CSF, Lumbar Puncture and Hydrocephalus Flashcards
Where would you find CSF?
Surrounding brain and spinal cord
What is the function of CSF?
Protection
Acts as shock absorber
Possible immunological function
In which space does CSF circulate?
Subarachnoid space between arachnoid and pia mater
Where is CFS produced?
Choroid plexuses
Where are the choroid plexuses?
Lateral ventricles
Fourth ventricle
What is CSF primarily absorbed by?
Arachnoid villi
What is the rate of absorption dependant on?
Pressure dependant
Which type of cells are found in CSF?
No cells found in CSF, no more than five lymphocytes
What is the appearance of CSF?
Clear and colourless
What differences are there in CSF in bacterial infection?
Raised protein
Raised pressure
Cloudy appearance
Reduced glucose
Raised WCC
What is the difference in CSF if there is viral infection?
WCC (white cell count) elevated a lot
What is the difference in CSF if there is fungal/TB infection?
Lower glucose
Raised WCC
List the normal constituents of CSF.
Sodium, potassium, chlorine, protein, glucose
How is CSF sampled?
Lumbar puncture
What position should the patient be in when taking a lumbar puncture?
Lateral recumbent position
Which vertebral level is a lumbar puncture taken at?
L4-5
What is the normal cause of hydrocephalus?
Abnormal CSF absorption
What are the two types of hydrocephalus caused by abnormal CSF absorption?
Obstructive hydrocephalus
Communicating hydrocephalus
What happens in obstructive hydrocephalus?
There is a block within the ventricular system causing obstruction of free fluid outlfow.
What happens in communicative hydrocephalus?
Defect in the CSF reabsorption by the arachnoid granulations
Apart from abnormal CSF absorption, what else can cause hydrocephalus?
Overproduction of CSF
Give an example of an individual who might overproduce CSF.
Those with choroid plexus papilloma’s, a type of tumour
What are some of the most common congenital causes of hydrocephalus?
Spina bifida, more specifically, myelomeningocele
Primary aqueduct stenosis
Dandy Walker Malformation
What is the most general cause of hydrocephalus?
Infection
After which incident may hydrocephalus be more likely to occur?
Post-haemorrhagic
Give an example of something which can cause obstructive hydrocephalus.
Tumour of brain
What are the signs and symptoms of hydrocephalus in older children and adults?
Increased intra-cranial pressure
Gait changes
Upgaze
Papilledema
Headache
Gaze palsy
What are the signs and symptoms of hydrocephalus in young children?
Abnormalities in head circumference
Cranium enlarges at a rate greater than facial growth
Irritability
Poor head control
Fontanelle full and bulging
Enlargement and engorgement of scalp veins
Upward gaze palsy
6th nerve palsy
Irregular respirations with apneic spells
Which investigations are used to identify hydrocephalus?
-> fundoscopy to check for papilledema
->CT
-> MRI, much more detailed
Which type of imaging is used when dealing with a small baby with suspected hydrocephalus?
Ultrasound
What is the treatment for communicating hydrocephalus?
Lumbar puncture
Lumbar drain
What is the treatment for obstructive hydrocephalus?
External ventricular drain
->these patients tend to be more unwell hence why a lumbar puncture/drain are not as safe
What will be carried out if someone needs a permanent diversion of excess CSF due to obstructive hydrocephalus?
Endoscopic third ventriculostomy
What will be carried our if a patient requires permanent diversion of CSF due to communicating hydrocephalus?
VP shunt (ventriculo-pertioneal shunt)
