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Neurology > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

1
Q

What is mean CSF pressure?

A

10 mmHg

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2
Q

A pressure value of _____ is abnormal

A

15 mmHg

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3
Q

What kind of rhythm is CSF secretion?

A

CIRCADIAN

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4
Q

Where is most CFS produced?

A

Choroid plexus

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5
Q

The production of CSF increases as you get older

A

FALSE - decreases

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6
Q

What drug reduces the secretion of CSF by 50%?

A

Acetazolamide

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7
Q

Resistance to outflow =

A

arachnoid granulations + sagittal sinus pressure

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8
Q

What drives CSF absorption?

A

ICP

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9
Q

Where is CSF absorbed?

A

Arachnoid granulations

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10
Q

What are the 2 main functions of CSF?

A

Buoyancy

Mediator of compliance

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11
Q

Describe buoyancy of CSF.

A

Reduces weight of brain by 95%

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12
Q

Describe the role of ‘mediator of compliance’.

A

Accommodates physiological changes in vascular volumes in the head by being displaced into the spinal canal

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13
Q

What are the 4 different classifications of hydrocephalus.

A
  • Infantile
  • Adult (acute/chronic)
  • Obstructive
  • Comminicating
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14
Q

I feel like this lecture is really annoying me?

A

Pie it off

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15
Q

Describe the signs of a blocked shunt in ADULTS

A
  • Headache + Vomiting
  • Lack of up-gaze
  • Blurred vision
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16
Q

What is the blurred vision in someone with a blocked shunt due to?

A

Papilloedema

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17
Q

What can the papilloedema result in suddenly?

A

BLINDNESS

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18
Q

Describe the signs of a blocked shunt in CHILDREN.

A

Sunsetting (infants eyes only look downward)

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19
Q

What will a CT of the head show in someone with a blocked shunt?

A

Hydrocephalus

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20
Q

What should be done urgently in someone with a blocked shunt?

A

Surgery to replace the shunt

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21
Q

Describe who gets ‘normal pressure hydrocephalus’,

A

ELDERY

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22
Q

What is the triad of symptoms in ‘normal pressure hydrocephalus’?

A
  • ATAXIA
  • MEMORY DECLINE
  • INCONTINENCE
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23
Q

What should you always do in someone who presents with the triad of symptoms of: ataxia, memory decline and incontinence?

A

CT

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24
Q

What time of the day is most CSF produced?

A

2am

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25
Q

What time of day is least CSF produced?

A

6pm

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26
Q

ON average, how much CSF is produced a day?

A

500 mrs

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27
Q

When does production of CSF decrease?

A

As we get older

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28
Q

Plexus secretion is __________ to CSF

A

Hypertonic

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29
Q

What is the main drug treatment for hydrocephalus?

A

Acetazolamide

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30
Q

What kind of process is CSF absorption?

A

Passive

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31
Q

What 2 things does CSF absorption rely on?

A
  • Intracranial pressure being greater than the pressure in the sagittal sinus
  • Resistance to outflow of CSF across the arachnoid granulations
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32
Q

What is CSF absortion diven by?

A

ICP

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33
Q

Raised ICP means you absorb more CSF

A

TRUE

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34
Q

Resistance to outflow =

A

arachnoid granulation + sagittal sinus pressure

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35
Q

Give examples of vitamins that CSF provides.

A

Vitamin C and thyroxine

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36
Q

Why can CSF cause dementia in old age?

A

As you get older your CSF doesn’t circulate as much, thus there is a build up of waste products in the brain, which could attribute to dementia

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37
Q

What 4 ways can hydrocephalus be classified?

A
  • Infantile
  • Adult – acute/chronic
  • Obstructive
  • Communicating
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38
Q

Describe the appearance of a baby with hydrocephalus.

A
  • Thin, shiny scalp with visible veins
  • Bulging fontanelle
  • Downward looking eyes – due to pressure of CSF on tectal plate
  • BIG HEAD
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39
Q

What do babies with hydrocephalus need?

A

A shunt

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40
Q

Outline some issues that congenital hydrocephalus of a baby can cause.

A
  • Poor feeding
  • Irritability
  • Vomiting
  • Sleepiness
  • Muscle stiffness + spasm in babies’ lower limbs
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41
Q

What kind of gaze do adults with hydrocephalus not have?

A

Upwards gaze

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42
Q

Why do adults with hydrocephalus not have an upwards gaze?

A

Due to pressure on the tectal plate

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43
Q

Describe prostitute sign.

A

Eyes accommodate to light but do not react

  • Seen in adults with hydrocephalus
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44
Q

List the various different options of valves which can be used in hydrocephalus

A
  • Fixed differential pressure
  • Adjustable
  • Antisyphon
  • Switch able
  • Constant flow
45
Q

After insertion of a valve, what percentage of people are satisfied?

A

80%

46
Q

What % of shunts are no longer functioning after 12 years?

