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Year 2 - Nervous > CSF, hydrocephalus & lumbar puncture > Flashcards

CSF, hydrocephalus & lumbar puncture Flashcards

1
Q

What is CSF produced by

A

Choroid plexus

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2
Q

Is CSF production/resorption metabolically active/passive

A

Production - active (requires ATP for Na/K ATPase)

Resorption - passive

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3
Q

How much CSF do we make daily

A

450-600ml

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4
Q

At any given moment, there’s how much CSF in the body

A

150ml

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5
Q

How much CSF is in the ventricles at any given moment

A

25ml

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6
Q

CSF exits the 4th ventricle into the subarachnoid space via what 2 foramen

A

Formamen of luschka - lateral

Foramen of magendie - medial

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7
Q

Define hydrocephalus

A

Excess CSF in the brain

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8
Q

2 types of hydrocephalus

A

Communicating (non-obstructive)

Non-communicating (obstructive)

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9
Q

Describe communicating (non-obstructive) hydrocephalus

A

CSF pathway open from start to finish, i.e. can travel from choroid plexus to arachnoid villi to be resorbed

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10
Q

Pathophysiology of communicating hydrocephalus (2)

A

CSF resorption < production
(under-absorption)

Ventricles dilate –> ICP rises

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11
Q

In a RARE type of communicating, CSF production > resorption - what condition is this

A

Choroid plexus papilloma

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12
Q

Causes of communicating hydrocephalus (4)

A

Infection
Subarachnoid haemorrhage - blood in subarachnoid space impairs arachnoid granulations so resorption impaired
Post-op
Head trauma

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13
Q

Describe non-communicating hydrocephalus (obstructive hydrocephalus)

A

CSF can’t travel freely from start to finish due to a PHYSICAL obstruction

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14
Q

Causes of non-communicating hydrocephalus (6)

A 
Aqueductal stenosis
Tumours/masses - MOST COMMON
Cysts, e.g. colloid cyst
Infection
Haemorrhage
Congenital malformations
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15
Q

Symptoms/signs of hydrocephalus

  • in babies (4)
  • in children with fused sutures/adults (7)
A 
Babies:
Massive head
Bulging fontanelle
Failure to thrive
Downward looking eyes
Children/adults:
Headache
Nausea
Vomiting
Sleepiness
Gait disturbance (difficulty walking)
Blurry vision
Urinary incontinence
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16
Q

Investigations of hydrocephalus

A

CT - shows dilated inferior/ temporal horns of lateral ventricles

MRI

17
Q

How is the Evans ratio used to diagnose hydrocephalus

A

Max width of anterior horns of lateral ventricles divided by max width of the skull at the same level

If ratio >30% = indicates ventriculomegaly and potentially hydrocephalus

18
Q

Treatment of:

  • communicating hydrocephalus (1)
  • non-communicating hydrocephalus (3)
A

Communicating:
Shunt placement

Non-communicating:
Shunt placement
Endoscopic third ventriculostomy
Remove obstructing mass

19
Q

How does shunt placement work

A

Shunt is implanted in the brain
. The excess cerebrospinal fluid (CSF) in the brain flows through the shunt to another part of the body, usually the chest or abdo cavity - from here, it’s absorbed into your bloodstream

20
Q

How does endoscopic third ventriculostomy work

A

Hole made in the floor of the 3rd ventricle to allow the trapped CSF to bypass cerebral aqueduct and escape to the brain’s surface, where it can be absorbed

21
Q

Most common type of shunt used for hydrocephalus

A

Ventriculo-peritoneal

22
Q

Treatment of acute hydrocephalus

A

External ventricular drain

23
Q

What is normal pressure hydrocephalus

A

Characterised by the clinical features of hydrocephalus (i.e., levodopa-unresponsive gait apraxia +/- urinary incontinence or cognitive impairment), but without significantly elevated CSF pressure

Despite this, the condition responds to a reduction in CSF pressure and/or a CSF diversion procedure

24
Q

What condition is normal pressure hydrocephalus a reversible cause of

A

Dementia

25
Q

Symptoms/signs of normal pressure hydrocephalus (3)

A

Wet, wobbly, wacky:

Urinary incontinence
Gait disturbance (unusual walking)
Cognitive impairment

26
Q

Investigations of normal pressure hydrocephalus (3)

A

CT
MRI
Lumbar puncture + CSF tap (i.e. lumbar drain) - if LP doesn’t improve symptoms

27
Q

Treatment of normal pressure hydrocephalus (1)

A

Surgery only if lumbar puncture/ lumbar drain was proven beneficial:

Shunt placement - ventriculoperitoneal shunt

28
Q

Place the wet, wobbly and wacky symptoms in order of which will most likely improve

A

Gait > incontinence > memory

29
Q

What vertebral level are LPs performed

A

Between L3 and L4

or L4 and L5

30
Q

What position does the patient have to lie in when doing an LP

A

Lateral decubitus position - maximally flex spine with chin near chest and knees near chest
-usually lying on their left side

31
Q

Indications of an LP (5)

A 
Meningitis
Encephalitis
Subarachnoid haemorrhage
Malignancy
Idiopathic intracranial hypertension
32
Q

Contra-indications of an LP (5)

A

Cardio or resp instability

Localised skin infection over puncture site

Evidence of unstable bleeding disorder

Increased ICP – as you can cause herniation syndrome
(HOWEVER, IS NOT A CONTRAINDICATION OF CoH as lumbar puncture would relieve the pressure)

Chiari malformation

33
Q

When doing an LP, will hear 2 pops when inserting spinal needle - what is being punctured in the first and second pop

A

Ligamentum flavum

Then dura mater

34
Q

Complications of an LP (7)

A

Post dural puncture headache – MOST COMMON
Apnoea – temporary stop of breathing
Back pain – maybe disc herniation
Bleeding or fluid leak around spinal cord
Infection
Nerve trauma
Brainstem herniation

35
Q

Management of a post dural puncture headache (4)

A

Lie flat
Hydration
Caffeine
Epidural blood patch - injecting own blood into the puncture site, clotting factors of the blood patch up the hole

36
Q

Prevention of a post dural puncture headache (spinal headache) (2)

A

Using smaller diameter or atraumatic needles

Passing spinal needle parallel to longitudinal fibres of dura

37
Q

Management of nerve root trauma caused by LP (2)

A

Remove needle immediately

Steroids

38
Q

Management of brainstem herniation caused by LP (4)

A

Remove needle ASAP
Raise head of head to improve venous return from brain to heart
Mannitol - diuretic
Intubate

39
Q

What properties of CSF can be analysed in CSF analysis (6)

A 
Colour
Opening pressure
Culture + gram stain
CSF glucose
CSF protein count
CSF cell count

Year 2 - Nervous (39 decks)

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