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Y3 NEUROLOGY > Disorders of Intracranial Pressure > Flashcards

Disorders of Intracranial Pressure Flashcards

1
Q

What level of ICP (mmHg) would be classed as abnormally high?

A

15

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2
Q

How much CSF do we produced each day?

A

1 pint

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3
Q

Which medication can reduce the amount of CSF we produce per day by 50%?

A

Acetazolamide

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4
Q

CSF is produced by the ____ and absorbed by ____

A

Choroid plexus

Arachnoid granulations

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5
Q

What factors create a resistance to CSF outflow?

A

Arachnoid granulations

Sagittal sinus pressure

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6
Q

What are the main functions of CSF?

A

Allow buoyancy of the brain
Adapt to changes in vascular volumes
Provide micronutrients and take away waste

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7
Q

What are the clinical signs of hydrocephalus from birth?

A 
Large head
Thin and shiny scalp with visible veins
Bulging or tense fontanelle
Downward looking eyes (sunsetting)
Macewan sign (cracked pot on head percussion)
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8
Q

How is hydrocephalus diagnosed in newborns?

A

US

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9
Q

Which symptoms in a newborn, can occur as a result of hydrocephalus?

A 
Poor feeding
Irritability
Vomiting
Sleepiness
Muscle stiffness and spasms in lower limbs
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10
Q

What is the main management option for hydrocephalus?

A

VP shunt

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11
Q

A VP shunt, once inserted, lasts a lifetime. True/ False?

A

False

Most need revising in 10 years time

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12
Q

What are some complications of VP shunts?

A

OVERDRAINAGE: Acute subdural haematoma
Slit ventricles
UNDERDRAINAGE: Blockage
Displaced catheter
INFECTION

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13
Q

What are the classifications of hydrocephalus?

A

Communicating: occurs when the flow of CSF is blocked after it exits the ventricles.

Obstructive: occurs when the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles.

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14
Q

What are the common causes of paediatric hydrocephalus?

A 
CONGENITAL
ACQUIRED
Trauma
Infection (post-meningitis)
Tumour
Haemorrhage
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15
Q

What signs in a patient would be suggestive of a blocked shunt?

A 
Headache
Vomiting
Sunsetting in children
Lack of upgaze in adults
Blurred vision (PAPILLOEDEMA - PRESSURE ON CN2)
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16
Q

What investigation MUST be carried out if a blocked shunt is suspected?

A

CT head to indicate hydrocephalus

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17
Q

Which surgical procedure can be used as an alternative to VP shunt?

A

Endoscopic 3rd ventriculostomy (bypasses blockage)

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18
Q

What is normal pressure hydrocephalus?

A

Enlarged cerebral ventricles with normal ICP

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19
Q

Who is most likely to get normal pressure hydrocephalus?

A

Elderly people

20
Q

What is the triad of signs found in normal pressure hydrocephalus?

A

Ataxia (shuffling gait)
Memory decline (dementia)
Urinary incontinence

21
Q

How is NPH diagnosed?

A 
CT/MRI
Tracer diffusion studies
ICP measurement
LP 'tap test' 
Lumar drainage tests
Infusion studies
22
Q

What is the aetiology of NPH?

A

Idiopathic

Post-inlfammatory - subarachnoid haemorrhage, meningitis, trauma, craniotomy

23
Q

What differential diagnoses should be considered in NPH?

A

Dementia - alzheimers, vascular

Ataxia - cerebellar, myopathy

24
Q

What is benign intracranial hypertension?

A

Normal sized ventricles with increased ICP (‘Slit-like ventricles’)

25
Q

Which conditions are associated with benign intracranial hypertension?

A 
Obesity (especially in young females)
Sleep apnoea
Hypothyroidism
Addison's disease
SLE
Steroid withdrawal
26
Q

What clinical signs would you look for in benign intracranial hypertension?

A

Papilloedema
Constriction of visual fields
Loss of visual acuity

27
Q

What symptoms would you look for in benign intracranial hypertension?

A

Headaches

Visual losses

28
Q

How is benign intracranial hypertension diagnosed?

A

LP showed increased CSF pressure

Normal CT/MRI

29
Q

What are the main management options for benign intracranial hypertension? What is first line?

A 
Acetazolamide
Diuretics
LP
VP shunt
WEIGHT LOSS - 1ST LINE
30
Q

What is the main side effect of acetazolamide?

A

Tingling in peripheries

31
Q

What is spontaneous intracranial hypotension?

A

Low pressure in brain cavity due to CSF leak

32
Q

What are the symptoms of spontaneous intracranial hypotension?

A 
Orthostatic headaches (relieved when horizontal)
Neck/arm pain
Diplopia/VF defects
Dizziness
Muffed hearing
Galactorrhea
Impaired sphincter control
33
Q

How is spontaneous intracranial hypotension diagnosed?

A

MRI
Spinal MRI
LP (low pressure)
CT/ isotope myelography

34
Q

How is spontaneous intracranial hypotension managed?

A

Conservative - bed rest, fluids, analgesics
Epidural blood patches
Surgical repair

35
Q

What is the aetiology of spontaneous intracranial hypotension?

A

Idiopathic
Collagen disorders
Dural diverticula
Trauma

36
Q

What sign would you look for on MRI, that would suggest spontaneous intracranial hypotension?

A

Meningeal enhancement

37
Q

What is syringomyelia?

A

Cyst in spinal cord (syrinx) expands over time to compress/ damage spinal cord

38
Q

What are the classifications of syringomyelia?

A

Craniovertebral junction
Spinal canal
Idiopathic

39
Q

What are the clinical signs of syringomyelia?

A 
Dissociated sensory loss
Cuts and burns on hands
Small muscle wasting
Clawed hands
Loss of UL reflexes and increased LL reflexes
40
Q

What classical signs would suggest there is a hindbrain hernia present, in association with a syrinx?

A 
Headache following valsalva
Visual disturbances
Dizziness
Hearing loss/ tinnitus
Dysarthria/ dysphasia
SOmatic sensory disturbances
41
Q

Which clinical condition is associated with syrinx at the craniovertebral junction?

A

Sleep apnoea

42
Q

What is the management options for syringomyelia?

A

Open up obstructed CSF channels (decompression, laminectomy, duroplasty)
Drain syrinx cavity
Lower CSF pressure
Conservative management

43
Q

What is papilloedema?

A

Optic disc swelling due to raised ICP

44
Q

What are the clinical features of papilloedema and how does it look on fundoscopy?

A

Symptoms of raised ICP (morning headache, N+V, tinnitus, reduced consciousness)
Transient LOV (only a few seconds)
Increased blind spot
Hyperaemic blurred disc

45
Q

What are the main clinical signs of acquired hydrocephalus?

A 
Morning headache
Vomiting
Diplopia
Impaired upgaze
Papilloedema
Drowsy
Incontinent
Gait abnormality

Y3 NEUROLOGY (22 decks)

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