A

80%

47
Q

List some common complications of shuts.

A
  • Overdrainage – acute subdural haematoma (SDH), slit ventricles (very small ventricles)
  • Under-drainage – blockage, displaced/disconnected catheter
  • Infection – use antibiotics or silver impregnanted shunts (use iodine)
48
Q

List some rare complications of shunts.

A
  • Intracerebral haemorrhage
  • Seizures
  • Craniosynostosis (premature ossification of sutures in a baby’s skull)
  • Dissemination of tumour cells
  • Umbilical fistula
  • Erosion into abdominal viscera
  • Ascites, hydrocele, inguinal hernia
  • Silicone allergies
49
Q

What can be used to prevents infections in a shunt?

A
  • Antibiotics
  • Silver impregnated shunts
  • Iodine
50
Q

What can happen if you get overdrainage of CSF from a shunt?

A
  • Actue subdural haematoma

* Slit ventricles (very small ventricles)

51
Q

Why might you get under-drainage from a CSF shunt?

A
  • Blockage

* Displaced or disconnected ventricle

52
Q

What should you ALWAYS ask a patient about if they present with symptoms of hydrocephalus?

A

Blurred vision

53
Q

What should be your management in someone with a suspected blocked shunt?

A

Do CT in someone with a blocked shunt, then call neurosurgery to replace the shunt

54
Q

What should you always ask someone with a suspected blocked shunt?

A

Have you had any blurred vision?

55
Q

Why is blurred vision worrying?

A

It is caused by papilloedema which can cause irreversible blindness

56
Q

List some signs + symptoms of someone with a blocked shunt.

A
  • Headache
  • Vomiting
  • Sunsetting in infants
  • Lack of upwards gaze in adults
  • BLURRED VISION
57
Q

If someone has a shunt, how can you check for infection?

A

Tap the shunt and send a sample to microbiology

58
Q

Describe ETV.

A

A surgical treatment for hydrocephalus

An opening is made in the floor of the 3rd ventricle using an endoscope and a burr hole

59
Q

What is a good alternative to a shunt?

A

ETV

60
Q

What is the difference between hydrocephalus and normal pressure hydrocephalus?

A

Normal pressure hydrocephalus develops much more slowly over time

61
Q

Describe ICP in normal pressure hydrocephalus

A

Normal or intermittently raised

62
Q

What is the triad of symptoms in normal pressure hydrocephalus?

A
  • Ataxia
  • Memory decline
  • Incontinence
63
Q

What Ix should you do in suspected normal pressure hydrocephalus?

A

CT scan

64
Q

Who usually gets normal pressure hydrocephalus?

A

Elderly people

65
Q

Why is it important to diagnose normal pressure hydrocephalus?

A

Because it is a reversible cause of dementia

66
Q

What are the 2 main causes of NPH?

A
  • Idiopathic

* Post-inflammatory – SAH, meningitis, trauma, craniotomy

67
Q

Describe dementia caused by NPH.

A
  • Delay in answering questions
  • Loss of spontaneity
  • May progress to akinetic mutism (someone that doesn’t move or speak)
  • Fluctuates in severity
  • Urinary incontinence
68
Q

Describe ataxia caused by NPH.

A
  • This proceeds all other symptoms
  • Difficulty rising from a chair
  • Tendency to fall backwards
  • Difficulty initiating gait
  • Broad based, shuffling gait
69
Q

Outline the Ix’s of NPH.

A
  • Clinical + CT
  • MRI
  • Tracer diffusion studies
  • ICP measurement
  • LP tap test
  • Lumbar drainage tests
  • Infusion studies
70
Q

What are the 2 different options for CSF diversion?

A
  • ‘Tap test’ LP

* Lumbar drain

71
Q

What should always be done with CSF diversion?

A

Measure NPH triad pre and post CSF drainage

72
Q

The treatment of NPH is via valves. Outline some of the various valves which can be used.

A
  • Anti syphon
  • Adjustable pressure
  • Combined
73
Q

Who typically gets IIH?

A

Young, obese, females

74
Q

Describe IIH.

A

Normal sized ventricles but raised ICP

75
Q

What are the 2 characteristic symptoms of IIH?

A

Headaches + visual loss

76
Q

What are the 3 characteristic signs of IIH?

A
  • Papilloedema
  • Constriction of visual fields
  • Loss of visual acuity
77
Q

What must you do if someone is going blind?

A

Shunt them

78
Q

Outline the Ix’s and results for IIH.

A
  • LP pressure > 25cm CSF
  • Normal CSF chemistry + cytology
  • Normal CT + MRI findings
  • No evidence of venous sinus thrombosis
79
Q

What is the no.1 treatment of IIH?

A

Weight loss

80
Q

What are the other treatment options for IIH?

