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Nervous System > CSF, Hydrocephalus, Lumbar Puncture > Flashcards

CSF, Hydrocephalus, Lumbar Puncture Flashcards

1
Q

Where is CSF found?

A

Subarachnoid space between arachnoid and pia mater in the brain and spinal cord

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2
Q

Role of CSF

A

Acts as shock absorber
Fills in gaps between brain and skull
Immunological role
Removal of some waste products

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3
Q

Specific gravity of CSF

A

1.007

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4
Q

pH of CSF

A

7.33-7.35

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5
Q

Contents of CSF

A

0-5 WBC
0 RBC
Protein 300mg/l
Glucose 40-80mg/dl

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6
Q

Total volume of CSF

A

150ml - 50% spinal, 50% intracranial

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7
Q

Production rate of CSF in adults

A

0.3-0.5 ml/kg/hour

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8
Q

Where is CSF produced?

A

Choroid plexus in the ventricles

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9
Q

Where is CSF absorbed?

A

Arachnoid villi

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10
Q

Components of ventricular system

A 
Lateral ventricles
Foramen of Munro (interventricular foramen)
Third ventricle 
Aqueduct of Sylvius 
Fourth ventricle
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11
Q

Meninges are

A

the membranous coverings of the brain and spinal cord - dura mater, arachnoid mater and pia mater

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12
Q

Function of meninges

A

Provide supportive framework for cerebral and cranial vasculature and protect the CNS from mechanical damage

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13
Q

What are the two main dural reflections?

A

Tentorium cerebelli

Falx cerebri

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14
Q

What do the tentorium cerebelli separate?

A

The cerebellum and brainstem from the occipital loves of the cerebrum

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15
Q

Where is the falx cerebri located and what does it separate?

A

Located in the longitudinal cerebral fissure and separates the two cerebral hemispheres

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16
Q

What structures pass through the foramen magnum?

A

The two vertebral arteries

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17
Q

What structures pass through the optic canals?

A

Optic nerve

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18
Q

What structures pass through the foramina ovale?

A

Mandibular branch of trigeminal nerve

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19
Q

What structures pass through the foramina rotunda?

A

Maxillary branch of trigeminal nerve

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20
Q

What structures pass through the jugular foramina?

A

Sigmoid sinuses, main venous outflow tracts from brain

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21
Q

What structures pass through cribriform plate?

A

Olfactory receptor neurones

22
Q

What structures pass through the superior orbital fissures?

A

Oculomotor, trochlear, ophthalmic and abducens nerves

23
Q

What structures pass through the internal auditory meati?

A

Facial and vestibulocochlear nerves

24
Q

What structures pass through the stylomastoid foramina?

A

Facial nerve

25
Q

What structures pass through carotid canals?

A

Internal carotid arteries

26
Q

What structures pass through the foramina spinosa?

A

Middle meningeal arteries

27
Q

What is hydrocephalus?

A

Accumulation of fluid in the brain resulting in the dilatation of the ventricles

28
Q

Functional classifications of hydrocephalus

A

Obstructive - blockage outflow from ventricles

Communicating - block at level of arachnoid granulation

29
Q

Congenital causes of hydrocephalus

A

Chiari malformation
Aqueductal stenosis
Dandy-Walker malformation

30
Q

Acquired causes of hydrocephalus

A 
Meningitis
Post-haemorrhagic 
Neoplastic 
Post-operative 
Cerebellar stroke 
Post-traumatic
31
Q

Symptoms and signs of hydrocephalus in infants

A 
Cranial enlargement 
Splaying of cranial surfaces 
Irritability 
Poor feeding 
Full and bulging fontanelles 
Engorged scalp veins 
Abducens nerve palsy 
Perinaud's syndrome 
Exaggerated reflexes 
Respiratory problems
32
Q

Symptoms and signs of hydrocephalus in older children and adults

A 
May be asymptomatic 
Increased ICP 
Headaches - worse in morning and on coughing/straining 
Papilloedema 
Visual disturbances 
Gaze abnormality 
Loss of up gaze - abducens nerve palsy 
Impaired consciousness
33
Q

Medical treatment of hydrocephalus

A

Acetazolamide

34
Q

Surgical treatment of hydrocephalus

A

External Ventricular Drain
Eliminate obstruction
CSF diversion - third ventriculostomy, shunt insertion
Endoscopic ventriculostomy

35
Q

Shunts which can be created in the surgical treatment of hydrocephalus

A 
Ventriculo-peritoneal 
Ventriculo-pleural 
Ventriculo-atrial 
Ventriculo-subarachnoid 
Lumbo-peritoneal 
Cysto-subarachnoid
36
Q

What is done in an endoscopic ventriculostomy, and when can it be done?

A

Create a fistula between third ventricle and subarachnoid cisterns
Can only be done in non-communicating hydrocephalus

37
Q

Presentation of normal pressure hydrocephalus

A

Dementia (potentially reversible)
Gait disturbance
Urinary incontinence
Age > 60

38
Q

Presentation of idiopathic intracranial hypertension

A

Young obese female
Headaches
Visual disturbances
Papilloedema

39
Q

Treatment of idiopathic intracranial hypertension

A

Weight loss
Acetazolamide
CSF diversion
Optic nerve sheath fenestration

40
Q

What position should a patient be in to undergo a lumbar puncture?

A

Foetal position - knees up, neck flexed, pillow between the knees

41
Q

At what vertebral level is a lumbar puncture carried out?

A

Between L3 and L4

42
Q

Describe basic technique for lumbar puncture

A 
Aseptic - clean skin with betadine 
Local anaesthetic 
Spinal needle angled towards umbilicus 
Aim for interlaminar space, through the ligamentum flavum 
Obtain samples and withdraw needle
43
Q

Indications for lumbar puncture

A

Need to obtain CSF for analysis
Measurement of ICP
CSF drainage for raised pressure
Diagnostic test for normal pressure hydrocephalus

44
Q

Pre-lumbar puncture checks

A

Patient awake and conscious
No focal neurological deficit
CT/MRI to rule out intracranial mass lesion
Ensure patient isn’t on anticoagulation

45
Q

Risks of lumbar puncture

A 
Bleeding 
Infection 
Nerve root injury 
Retroperitoneal/intra-abdominal injury 
Brainstem herniation
46
Q

Post-lumbar puncture care

A

24 hours bed rest
Warn about low-pressure headaches
Stop LP if patient is developing neurological deficit or becoming unconscious

47
Q

Contraindications for lumbar puncture

A

Skin infection near LP site
Suspicion of increased ICP due to cerebral mass lesion
Uncorrected coagulopathy
Acute spinal cord trauma

48
Q

Describe CSF in meningitis

A

Cloudy, turbid
Lots of WBC
Protein > 1g/l
Low glucose

49
Q

Causes of bloody CSF

A

Traumatic tap

Subarachoid haemorrhage

50
Q

Causes of yellow CSF

A

Yellow due to blood breakdown products

Most commonly seen in SAH

Nervous System (44 decks)

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