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Year Two - Neurology System > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

1
Q

What is hydrocephalus?

A

It is defined as an abnormal increase in the volume of cerebrospinal fluid (CSF) within the ventricular system of the brain

This increase in volume results in increased intracranial pressure within the cranium, which can cause irreversible damage to brain tissue

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2
Q

What are the three classifications of hydrocephalus?

A

Non-communicating hydrocephalus

Communicating hydrocephalus

Normal pressure hydrocephalus

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3
Q

What is another term for non-communicating hydrocephalus?

A

Obstructive hydrocephalus

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4
Q

What is non-communicating hydrocephalus?

A

It is defined as an accumulation of CSF due to an obstruction of CSF outflow

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5
Q

At four locations does non-communicating hydrocephalus tend to occur within the ventricular system?

A

Interventricular foramen

Cerebral aqueduct

Median apertures of the fourth ventricle

Lateral apertures of the fourth ventricle.

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6
Q

What are the three causes of non-communicating hydrocephalus?

A

Brain Tumours

Brain Cysts

Congenital Aqueduct Stenosis

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7
Q

What is congenital aqueduct stenosis?

A

It is narrowing of the cerebral aqueduct in the ventricular system, which usually allows CSF to flow from the third to the fourth ventricle

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8
Q

What brain tumours are most commonly associated with non-communicating hydrocephlaus?

A

Posterior fossa tumours

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9
Q

What is another term for communicating hydrocephalus?

A

Non-obstructive hydrocephalus

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10
Q

What is communicating hydrocephalus?

A

It is defined as an accumulation of CSF due to reduced absorbance into the dural venous sinuses

This is as a result of functional impairment of the arachnoid villi

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11
Q

What are the four causes associated with communicating hydrocephalus?

A

Infective Meningitis

Subarachnoid Haemorrhages

Spina Bifida

Dandy-Walker Syndrome

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12
Q

What is spina bifida?

A

It is a condition in which a baby’s spine and spinal cord doesn’t develop properly in the womb, resulting a gap in the spine

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13
Q

What form of spina bifida is most commonly associated with communicating hydrocephalus?

A

Myelomeningocele

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14
Q

What is myelomeningocele?

A

It is the most severe type of spina bifida, in which the baby’s spina canal remain open along several vertebrae in the back allowing the spinal cord and protective membranes around it to push out and form a CSF-filled sac

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15
Q

What is Dandy Walker malformation?

A

It is a condition in which there is atresia of the foramina of Luschka and the foramina of Magendie, which usually allow CSF to escape from the fourth ventricle into the subarachnoid space to be reabsorbed

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16
Q

What is atresia?

A

It means that a body part that is tubular in nature does not have a normal opening, or lacks the ability to allow material to pass through it

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17
Q

What is normal pressure hydrocephalus (NPH)?

A

It is defined as an accumulation of CSF due to reduced absorption at the arachnoid villi

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18
Q

Which age group tend to be affected by normal pressure hydrocephalus?

A

> 60

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19
Q

What are the triad of clinical features associated with normal pressure hydrocephalus?

A

Urinary incontinence

Dementia

Gait abnormality

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20
Q

Why is it important to differentiate between dementia and normal pressure hydrocephalus?

A

The clinical features of normal pressure hydrocephalus can be reversed with appropriate treatment

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21
Q

What are the four causes associated with normal pressure hydrocephalus?

A

Brain Injury

Stroke

Subarachnoid Haemorrhage

Meningitis

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22
Q

How does normal pressure hydrocephalus present on neurogimaging?

A

Ventriculomegaly in the absence, or out of porportion to, sulcal enlargement

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23
Q

What are the five clinical features of hydrocephalus in infants?

A

Large Cranial Circumference

Fontanel Development

Dilated Scalp Veins

Sunset Sign

Seizures

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24
Q

What is a fontanel?

A

It is a bulging or tense soft spot on the top of the head

25
Q

What is the sunset sign?

A

It describes the presentation of the patients’ eyes pointing downwards with upper eyelids retracted

26
Q

What are the six clinical features of hydrocephalus in adults?

A

Headaches

Diplopia

Nausea & Vomiting

Confusion

Coordination Issues

Urinary Incontinence

27
Q

What type of headaches are associated with hydrocephalus? Why?

A

Morning headaches

This is due to a prolonged period of supine lying

28
Q

What are the four investigations used to diagnose hydrocephalus?

A

MRI Scan

CT Scan

Ultrasound Scan

Lumbar Puncture

29
Q

What is the gold standard imaging technique used to diagnose hydrocephalus?

