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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
Which conditions are associated with benign intracranial hypertension?
``` Obesity (especially in young females) Sleep apnoea Hypothyroidism Addison's disease SLE Steroid withdrawal ```
26
What clinical signs would you look for in benign intracranial hypertension?
Papilloedema Constriction of visual fields Loss of visual acuity
27
What symptoms would you look for in benign intracranial hypertension?
Headaches | Visual losses
28
How is benign intracranial hypertension diagnosed?
LP showed increased CSF pressure | Normal CT/MRI
29
What are the main management options for benign intracranial hypertension? What is first line?
``` Acetazolamide Diuretics LP VP shunt WEIGHT LOSS - 1ST LINE ```
30
What is the main side effect of acetazolamide?
Tingling in peripheries
31
What is spontaneous intracranial hypotension?
Low pressure in brain cavity due to CSF leak
32
What are the symptoms of spontaneous intracranial hypotension?
``` Orthostatic headaches (relieved when horizontal) Neck/arm pain Diplopia/VF defects Dizziness Muffed hearing Galactorrhea Impaired sphincter control ```
33
How is spontaneous intracranial hypotension diagnosed?
MRI Spinal MRI LP (low pressure) CT/ isotope myelography
34
How is spontaneous intracranial hypotension managed?
Conservative - bed rest, fluids, analgesics Epidural blood patches Surgical repair
35
What is the aetiology of spontaneous intracranial hypotension?
Idiopathic Collagen disorders Dural diverticula Trauma
36
What sign would you look for on MRI, that would suggest spontaneous intracranial hypotension?
Meningeal enhancement
37
What is syringomyelia?
Cyst in spinal cord (syrinx) expands over time to compress/ damage spinal cord
38
What are the classifications of syringomyelia?
Craniovertebral junction Spinal canal Idiopathic
39
What are the clinical signs of syringomyelia?
``` Dissociated sensory loss Cuts and burns on hands Small muscle wasting Clawed hands Loss of UL reflexes and increased LL reflexes ```
40
What classical signs would suggest there is a hindbrain hernia present, in association with a syrinx?
``` Headache following valsalva Visual disturbances Dizziness Hearing loss/ tinnitus Dysarthria/ dysphasia SOmatic sensory disturbances ```
41
Which clinical condition is associated with syrinx at the craniovertebral junction?
Sleep apnoea
42
What is the management options for syringomyelia?
Open up obstructed CSF channels (decompression, laminectomy, duroplasty) Drain syrinx cavity Lower CSF pressure Conservative management
43
What is papilloedema?
Optic disc swelling due to raised ICP
44
What are the clinical features of papilloedema and how does it look on fundoscopy?
Symptoms of raised ICP (morning headache, N+V, tinnitus, reduced consciousness) Transient LOV (only a few seconds) Increased blind spot Hyperaemic blurred disc
45
What are the main clinical signs of acquired hydrocephalus?
``` Morning headache Vomiting Diplopia Impaired upgaze Papilloedema Drowsy Incontinent Gait abnormality ```

Y3 NEUROLOGY (22 decks)

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