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Brain and behavior > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

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1
Q

Functions of CSF

A

Prevent contact between delicate neural structures. Support the brain. Transport nutrients, chemical messengers, and waste products. Transduce hormones.

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2
Q

Is choroid permeable?

A

No, but other ependymal lining is permeable.

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3
Q

What is CSF derived from?

A

Blood plasma

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4
Q

CSF comparison to blood plasma

A

CSF has higher concentrations of Cl, Mg, Na.

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5
Q

How is NaCl transported into ventricles? Large molecules?

A

NaCl= Active transport, water passively follows. Large molecules = pinocytotic vesicles from basal to apical epithelial surface, then into CSF.

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6
Q

Average volume of CSF?

A

120mL

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7
Q

Average production of CSF/day?

A

450-500mL.

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8
Q

CSF Pathway

A

Lateral ventricle, through interventricular foramen of Monro into 3rd ventricle, then through the Cerebral aqueduct of Sylvius, into the 4th ventricle, then into subarachnoid cistern through foramina of Luschka and foramen of Magendie.

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9
Q

Arachnoid Villi

A

Pressure-dependent one way valves that open into dural sinuses when ICP is 3-5 cm H2O greater than dural venous pressure.

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10
Q

Does CSF production use ATP?

A

Yes, but reabsorption is passive.

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11
Q

How does CSF move?

A

Subtle pressure gradient between production and reabsorption sites. Mechanical movement due to brain shifting/arterial pulsations.

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12
Q

CSF constituents

A 
50-180 mm H2O, 
15-45 mg/dl protein, 
50-80 mg glucose (2/3 of blood glucose), 
0-5 mononuclear cells,
1 wbc/700rbc
1dl protein/1000 rbc
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13
Q

Complications of lumbar puncture

A

Low-pressure headache, herniation syndromes, infection

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14
Q

Where is BBB not intact?

A

Portions of hypothalamus (to expose it to hormones), pineal gland (to allow secretions into circulation), choroid plexus

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15
Q

Symptoms of hydrocephalus

A

headache, nausea, vomiting, papilladema, diplopia, lethargy, coma

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16
Q

Communicating hydrocephalus pathogenesis

A

Caused by problems in CSF reabsorption. Causes ventricular system to dilate, ICP rises.

17
Q

Causes of communicating hydrocephalus

A

Absence of arachnoid villi, blockage by RBCs due to subarachnoid hemorrhage, high protein in CSF (caused by CNS tumors or inflammation), infection (meningitis)

18
Q

Signs of communicating hydrocephalus

A

Huge head in young kids, people whose sutures have fused present with symptoms.

19
Q

Choroid Plexus tumors cause?

A

Oversecretion of CSF, causing HC. Extremely rare– in most cases HC caused by reabsorption issues.

20
Q

When do choroid plexus papillomas/carcinomas occur?

A

Between birth and 10 years.

21
Q

Where do most choroid tumors occur?

A

4th ventricle (40-50%)

22
Q

Hydrocephalus ex vacuo

A

Not a true hydrocephalus. Brain atrophy makes ventricles appear large in comparison to grey/white matter. Treatment not indicated.

23
Q

Normal Pressure Hydrocephalus

A

Rare preventible cause of dementia. Wet wacky wobbly. Wet improves first, wacky improves last.

24
Q

What improves prognoses for NPH?

A

If symptoms haven’t been present for that long. Treat with VP shunt.

25
Q

Noncommunicating (Obstructive) Hydrocephalus Pathogenesis

A

Mass blocks the outflow of CSF (intraventricular bleed too causes rapid decline).

26
Q

NCHC Etiologies

A

Aqueductal stenosis, masses, cysts, infection, hemorrhage

27
Q

Ependyoma

A

5-6% of all glial cell neoplasms. 60-75% are found in posterior fossa, but some in spinal cord. In children under 5.

28
Q

Infra vs supratentorial ependyoma symptoms

A

Infratentorial can cause CN palsies, both causes HC symptoms (NV, etc).

29
Q

Is congenital HC genetic?

A

It can be! But can be caused by intrauterine infection/birth trauma.

30
Q

What causes aqueductal stenosis

A

Pineoblastoma/meningioma.

31
Q

Treatment of NCHC

A

remove mass–shunt can sometimes be avoided.

32
Q

Use of external ventricular drain

A

Can’t be maintained, not permanent.

33
Q

3rd ventriculostomy

A

Open floor of 3rd ventricle to basal cisterns.

34
Q

Frequent complication of lumbar-peritoneal shunt?

A

Overdrainage

35
Q

Pseudotumor cerebri

A

AKA idiopathic intracranial hypertension. Frequently seen in obese women of child-bearing age and in persons with chronic renal failure. Headache and visual disturbances due to papilledema. Also can be related to vitamin A deficiency. Increase in ICP, but without accompanying evidence on CT.

36
Q

What can cause pseudotumor cerebri?

A

Overweight women, chronic renal failure, endocrinopathies, vitamin A deficiency.

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