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N - C > CSF, Hydrocephalus, Lumbar Puncture > Flashcards

CSF, Hydrocephalus, Lumbar Puncture Flashcards

1
Q

What are the constituents of CSF?

A

Clear colourless, pH 7.33-7.35

WBC = 0-5
RBCs = 0
Protein = 30mg/dl
Glucose 40-80mg/dl (glucose ratio CSF: Plasma 0.5)

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2
Q

What produces CSF?

A

80% in choroid plexus in lateral ventricles and 4th ventricle

Ependymal lining of the ventricles

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3
Q

Describe the flow of CSF

A
  • lateral ventricles
  • Foramina of munro
  • 3rd ventricle
  • Aqueduct of Sylvius
  • 4th ventricle
  • Foraminae of magendie and lushka
  • Central spinal canal
  • Subarachnoid spaces
  • Arachnoid granulations
  • Dural venous sinuses
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4
Q

What is the functional classification of hydrocephalus?

A

Obstructive
-Block proximal to arachnoid granulations

Communicating
-Block at level of arachnoid granulations

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5
Q

What is the congenital aetiology of hydrocephalus?

A

Chiari malformation

Aqueductal stenosis

Dandy-Walker malformation

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6
Q

What is the aquired aetiology of hydrocephalus?

A
  • Infections
  • Post-haemorrhagic
  • Vascular malformations
  • Neoplastic: Benign and Malignant
  • Post-op (esp.posterior fossa surgery)
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7
Q

What are the signs and symptoms of hydrocephalus in young children?

A
  • Cranial enlargement
  • Splaying of cranial sutures
  • Irritability
  • Fontanelles full and bulging
  • Engorged scalp veins
  • Abducens palsy (6th nerve course is long and tortuous)
  • Perinaud’s syndrome
  • Exaggerated reflexes
  • Respiratory problems
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8
Q

What is perinaud’s syndrome?

A
  • “Sunsetting” (upwards gaze palsy)
  • Convergent nystagmus
  • Eyelid retraction
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9
Q

What are the symptoms and signs of hydrocephalus in older children and adults?

A
  • May be asymptomatic
  • Increased ICP
  • Headaches
  • Papiloedema
  • Visual disturbances
  • Gait abnormality
  • Upgaze or abducens palsy
  • Impaired consciousness
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10
Q

What is the medical treatment for hydrocephalus?

A

Diuretics

  • Acetazolamide: carbonic anhydrase inhibitor
  • Furosemide: loop diuretic
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11
Q

What is the surgical treatment for hydrocephalus?

A
  • Eliminating obstruction
  • CSF diversion
  • 3rd Ventriculostomy
  • Shunt insertion
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12
Q

Where may shunts in hydrocephalus be placed?

A 
Ventriculo-peritoneal
Ventriculo-pleural
Ventriculo-subarachnoid
Lumbo-peritoneal
Cysto-subarachnoid
Gall bladder
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13
Q

What are the complications of shunts?

A 
Over drainage
-Low pressure headaches
-Subdural haematomas
Under-drainage
Blockage
Infection
Fracture
Disconnection
Seizures
Distal end problems:
-Abdominal harnias (VPS)
-Cardiac Arrhythmias (VAS)
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14
Q

Describe endoscopic 3rd ventriculostomy (ETV)

A
  • Division of basal membrane
  • Creating a fistula between 3rd ventricle and subarachnoid spaces/ basal cisterns

56% success rate overall

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15
Q

What are the risk factors for an Endoscopic 3rd ventriculostomy (ETV)?

A

Younger age
Unknown aetiology
Failed shunt surgery

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16
Q

When can ETV block of?

A

Days, weeks or years later

17
Q

What is the classical triad in normal pressure hydrocephalus?

A

Dementia
Gait disturbance
Urinary incontinence

18
Q

What is normal pressure hydrocephalus?

A

Communicating hydrocephalus

“Normal” pressure on LP
-Raised ICP waves if monitored

Improvement after CSF diversion

19
Q

What is intractable intracranial hypertension?

A

Raised ICP without obvious cause

Prevalent in young obese females

Often present with headaches and visual disturbances

20
Q

What is the treatment for intractable intracranial hypertension?

A

Medical (diuretics)

CSF diversion

Optic nerve sheath fenestration

21
Q

Why may you perform a lumbar puncture?

A

Obtain CSF for analysis

CSF drainage for raised pressure

CSF diversion (treatment of CSF leak elsewhere)

Diagnostic for normal pressure hydrocephalus

22
Q

What should your Pre-LP checks be?

A

Awake and conscious patient

No focal neurological deficit (6th nerve palsy)

CT/MRI: rule out major obstructuve lesion

  • At craniocervical junction
  • Level of tentorium cerebelli
23
Q

What is a brief runthrough for preparing the patient for LP?

A

Verbal consent

Correct positioning

Fetal position: knees up, neck flexed

Back parallel to end of bed

Pillow between the knees and under head

Level of iliac crest L3/4

24
Q

How do you perform a lumbar puncture?

A
  • Aseptic technique
  • Local technique
  • Spinal needle, angled towards umbilicus
  • Aim for interlaminar space through ligamentum flavum
  • Feel for “a give” after log flavum
  • Check for CSF
  • Obtain samples
  • Withdraw needle
  • Pressure dressing
25
Q

What is involved in the post LP care?

A

Bed rest for 2-4 hrs

Warn pt about low pressre headaches

STOP if patient developing neurological deficit or becoming unconscious

  • Think of herniation syndromes
  • Head down, feet up
  • IV fluids
  • CT to rule out subdural haematoma if not getting better

N - C (35 decks)

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