low glucose