A

MRI scan

30
Q

What are the three signs of hydrocephalus on an MRI scan?

A

Ventricle enlargement

Loss of sulcal gyral pattern

CSF exudation from the ventricles

31
Q

In what other way can MRI scans be used to investigate hydrocephalus?

A

They can be used to identify if there are any underlying causes

32
Q

What are the three signs of hydrocephalus on a CT scan?

A

Ventricle enlargement

Loss of sulcal gyral pattern

CSF exudation from the ventricles

33
Q

When are ultrasound scans used to diagnose hydrocephalus?

A

Antenatally

34
Q

What are the three signs of hydrocephalus on an ultrasound scan?

A

Enlarged ventricles

Parenchymal thinning

Dangling choroid sign

35
Q

What is the dangling choroid sign?

A

This is when the choroid is seen floating within the ventricle, specifically a separation of more than 3mm between the choroid plexus and the margin of the ventricle is considered abnormal

36
Q

What is a lumbar puncture?

A

It involves obtaining a sample of CSF by inserting of a needle into the subarachnoid space of the spinal cord, specifically between L3 and L4 vertebrae

37
Q

How are lumbar punctures used to investigate hydrocephalus?

A

They allow the pressure of the CSF sample to be obtained

In addition, they provide symptomatic benefit

38
Q

What MUST be conducted prior to a lumbar puncture? Why?

A

CT scan

This is to determine the classification of hydrocephalus that the patient has

This is due to the fact that it lumbar punctures are only deemed as an appropriate investigation in individuals with communicating hydrocephalus and normal pressure hydrocephalus, however contraindicated in non-communicating hydrocephalus

39
Q

Why are lumbar punctures contraindicated in individuals who have non-communicated hydrocephalus?

A

This is due to the fact that non-communicating hydrocephalus is associated with a raised intracranial pressure and reduced spinal cord pressure, which means that a lumbar puncture procedure could result in a pressure gradient that could compresses the brain into the foramen magnum

40
Q

When is pharmacological management of hydrocephalus used?

A

It is used as a second line treatment option in an acute setting

41
Q

What is the aim of pharmacological management of hydrocephalus?

A

To delay surgical intervention

42
Q

What drug class is used to treat hydrocephalus?

A

Loop diuretics

43
Q

What three loop diuretics can be used to treat hydrocephalus?

A

Furosemide

Acetazolamide

Isosorbide

44
Q

How do furosemide and acetazolamide treat hydrocephalus?

A

They decrease the CSF secretion by the choroid plexus

45
Q

How does isosorbide treat hydrocephalus?

A

It increases CSF reabsorption

46
Q

What are the four surgical management options for hydrocephalus?

A

Lumbar drain

Extraventricular drain

Shunting

Endoscopic third ventriculosotomy

47
Q

What is a lumbar drain?

A

It is a procedure that involves removal of CSF from the ventricular system through inserting of a tube into the subarachnoid space of the spinal cord, specifically between L3 and L4 vertebrae

48
Q

When two classifications of hydrocephalus can be treated with a lumbar drain?

A

Communicating hydrocephalus

Normal pressure hydrocephalus

49
Q

What is an external ventricular drain?

A

It involves the insertion of a catheter into the frontal lobe of the brain where the lateral ventricles are situated, enabling drainage of CSF into an external collecting system

50
Q

When do we use external ventricular drains to treat hydrocephalus?

A

It is the first line treatment option of hydrocephalus in an acute setting and is a temporary measure

51
Q

What is shunting?

A

It involves the insertion of a valved tube into one of the brain’s ventricles and tunnelling it to another region of the body where the excess fluid can be more easily absorbed

52
Q

In which two regions of the body do we shunt CSF to?

A

Abdominal peritoneum

Right atrium

53
Q

What are the two types of shunts?

A

VP shunt

VA shunt

54
Q

What is a VP shunt?

A

It is a shunt in which CSF circulates from the cerebral ventricles to the peritoneal cavity

55
Q

What is a VA shunt?

A

It is a shunt in which CSF circulates from the cerebral ventricles to the right atrium

56
Q

What is first line a VP or VA shunt?

A

VP

57
Q

What are the three complications associated with shunts?

A

Infections

Intracerebral haemorrhages

Seizures

58
Q

What is endoscopic third ventriculostomy (ETV)?

A

It is a procedure that involves the formation of a hole in the bottom of one of the ventricles or between ventricles to enable CSF to flow out of the brain

59
Q

What classification of hydrocephalus can be treated with ETV?

A

Non-communicating hydrocephalus

Year Two - Neurology System (25 decks)

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