CSF lectures

Question 1

How would you treat a subarachnoid hemorrhage for hydrocephalus

Answer 1

Place an external ventricular drain - but if you have scarring in that space, and you can’t absorb CSF at all if you wean patients off the EVD
then oPT for a VENTRICULOPERITONEAL shunt

Question 2

What is the VP shunt

Answer 2

Permanent alternative to the External ventricular drain

Question 3

Which ventricles are enlarged in triventricular hydrocephalus?

Answer 3

Enlargement of third ventricle and lateral ventricles, 4th ventricle is NORMAL size

Question 4

What is aqueductal stenosis and how do you treat it?

Answer 4

1. Noncommunicating hydrocephalus often congenital in origin

2. ENDoscopic third ventriculostomy

Question 5

How is ICP lowered

Answer 5

1. decrease CSF volume (EVD, cabonic anhydrase, osmotic diuresis)
2. decrease CBV (decrease CO2, hyperventilate, maximize venous outflow, increase perfusion, increase MAP)
3. relieve mass efect, craniectomy

Question 6

CSF pressure is ? mmHg

Answer 6

9-12 mmHg - similar to ICP

Question 7

How much blood flow is needed for the brain?

Answer 7

50-55ml/min/100g of brain tissue

Question 8

CBF =

Answer 8

Cerebral perfusion pressure / Cerebral vascular resistance

Question 9

A rise in ICP will lead to… ? on (CPP)

Answer 9

Reduced CPP

Question 10

There are three causes of mortality for SAH

Answer 10

1. rupture-associated aneurysm trauma
2. Acute hydrocephalus
3. repeat hemorrhage

Question 11

CT will show acute blood very well

Answer 11

Appears bright

Question 12

how can you decrease CSF volume

Answer 12

1. EVD
2. Decrease production- acetzolamide
3. Decrease ISF - Osmotic diuresis mannitol

Question 13

How can you decrease CBV?

Answer 13

1. Maximize venous outflow (head up, free the jugulars)
2. Decrease pCOs, hyper ventilate
3. Increase perfusion paradoxically to lower ICP