CSF, Hydrocephalus, Lumbar Puncture Flashcards
What are the constituents of CSF?
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)
What produces CSF?
80% in choroid plexus in lateral ventricles and 4th ventricle
Ependymal lining of the ventricles
Describe the flow of CSF
- 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
What is the functional classification of hydrocephalus?
Obstructive
-Block proximal to arachnoid granulations
Communicating
-Block at level of arachnoid granulations
What is the congenital aetiology of hydrocephalus?
Chiari malformation
Aqueductal stenosis
Dandy-Walker malformation
What is the aquired aetiology of hydrocephalus?
- Infections
- Post-haemorrhagic
- Vascular malformations
- Neoplastic: Benign and Malignant
- Post-op (esp.posterior fossa surgery)
What are the signs and symptoms of hydrocephalus in young children?
- 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
What is perinaud’s syndrome?
- “Sunsetting” (upwards gaze palsy)
- Convergent nystagmus
- Eyelid retraction
What are the symptoms and signs of hydrocephalus in older children and adults?
- May be asymptomatic
- Increased ICP
- Headaches
- Papiloedema
- Visual disturbances
- Gait abnormality
- Upgaze or abducens palsy
- Impaired consciousness
What is the medical treatment for hydrocephalus?
Diuretics
- Acetazolamide: carbonic anhydrase inhibitor
- Furosemide: loop diuretic
What is the surgical treatment for hydrocephalus?
- Eliminating obstruction
- CSF diversion
- 3rd Ventriculostomy
- Shunt insertion
Where may shunts in hydrocephalus be placed?
Ventriculo-peritoneal Ventriculo-pleural Ventriculo-subarachnoid Lumbo-peritoneal Cysto-subarachnoid Gall bladder
What are the complications of shunts?
Over drainage -Low pressure headaches -Subdural haematomas Under-drainage Blockage Infection Fracture Disconnection Seizures Distal end problems: -Abdominal harnias (VPS) -Cardiac Arrhythmias (VAS)
Describe endoscopic 3rd ventriculostomy (ETV)
- Division of basal membrane
- Creating a fistula between 3rd ventricle and subarachnoid spaces/ basal cisterns
56% success rate overall
What are the risk factors for an Endoscopic 3rd ventriculostomy (ETV)?
Younger age
Unknown aetiology
Failed shunt surgery
