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The Nervous System: Pathology > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

1
Q

What is hydrocephalus

A

Excess cerebro-spinal fluid within the intracranial space leading to dilation and ventricles and increased intracranial pressure

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2
Q

What is the tow distinctions of hydrocephalus

A

Communicating hydrocephalus

Non Communicating hydrocephalus

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3
Q

What is the pathology of communicating hydrocephalus

A

Problem with CSF re-absorbtion
(production> reabsorption)

Overproduction of CSF

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4
Q

What is the main pathology of communicating hydrocephalus

A

Problem with CSF reabsorption - as cannot keep the pace of CSF production

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5
Q

What is cause of overproduction go CSF leading to communicating hydrocephalus

A

Choroid plexus papillomas

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6
Q

What is the signs and symptoms of communicating hydrocephalus in a child whose sutures have not yet fused

A

there is disproportional increase in head circumference compared to the rest of the face/body

Failure to thrive

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7
Q

What causes the sighs and symptoms of hydrocephalus in children with fused sutures and adults

A

The increased intracranial pressure

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8
Q

What is the signs and symptoms of adults with communicating hydrocephalus

A

Papilledema

Headache

Nausea/vomiting

Up gaze difficulty

gait disturbance

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9
Q

What is the aetiology of communicating hydrocephalus

A

Infection
Subarachnoid haemorrhage
Post-operative
Head trauma

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10
Q

What infection has a high incidence of hydrocephalus

A

Meningitis

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11
Q

How does subarachnoid haemorrhage lead to acute communicating hydrocephalus

A

Blood and blood breakdown products cause scarring of arachnoid granulation

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12
Q

Why would acute communicating hydrocephalus where is CSF reabsorption is significantly and suddenly reduced present as an emergency

A

The neurological decline is rapid

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13
Q

What can be seen in emergency communicating hydrocephalus

A

patients presents as sleep then obtunded then requiring intubation

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14
Q

What occurs in non communicating hydrocephalus

A

Occurs whenever there is any physical obstruction to normal flow of CSF before it leaves the ventricles

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15
Q

What is the pathology of non communicating hydrocephalus

A

Obstruction likely to come acutely as results from CSF follow obstruction at any point along the intra-ventricular pathway

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16
Q

What is the causes of non communicating hydrocephalus

A

Aqueductal stenosis

Tumours/cancers/masses
Cysts

Infection

Haemorrhage

hematoma

Congenital malformation

17
Q

How is hydrocephalus investigated

A

Radiography

CT/MRI

18
Q

What are the early signs seen in radiography of hydrocephalus

A

dilation of temporal horns of the lateral ventricles

19
Q

What can be seen in radiography of hydrocephalus

A

Third ventricle becomes ballooned

Lateral ventricle size increases

Peripheral sulci erased

20
Q

What diagnostic techniques shows ventriculmomegaly has occurred in a radiography of hydrocephalus

A

Evans ratio - the ratio of the maximum width of the anterior horns of the lateral ventricles to the maximum width of the calvarium at the same level of the foramen mono

if greater than 0.3 `(30%) = venticulomegaly

21
Q

What is the surgical treatment for emergency acute hydrocephalus

A

External ventricular drain

22
Q

What is the problems with external ventricular drain

A

Cannot be maintained indefinitely

Some patients unable to tolerate weaning/clamping of EVD prior to removal

Infection risk is high

23
Q

What is the treatment of communicating hydrocephalus

A

Shunt placement

  • ventriculoperitoneal
  • lumbar peritoneal
  • ventriculoatrial (if peritoneal failure)
24
Q

When would patients be given a permanent shunt placement

A

If patient cannot tolerate EVD

Weeks or months after EVD

25
Q

What is the most frequent shunt

A

Ventroperitoneal

26
Q

What is the problem with lumbar peritoneal

A

Overdrainage

27
Q

The indecent of shunt failure is high, what is the common causes

A

Mechanical failure from occlusion

disconnection migration

Overdrainage/underdrainage

Infection

skin erosion

28
Q

What is a sign of shunt failure

A

Headache (always investigate)

29
Q

What is the three treatment options for non communicating hydrocephalus

A

Removal of obstructive lesson

Shunt placement

Third ventriculostomy

30
Q

What is often performed in junction with third ventriculostomy

A

Ventriculoperitoneal shunt

31
Q

What occurs in third ventriculostomy

A

Hole is opened in floor of third ventricle so CSF flows out into the interperduncular cistern and pre-pontine space by passing cerebral aqueduct

32
Q

What is a rare preventable and/or reversible cause of dementia

A

Non pressure hydrocephalus

33
Q

What is the classic triad of non pressure hydrocephalus

A

WET- Urinary incontinence

WOBBY - Gait disturbance (wide stance, short and shuffle steps)

WACKY - rather quickly progressive dementia

34
Q

What are the investigation of non pressure hydrocephalus

A

CT/MRI

Gait assessment

Mini-mental state examination

Lumpar puncture

35
Q

What occurs with lumbar puncture and normal pressure hydrocephalus

A

Symptoms improve with CSF removal

36
Q

What is the common treatment for non pressure hydrocephalus

A

Ventricoperitoneal shunt

37
Q

what is the order of improvement in symptoms in the treatment of non pressure hydrocephalus

A

Most likely symptoms to improve Gait > incontinence> memory

38
Q

Why is it important to have an early diagnosis of non pressure hydrocephalus

A

Chance of outcome is improved if symptoms have been present for shorter periods of time so failure to recognise delays treatment and lessens their chances

39
Q

What is non pressure hydrocephalus usually diagnosed as and how is this a problem

A

Many patients with NPH to be diagnosed with alzheimers or age related dementia. therefore never seek treatment

The Nervous System: Pathology (25 decks)

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