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Neuro > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

1
Q

What is hydrocephalus

A

Excess CSF in the intracranial and intraventricular spaces causing dilatation of the ventricles (ventriculomegaly) superior to obstruction
Due to imbalance between absorption and production

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2
Q

What causes absorption of CSF

A

Passive process by conc gradient so if raised ICP it is disrupted by arachnoid granulations in venous sinus

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3
Q

What causes CSF production

A

Metabolically active process produced by ependymal cells in choroid plexus

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4
Q

What affects CSF production

A

Acidosis
Altitude
Carbonic anhydrase inhibitor drugs

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5
Q

What are the non-obstructive / communicating causes of hydrocephalus

A 
Production > resorption
Choroid plexus papilloma = very rare 
Arnold chiairi malformation
Tiny trauma blocks granulations 
Infection - meningitis 
SAH 
Post-op
Trauma 
Drugs
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6
Q

What are the obstructive causes of hydrocephalus

A 
Aqueduct stenosis (children) 
Tumours - gradual onset 
Cysts 
Infection
Haemorrhage 
Spina-bifida
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7
Q

What are the symptoms in children

A 
Increase in head circumference
Bulging / tense anterior fontanelle 
Failure to thrive 
Frontal bottling
Venous scalp distention
Parinaud syndrome - can't look up
Bradycardia
Seizure
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8
Q

What are the symptoms in adults

A 
Raised ICP 
Headache - worse lying down / Valsalva 
N+V
Papilloedema 
Gait disturbance 
6th nerve palsy
Up gaze difficulty 
Coma if severe
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9
Q

How do you Dx hydrocephalus

A

CT head = 1st line
MRI to look in more detail
LP = therepatuic and diagnostic as will reduce pressure

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10
Q

When is LP CI

A

In obstructing hydrocephalus as difference in brain and spinal pressure will cause herniation

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11
Q

How do you treat communicating hydrocephalus

A

Shunt
Ventriculo-peritoneal most common
Ventriculo-atrial if peritoneal failure

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12
Q

How do you treat NCH

A

Remove obstructing lesion

Shunt

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13
Q

What are causes shunt malfunction

A

Skin erosion
Infection
Mecahincal failure
50% will fail in 5 years

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14
Q

How do you treat acute hydrocephalus and where

A

EMERGENCY
External ventricular drain into R lateral ventricle
Huge infection risk

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15
Q

What are symptoms of shunt malfunction

A

Return of original symptoms

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16
Q

How much CSF is produced by choroid plexus

A

500ml

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17
Q

What is the approx volume in brain

A

150ml

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18
Q

What is the composition

A

Glucose - look for this to make sure CSF
Protein
WCC

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19
Q

How does CSF circulate

A 
Lateral ventricle
Through foramen of munro
3rd ventricle
Through cerebral aqueduct
4th formane
Through foramen of Magendie / Luscka
Into Subarachnoid space
Reabsorbed
20
Q

What are Arnold chair malformation

A

Congenital
Acquired through trauma
Cause downward displacement of herniation of cerebellar tonsil through Forman magnum

21
Q

What are the symptoms

A

NCH
Headache
Synringomyelia (fluid filled cyst within spinal cord)

22
Q

What causes normal pressure hydrocephalus

A

Secondary to reduced reabsorption at arachnoid villi
Head injury
SAH
Meningitis

23
Q

What are the Sx of normal pressure hydrocephalus

A

Urinary incontinence
Gait disturbance - wide stance / short shuffle
Quickly progressive dementia

24
Q

How do you Dx

A

CT / MRI
LP
Gait assessment / MMSE

25
Q

How do you Rx

A

Programmable VP shunt to change pressure

Gait improves the most then incontinence then memory

26
Q

Complications of shunt

A

Infection
Haemorrhage
Seizure

27
Q

What should CSF be on removal

A

Clear
Colourless
Opening pressure
Glucose, protein and WCC within normal levels

28
Q

Infection

A

Low glucose

29
Q

GBS

A

High protein

30
Q

Inflammation

A

High WCC

31
Q

Bacterial Menignitis

A

High opening
High neutrophil
Low glucose

32
Q

Encephalitis / viral

A

High opening
High WCC
Normal glucose

33
Q

Lyme’s / syphillis

A

High WCC

34
Q

How do you do LP

A

Cleanse iodine
Anaethetize area
22 gauge needle
Pop indicates punctured dura

35
Q

Where do you inset needle

A

L3/4

36
Q

What position of patient

A

Lateral debiscus

37
Q

Where does CSF lie

A

Space between Pia and arachnoid matter

38
Q

What are each tubes for

A 
1 = gram stain and culture 
2 = glucose and protein 
3 = cell count and differential
39
Q

What do you do if procedure fails

A

USS guided

40
Q

What are indications

A

Meningitis
SAH
Malignancy
Intracranial hypertension

41
Q

What are CI

A 
Unstable 
SKin infection
Bleeding disorder
Increased ICP
Chiairi malformation
42
Q

What are complications

A 
Spinal headache
Apnoea
Back pain 
Infection
Cyst
Haemorrhage 
Nerve root trauma
43
Q

What are symptoms of spinal headache

A

Bilateral
Improves supine
Typically young female with low BMI

44
Q

How do you treat

A

IV saline
IV caffieine
Epidural blood patch

45
Q

What are the symptoms of nerve root trauma

A 
Electric shock
Back pain
Altered mental status
CN abnormality 
Cushings - Brady / hypertension / irregular breathing
46
Q

How do you treat

A 
Immediately remove needle
Raise head to increase venous return
Mannitol
Intubate
Corticosteroid
Nerve conduction study

Neuro (19 decks)

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