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Neurology > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

1
Q

What is hydrocephalus

A

Group of disorders resulting in excess CSF within the intracranial cavity

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2
Q

Two types of hydrocephalus

A

Obstructive and communicating

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3
Q

What is primary hydrocephalus

A

Any disorder where the accumulationof CSF is accompanied by raised ICP

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4
Q

Three main caues of primary hydrocephalus

A

Obstruction to CSF flow, impaired absorption at arachnoid villi or excess CSF production by choroid plexus

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5
Q

Examples of what can cause primary hydrocephalus

A

Aqueductal stenosis, herniation, blood clot, inflammatory exudate, colloid cysts or tumours

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6
Q

What is secondary hydrocephalus

A

Compensatory as an increase in CSF follows loss of brain tissue, so no overall increase in the ICP

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7
Q

Causes of secondary hydrocephalus

A

Atrophy, infarction

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8
Q

Treatment of hydrocephalus

A

Inserting a ventricular shunt with one way valve to drain CSF

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9
Q

Where does the flow of CSF flow

A

2 lateral ventricles -> foramen of munro -> 3rd ventricle -> cerebral aqueduct -> 4th ventricle -> 2 lateral foramen of lushka or foraman Magendie -> spinal CSF space and around brain in subarachnoid space

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10
Q

Causes of obstructive hydrocephalus

A

Tumour, congenital, post-infectious, or post-haemorrhage

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11
Q

Important causes of obstruction in subarachnoid space

A

Subarachnoid haemorrhage, infection such as pyegenic meningitis, TB, cryptosporidium and carcinomatous meningitis

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12
Q

Congenital malformations causing obstructive hydrocephalus

A

aqueductal stenosis, Chiari II, Dandy-Walker syndrome

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13
Q

Which group of hydrocephalus patients should not have an LP

A

Obstructive

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14
Q

Causes of increased CSF production

A

Choroid plexus papilloma / carcinoma but this is rare

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15
Q

What do the ventricles look like on a MRI in obstructive hydrocephalus

A

Ventricle dilation

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16
Q

What happens in impaired absorption of CSF

A

Increased venous pressure, will cause decreased CSF absorption, and if there are no obstructions in the CSF pathways, it will cause a rise in intracranial pressure without ventricular dilation

17
Q

Examples of impaired absorption to CSF flow

A

Idiopathic intracranial hypertension and benign external hydrocephalus

18
Q

Features of congenital hydrocephalus

A

Increase in head circumference

19
Q

Late signs of congenital hydrocephalus

A

Cracked pot sound on percussion, sunsetting, atrophy of the optic nerves, lethargy, failure to thrive, vomiting, ophisthotonus and coma

20
Q

Features of adult hydrocephlus

A

Headache, vomiting, visual impairment, visual obscurations, drowsiness, coma

21
Q

What is Parinaud’s syndrome

A

Paralysis of upgaze, dilated pupils - fixed to light, retractile convergence nystagmus, lid retraction

22
Q

Features of normal pressure hydrocephalus

A

Triad of gait disturbance, urinary incontinence, and dementia

23
Q

Which category of patients does normal pressure hydrocephalus occur

A

Elderly

24
Q

How to investigate into normal pressure hydrocephalus

A

Lumbar tap, lumbar infusion test and/or lumbar drain - see if patient improves after removal of CSF

25
Q

Investigations into hydrocephalus

A

US through fontanelle, OFC as initial investigations in the neonate, but treatment will require CT and MRI

26
Q

What type of hydrocephalus should be treated

A

Only if it is sympatomatic

27
Q

Options for treatment of hydrocephalus

A

Remove obstruction, create new intracranial pathway, shunt, external ventricular drain

28
Q

How to treat hydrocephalus using intracranial pathway

A

With endoscopic third ventriculostomy (EVT) by making a hole in the floor of the fourth ventricle

29
Q

What is the preferred shunt to use

A

Venticle to peritoneal cavity (VP shunt)

30
Q

When is ETV used

A

If the obstruction is downstream to the 3rd ventricle and the lateral ventricles are large enough to introduce an endoscope

31
Q

Complications associated with VP shunts

A

Fracture, dislodge, disconnect, infection

32
Q

What is the usual cause of shunt infection

A

Coagulase negative staph

33
Q

Symptoms of failed/broken shunt

A

Raised ICP, blockage and fever, causing rapid decline

Neurology (21 decks)

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