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Neurology > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

1
Q

What is CSF

A

clear fluid found in ventricles and subarachnoid space

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2
Q

How much CSF will ventricles normally contain?

A

25 ml in each

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3
Q

What cells produce CSF?

A
  • modified ependymal cells
  • which form the choroid plexus
  • can also arise from interstitial fluid
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4
Q

What are the constituents of CSF?

A
  • very similar biochemistry to blood
  • far fewer proteins or WBC
  • increased Mg
  • decreased Ca
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5
Q

Where is the choroid plexus located?

A
  • lateral ventricles

- not in third or fourth

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6
Q

What drug can reduce CSF production?

A
  • acetazolamide (carbonic anhydrase inhibitor)
  • remifentanil
  • noradrenaline
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7
Q

What can increase CSF production?

A
  • volatile anaesthesic agenst
  • NO
  • hypercapnoea (CO2 retention)
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8
Q

What is the function of CSF?

A
  • provides buoyancy to lighten weight of brain
  • protects from acc/dec injuries
  • removes waste from brain
  • forms pressure buffer to reduce brains impact on ICP
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9
Q

Where does CSF drain after the fourth ventricle?

A
  • cisterns then through arachnoid granulations into dural venous sinuses
  • carried in venous blood and recycled
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10
Q

How does flow of CSF depend on pressure?

A
  • raised ICP means increased flow of CSF

- raised venous pressure can get back flow from venous sinsuses

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11
Q

What is Hydrocephalus?

A

increase in CSF in the head which results in increased ICP

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12
Q

When is hydrocephalus most common?

A
  • birth (often treated before birth)

- patients with Spina Bifida

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13
Q

What can hydrocephalus result in if untreated?

A

neurological deficits and cognitive disorders

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14
Q

What are the causes of hydrocephalus?

A
  • Communicating blockage
  • Non-communicating blockage
  • Congenital
  • Acquired
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15
Q

What is the difference between communicating and non-communicating blockages?

A

Communicating - blockage to CSF resorption in arachnoid granulations/overproduction
Non-communicating - blockage within pathway

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16
Q

What are examples of congenital and acquired causes of hydrocephalus?

A

Congenital - spina bifida or aqueduct stenosis

Acquired - infection, tumour or subarachnoid haemorrhage

17
Q

How does hydrocephalus present in infants?

A
  • macrocrania (larger skull)
  • recurrent vomiting
  • abnormal cry
  • recurrent apneoa
  • bradycardia
  • sunsetting eyes/gaze (late sign)
18
Q

How does hydrocephalus present in children/adults?

A
  • headache
  • vomiting
  • confusion
  • diplopia/CN palsy (usually CN6)
  • ataxia/dementia
  • bradycardia/hypertension
19
Q

What investigations should be done for hydrocephalus?

A
  • fundoscopy check for papilloedema

- CT or MRI of brain

20
Q

What does each colour on a CT scan if brain show?

A 
white = bone
Grey = brain tissue
black = CSF
21
Q

What other problems can present on a brain CT that looks like hydrocephalus?

A
  • Scan can show enlarged ventricles that look like hydrocephalus which can just be due to the brains atrophy as we age
  • idiopathic intracranial hypertension (seen in young, obese females)
22
Q

What problem can occur when shunt used to treat hydrocephalus in infants?

A
  • shunt can become blocked

- but CT scan can still show reduction in ventricle size as ventricles lose their compliance

23
Q

How is hydrocephalus treated?

A
  • Ventricular shunt

- Endoscopic Third Ventriculostomy (ETV)

24
Q

What is a ventricular shunt?

A

catheter which is put into drain CSF from ventricles either out the body or to another area in the body outside the head (usually abdomen)

25
Q

What are the locations ventricular shunts can drain into?

A
  • External drain (drains out body)
  • Peritoneum
  • Atria
  • Pleural space
26
Q

How does ETV work and what should you be cautious of?

A
  • pass an endoscope in through lateral ventricles and drain CSF
  • must be careful to not damage basilar artery
27
Q

What is the most common cause of posterior fossa stroke?

A

cardiac emboli

28
Q

blockage of what blood vessel will cause posterior fossa stroke?

A

basilar

29
Q

What is the treatment for supratentorial infarction?

A
  • brain will swell

- to reduce pressure can remove part of the skull to allow brain to swell

Neurology (53 decks)

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