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NEURO > CSF, Hydrocephalus and Lumbar Puncture > Flashcards

CSF, Hydrocephalus and Lumbar Puncture Flashcards

1
Q

What is the main role of cerebrospinal fluid? (CSF) Where is CSF located?

A
  • Shock absorbance

- Located in subarachnoid space (between arachnoid and pia)

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2
Q

What are the main constituents of CSF?

A
  • White blood cells (0-5)
  • Protein (300mg/L)
  • Glucose (40-80mg/dl)
  • Na / Cl
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3
Q

What is the approximate total volume of CSF? How is volume distributed between cranium and spine?

A
  • 150mL

- 50% intracranial, 50% spinal

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4
Q

What is responsible for the secretion and absorption of CSF?

A

Secretion:

  • 80% from choroid plexus in ventricles
  • Lining of ventricles (ependyma)

Absorption:
- Arachnoid villi (granulations)

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5
Q

What is the rate of production of CSF? Does it depend on intracranial pressure?

A
  • 0.3-0.5ml/kg/hr (adult - 500ml/day)

- CSF production is independent of ICP

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6
Q

Where is the choroid plexus located?

A
  • Mostly on floors of lateral ventricles
  • Some on roof of 3rd ventricle
  • Some between 4th ventricle and cerebellum
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7
Q

What are arachnoid granulations? Function?

A
  • They are projections of the arachnoid membrane into the venous dural sinuses
  • Function to allow CSF to pass from subarachnoid space to the venous system
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8
Q

Two main functional causes of hydrocephalus?

A
  • Obstructive: blockage of CSF outflow from ventricles

- Communicating: blockage at level of arachnoid granulations

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9
Q

What causes hydrocephalus?

A

Congenital:
- Chiari malformation / aqueductal stenosis / Dandy-Walker malformation

Acquired:

  • Meningitis
  • Post-haemorrhagic
  • Neoplastic (benign or malignant)
  • Cerebellar stroke
  • Post trauma / surgery
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10
Q

Symptoms and signs of hydrocephalus in infants?

A
  • Cranial enlargement / splaying of sutures
  • Fontanelles bulging / engorged scalp veins
  • Abducens (CN VI) palsy
  • Perinaud’s syndrome (eyes can’t move up/down)
  • Exaggerated reflexes / resp. problems / irritable
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11
Q

Symptoms and signs of hydrocephalus in adults?

A
  • Headaches (worse in morning & on coughing / straining)
  • Papilloedema
  • Visual disturbances
  • Gait abnormality
  • Abducens palsy
  • Impaired consciousness
  • May be asymptomatic
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12
Q

Treatment of hydrocephalus?

A

Pharmacological:
- Carbonic anhydrase inhibitor (Acetazolamide), reduces CSF production from choroid plexus

Surgical:

  • EVD if emergency (external ventricular drain)
  • Eliminate obstruction
  • Shunting **
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13
Q

Complications of shunting to allow passage of CSF?

A
  • Over drainage (low pressure headache / subdural haematoma)
  • Under drainage
  • Blockage
  • Infection
  • Disconnection
  • Seizures
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14
Q

What is an ETV?

A
  • Endoscopic 3rd ventriculostomy, treatment for hydrocephalus
  • Create a stoma between 3rd ventricle and subarachnoid spaces
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15
Q

What is Normal Pressure Hydrocephalus? Symptoms?

A
  • Hydrocephalus, but CSF pressure measured during lumbar puncture is normal. Can be a reversible cause of dementia

Classic triad of symptoms:

  • Dementia
  • Gait disturbance
  • urinary incontinence
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16
Q

Treatment of normal pressure hydrocephalus?

A
  • Usually improves after shunting

- Can be hard to diagnose though bc of normal pressure

17
Q

What is idiopathic intracranial hypertension? Who is most at risk? How does it present?

A
  • Raised ICP without obvious cause
  • Typical patient is young, obese female
  • Present with headaches, visual disturbances and papilloedema
18
Q

Treatment for idiopathic intracranial hypertension?

A
  • Carbonic anhydrase inhibitor (acetazolomide)
  • Shunting
  • Weight loss
19
Q

What are the uses of a lumbar puncture?

A
  • Obtain CSF for analysis (infection / protein etc.)
  • Measure pressure (ICP)
  • CSF drainage if ICP is high
  • Diagnosis of normal pressure hydrocephalus
20
Q

Things to check pre-Lumbar Puncture?

A
  • Patient is awake and conscious
  • No focal neurological deficit (VI nerve palsy)
  • CT/MRI to rule out intracranial mass lesion
  • Ensure patient not on anticoagulants
21
Q

What vertebral level is a lumbar puncture taken at?

A

Between L3/4 or L4/5

22
Q

Positioning of patient during a lumbar puncture?

A
  • Fetal position: knees up and neck flexed

- Pillow behind the knees (?)

23
Q

Lumbar puncture technique?

A
  • Get patient to lie on side in fetal position
  • Insert needle, angled towards umbilicus
  • Feel for “a give” after piercing ligamentum flavum
  • Check for CSF, measure pressure etc.
24
Q

What does cloudy, turbid CSF indicate? What would you expect to see on CSF analysis?

A
  • Meningitis (infection)

On testing CSF:

  • High WBC
  • High protein (>1g/L)
  • Low glucose
25
Q

When would CSF appear bloody?

A
  • Traumatic spinal tap

- Following subarachnoid haemorrhage

26
Q

What does yellow CSF indicate?

A
  • Yellow because of blood breakdown products, most commonly seen following SAH

NEURO (52 decks)

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