CSF, Lumbar Puncture and Hydrocephalus

Question 2

Where would you find CSF?

Answer 2

Surrounding brain and spinal cord

Question 3

What is the function of CSF?

Answer 3

Protection
Acts as shock absorber
Possible immunological function

Question 4

In which space does CSF circulate?

Answer 4

Subarachnoid space between arachnoid and pia mater

Question 5

Where is CFS produced?

Answer 5

Choroid plexuses

Question 6

Where are the choroid plexuses?

Answer 6

Lateral ventricles
Fourth ventricle

Question 7

What is CSF primarily absorbed by?

Answer 7

Arachnoid villi

Question 8

What is the rate of absorption dependant on?

Answer 8

Pressure dependant

Question 9

Which type of cells are found in CSF?

Answer 9

No cells found in CSF, no more than five lymphocytes

Question 10

What is the appearance of CSF?

Answer 10

Clear and colourless

Question 11

What differences are there in CSF in bacterial infection?

Answer 11

Raised protein
Raised pressure
Cloudy appearance
Reduced glucose
Raised WCC

Question 12

What is the difference in CSF if there is viral infection?

Answer 12

WCC (white cell count) elevated a lot

Question 13

What is the difference in CSF if there is fungal/TB infection?

Answer 13

Lower glucose
Raised WCC

Question 14

List the normal constituents of CSF.

Answer 14

Sodium, potassium, chlorine, protein, glucose

Question 15

How is CSF sampled?

Answer 15

Lumbar puncture

Question 16

What position should the patient be in when taking a lumbar puncture?

Answer 16

Lateral recumbent position

Question 17

Which vertebral level is a lumbar puncture taken at?

Answer 17

L4-5

Question 18

What is the normal cause of hydrocephalus?

Answer 18

Abnormal CSF absorption

Question 19

What are the two types of hydrocephalus caused by abnormal CSF absorption?

Answer 19

Obstructive hydrocephalus
Communicating hydrocephalus

Question 20

What happens in obstructive hydrocephalus?

Answer 20

There is a block within the ventricular system causing obstruction of free fluid outlfow.

Question 21

What happens in communicative hydrocephalus?

Answer 21

Defect in the CSF reabsorption by the arachnoid granulations

Question 22

Apart from abnormal CSF absorption, what else can cause hydrocephalus?

Answer 22

Overproduction of CSF

Question 23

Give an example of an individual who might overproduce CSF.

Answer 23

Those with choroid plexus papilloma’s, a type of tumour

Question 24

What are some of the most common congenital causes of hydrocephalus?

Answer 24

Spina bifida, more specifically, myelomeningocele
Primary aqueduct stenosis
Dandy Walker Malformation

Question 25

What is the most general cause of hydrocephalus?

Answer 25

Infection

Question 26

After which incident may hydrocephalus be more likely to occur?

Answer 26

Post-haemorrhagic

Question 27

Give an example of something which can cause obstructive hydrocephalus.

Answer 27

Tumour of brain

Question 28

What are the signs and symptoms of hydrocephalus in older children and adults?

Answer 28

Increased intra-cranial pressure Gait changes Upgaze Papilledema Headache Gaze palsy

Question 29

What are the signs and symptoms of hydrocephalus in young children?

Answer 29

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

Question 30

Which investigations are used to identify hydrocephalus?

Answer 30

-> fundoscopy to check for papilledema ->CT -> MRI, much more detailed

Question 31

Which type of imaging is used when dealing with a small baby with suspected hydrocephalus?

Answer 31

Ultrasound

Question 32

What is the treatment for communicating hydrocephalus?

Answer 32

Lumbar puncture Lumbar drain

Question 33

What is the treatment for obstructive hydrocephalus?

Answer 33

External ventricular drain ->these patients tend to be more unwell hence why a lumbar puncture/drain are not as safe

Question 34

What will be carried out if someone needs a permanent diversion of excess CSF due to obstructive hydrocephalus?

Answer 34

Endoscopic third ventriculostomy

Question 35

What will be carried our if a patient requires permanent diversion of CSF due to communicating hydrocephalus?

Answer 35

VP shunt (ventriculo-pertioneal shunt)