Hydrocephalus

Question 1

What is hydrocephalus?

Answer 1

Excess CSF within the intracranial space & ventricular system causing dilation of the ventricles

Question 2

Where is the majority of CS produced? How?

Answer 2

Choroid plexus

Actively via Na pump

Question 3

How much CSF is produced/ day?

Answer 3

450-600cc

Question 4

Hoe often does the CSF turnover each day?

Answer 4

3/4 times

Question 5

Where does the CSF move after leaving the ventricular system?

Answer 5

Subarachnoid space

Question 6

Where is CSF reabsorbed?

Answer 6

Arachnoid granulations

Question 7

Where does CSF move from the arachnoid villi? How?

Answer 7

Venous sinuses

Passively

Question 8

What are the 2 major types of hydrocephalus?

Answer 8

Communicating (CoH)

Non-communicating (NCH)

Question 9

What is communicating hydrocephalus also known as?

Answer 9

Non-obstructive

Question 10

What is non-communicating also known as?

Answer 10

Obstructive

Question 11

In CoH, where is the problem observed?

Answer 11

Most commonly due to CSF resorption rather than over production of CSF

Question 12

What are some of the signs & symptoms observed in CoH?

Answer 12

In infants - increase in head 
Headache
Nausea & vomiting 
Papillodema 
6th nerve palsy 
Focal neurological deficit

Question 13

What are some of the causes of CoH?

Answer 13

Subarachnoid haemorrhage
Head trauma
Infective (bacterial meningitis)

Question 14

When does NCH occur?

Answer 14

When there is any physical obstruction to normal CSF flow

Question 15

What are some of the causes of NCH?

Answer 15

Aqueductal stenosis 
Tumours
Cysts
Infection 
Haemorrhage 
Congenital malformations

Question 16

What is the earliest imaging evidence of hydrocephalus?

Answer 16

Dilation of the temporal horn of lateral ventricles

Question 17

What is the treatment for hydrocephalus?

Answer 17

External Ventricular Drain (EVD) - drains the CSF from the ventricular system

Question 18

What is the mainstay of treatment for CoH?

Answer 18

Shunt placement (Ventriculo-peritoneal shunt)

Question 19

How can NCH be treated?

Answer 19

Removal of the obstructing lesion
Shunt placement
Thrid ventriculoectomy

Question 20

What is one of the downsides of VP shunts?

Answer 20

They can fail, disconnection or cause infection

Question 21

What is the mneumonic for the classic triad of NPH?

Answer 21

Wet, Wobbly & Wacky

Question 22

What is one of the reversible causes of dementia?

Answer 22

Normal Pressure Hydrocephalus

Question 23

What are the symptoms described by Wet Wobbly & Wacky in NPH?

Answer 23

Urinary incontinence
Gait disturbance
Dementia

Question 24

What investigations would you do in CoH?

Answer 24

CT/MRI

LP - symptoms improve with CSF removal

Question 25

What is the treatment for patients with NPH?

Answer 25

VP shunt placement

Question 26

What are LPs used in the diagnosis of?

Answer 26

``` Meningitis SAH Malignancy Meningoencephalitis Infusion of drugs ```

Question 27

What are some contraindications for LP?

Answer 27

Increased ICP Bleeding disorder Infection at site

Question 28

What needle helps to reduce spinal shock in LP?

Answer 28

Atraumatic

Question 29

At what level do you perform LP?

Answer 29

L3-4 (L4/5)

Question 30

What position should the patient lie at?

Answer 30

Lateral Decubitus Position

Question 31

Which way should the bevel face when performing LP?

Answer 31

Up to keep parallel with nerve/ ligament fibres

Question 32

What ligament will you pierce when performing LP?

Answer 32

Ligamentum flavum

Question 33

How can you assess opening pressure in LP?

Answer 33

Attach manometer

Question 34

How many vials do you take when doing an LP? What are they for?

Answer 34

3 1: Culture & gram stain 2: Glucose & protein 3: Cell count & differential

Question 35

What are some complications of LP?

Answer 35

``` Back pain Spinal headache Bleeding or fluid leak Infection Nerve trauma Brainstem herniation ```

Question 36

What is the most common complication of LP?

Answer 36

Spinal headache

Question 37

How can you reduce the complications including spinal headache?

Answer 37

Supine position Caffeine Hydration

Question 38

In coning or tonsillar herniation, what are the presenting signs?

Answer 38

Altered mental status Cranial nerve abnormalities Cushing triad - bradycardia

Question 39

How would you manage a patient who presents with coning?

Answer 39

Raise bed Mannitol or 3% saline Intubate patient

Question 40

If you are sending sample for xanthochromia what are you testing for? and what should the sample be contained in?

Answer 40

Blood | Brown paper envelope