A
  • Diuretics
  • Lumbar puncture
  • Lumbo- / ventriculo- peritoneal shunt
  • Optic nerve sheath fenestration
  • Subtemporal decompression
  • Venous stents
81
Q

List some complications of LP shunts.

A
  • Blockage
  • Infection
  • Nerve root irritation
  • Low pressure headaches
  • Subdural haemorrhage
  • Arachnoiditis
  • Tonsillar herniation
82
Q

What is spontaneous intracranial hypotension?

A

The amount of pressure inside the skull is lower than normal and thus CSF levels are lower too

83
Q

Outline symptoms of spontaneous intracranial hypotension.

A
  • Orthostatic headaches – headache that gets worse when you stand up
  • Neck pain
  • Diplopia /visual field defects
  • Dizziness
  • Muffled hearing
  • Galactorrhoea – due to hyperaemia in the pituitary
  • Impaired sphincter control
  • Symptomatic subdural haematomas
84
Q

Outline the 4 main causes of spontaneous intracranial hypotension.

A
  • Idiopathic
  • Collagen disorders
  • Dural diverticula
  • Trauma
85
Q

What are the 2 main Ix’s for spontaneous intracranial hypotension?

A

MRI of brain and LP

86
Q

What would an MRI of the head of someone with spontaneous intracranial hypotension show?

A
  • Meningeal enhancement
  • Chronic subdural haematomas
  • Hindbrain herniation
87
Q

What would an LP of someone with spontaneous intracranial hypotension show?

A
  • Low pressure
  • Pleocytosis
  • Raised protein
  • Xanthochromia
88
Q

Outline the treatment of spontaneous intracranial hypotension.

A
  • Conservative – bed rest, fluids, analgesics
  • Epidural blood patches
  • Surgical repair
89
Q

What is Syringomyelia?

A

A chronic progressive disease in which longitudinal cavities form in the cervical region of the spinal cord

This characteristically results in wasting of the muscles in the hands and a loss of sensation

90
Q

What is the characteristic morphological appearance of syringomyelia?

A
  • Dilated central canals
  • Spindles
  • Holocord – entire spinal cord
  • Tethered conus
91
Q

What are the 3 classifications of syringomyelia?

A
  • Craniovertebral junction
  • Spinal canal
  • Idiopathic
92
Q

Outline the typical presentation of someone with syringomyelia.

A
  • Dissociated sensory loss
  • Cuts + burns on hands (loss of STT)
  • Small muscle wasting
  • Clawed hands
  • Loss of upper limb reflexes
  • Increased lower limb reflexes
  • Hyperhidrosis
93
Q

Why is the STT affected in syringomyelia?

A

STT fibres are found anterolaterally in the spinal cord but there is medial crossing of fibres

94
Q

What is hyperhidrosis?

A

This is abnormal sweating

It is a feature of early stage syringomyelia

Indicates hyperactivity in pre-ganglionic

95
Q

What is often a presenting feature of syringomyelia?

A

Involuntary movements - due to the excitability of spinal neurones

96
Q

What sleep disturbance is also seen in syringomyelia?

A

Sleep apnoea

97
Q

72% of people with craniovertebral junction abnormalities have sleep apnoea

A

True

98
Q

Outline the treatment of syringomyelia.

A
  • Open up obstructed CSF channels
  • Drain syrinx cavity
  • Lower overall CSF pressure
  • Conservative management
99
Q

What is collapse of the syrinx cavity in syringomyelia related to?

A

Collapse of the syrinx cavity is related to the extent of arachnoid adhesions and fibroids

100
Q

What type of patient is only suitable for conservative management in syringomyelia?

A
  • Spindles
  • Dilated central canals
  • Clinically stable cavities
  • Extensive fibrosis
  • Medically unfit
101
Q

What are a large proportion of syrinxes associated with?

A

Hindbrain hernia

102
Q

People with a hindbrain hernia will get a headache after …

A
  • Coughing
  • Sneezing
  • Straining
  • Laughing
  • Bending forward
103
Q

List symptoms of hindbrain hernia.

A
  • Visual disturbances
  • Dizziness
  • Deafness
  • Tinnitus
  • Dysarthria
  • Dysphagia
  • Somatic sensory disturbances
104
Q

Why do people with syringomyelia present with cuts and burns on their hands?

A

Due to loss of STT

This usually sits anterolateral in the spinal cord but fires cross medially

105
Q

Do patients with syringomyelia present with unilateral or bilateral pain and temperature loss?

A

BILATERAL - as this is a central cord lesion

106
Q

Where in the spinal cord does a syrinx usually occur?

A

Cervical to upper thoracic

107
Q

Loss of pain and temperature in syringomyelia is usually in what type of distribution?

A

‘Cape like’ distribution

108
Q

Why do patients with syringomyelia get muscle atrophy and weakness?

A

If anterior motor horns are involved

109
Q

A syrinx usually starts small and centrally and expands out

A

True

Neurology (42 decks)

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