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Neurology > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

1
Q

What is hydrocephalus?

A

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

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2
Q

Where is the majority of CS produced? How?

A

Choroid plexus

Actively via Na pump

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3
Q

How much CSF is produced/ day?

A

450-600cc

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4
Q

Hoe often does the CSF turnover each day?

A

3/4 times

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5
Q

Where does the CSF move after leaving the ventricular system?

A

Subarachnoid space

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6
Q

Where is CSF reabsorbed?

A

Arachnoid granulations

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7
Q

Where does CSF move from the arachnoid villi? How?

A

Venous sinuses

Passively

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8
Q

What are the 2 major types of hydrocephalus?

A

Communicating (CoH)

Non-communicating (NCH)

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9
Q

What is communicating hydrocephalus also known as?

A

Non-obstructive

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10
Q

What is non-communicating also known as?

A

Obstructive

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11
Q

In CoH, where is the problem observed?

A

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

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12
Q

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

A 
In infants - increase in head 
Headache
Nausea & vomiting 
Papillodema 
6th nerve palsy 
Focal neurological deficit
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13
Q

What are some of the causes of CoH?

A

Subarachnoid haemorrhage
Head trauma
Infective (bacterial meningitis)

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14
Q

When does NCH occur?

A

When there is any physical obstruction to normal CSF flow

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15
Q

What are some of the causes of NCH?

A 
Aqueductal stenosis 
Tumours
Cysts
Infection 
Haemorrhage 
Congenital malformations
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16
Q

What is the earliest imaging evidence of hydrocephalus?

A

Dilation of the temporal horn of lateral ventricles

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17
Q

What is the treatment for hydrocephalus?

A

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

18
Q

What is the mainstay of treatment for CoH?

A

Shunt placement (Ventriculo-peritoneal shunt)

19
Q

How can NCH be treated?

A

Removal of the obstructing lesion
Shunt placement
Thrid ventriculoectomy

20
Q

What is one of the downsides of VP shunts?

A

They can fail, disconnection or cause infection

21
Q

What is the mneumonic for the classic triad of NPH?

A

Wet, Wobbly & Wacky

22
Q

What is one of the reversible causes of dementia?

A

Normal Pressure Hydrocephalus

23
Q

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

A

Urinary incontinence
Gait disturbance
Dementia

24
Q

What investigations would you do in CoH?

A

CT/MRI

LP - symptoms improve with CSF removal

25
Q

What is the treatment for patients with NPH?

A

VP shunt placement

26
Q

What are LPs used in the diagnosis of?

A 
Meningitis
SAH
Malignancy 
Meningoencephalitis 
Infusion of drugs
27
Q

What are some contraindications for LP?

A

Increased ICP
Bleeding disorder
Infection at site

28
Q

What needle helps to reduce spinal shock in LP?

A

Atraumatic

29
Q

At what level do you perform LP?

A

L3-4 (L4/5)

30
Q

What position should the patient lie at?

A

Lateral Decubitus Position

31
Q

Which way should the bevel face when performing LP?

A

Up to keep parallel with nerve/ ligament fibres

32
Q

What ligament will you pierce when performing LP?

A

Ligamentum flavum

33
Q

How can you assess opening pressure in LP?

A

Attach manometer

34
Q

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

A

3

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

35
Q

What are some complications of LP?

A 
Back pain 
Spinal headache
Bleeding or fluid leak 
Infection 
Nerve trauma 
Brainstem herniation
36
Q

What is the most common complication of LP?

A

Spinal headache

37
Q

How can you reduce the complications including spinal headache?

A

Supine position
Caffeine
Hydration

38
Q

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

A

Altered mental status
Cranial nerve abnormalities
Cushing triad - bradycardia

39
Q

How would you manage a patient who presents with coning?

A

Raise bed
Mannitol or 3% saline
Intubate patient

40
Q

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

A

Blood

Brown paper envelope

Neurology (16 decks)

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