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Neurology > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

1
Q

Describe the pathway of CSF through the brain

A
  1. Produced in choroid plexus
  2. Lateral ventricle
  3. Third ventricle
  4. Cerebral aqueduct
  5. Fourth ventricle
  6. Subarachnoid space
  7. Arachnoid granuations drains into dural venous sinus
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2
Q

What effect does ICP have on the rate of production of CSF?

A

CSF production rate is constant and not influenced by ICP

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3
Q

What drives the CSF resorption rate?

A

The difference between ICP and venous sinus pressure

If ICP is much higher than venous pressure, the resorption rate will be high
helps drain fluid to lower high ICP

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4
Q

What are the classical signs of ICP?

A 
Headache
Nausea and vomiting
Neurological signs
Neck stiffness
Papilloedema
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5
Q

Definition and clinical signs of tonsilar herniation.

A

Herniation of cerebral tonsils through foramen magnum causing brainstem compression.

Bradycardia, hypertension, irregular breathing

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6
Q

Definition and clinical signs of subfalcine/cingulate herniation.

A

Herniation of cingulate gyrus under falx cerebri.

Compresses anterior cerebral artery causing leg sensorimotor symptoms

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7
Q

Definition and clinical signs of tentorial/uncal herniation.

A

Herniation of medial temporal lobe over tentorium cerebelli

Compresses oculomotor nerve causing exotropia, pupillary dilation and ptosis

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8
Q

Name of herniation of brain through fracture site.

A

Transcalvarial herniation

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9
Q

Name of herniation of medial temporal lobe over tentorium cerebelli.

A

Uncul/tentorial herniation

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10
Q

Name of herniation of cingulate gyrus under falx cerebri.

A

Subfalcine/cingulate herniation

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11
Q

Name of herniation of cerbellar tonsils through foramen magnum

A

Tonsilar herniation/Chiari malformation

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12
Q

Presentation of congenital hydrocephalus.

A

Bulging fontanelle
Large head diameter
Sunsetting (eyes pushed down)
Failure to thrive

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13
Q

Treatment of congenital hydrocephalus.

A

Shunt

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14
Q

What is the commonest cause of congenital hydrocephalus?

A

Aqueductal stenosis

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15
Q

Is congenital hydrocephalus communicating or communicating?

A

Non-communciating

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16
Q

Name 3 causes of acquired non-communicating hydrocephalus.

A

Brain tumour
Infection
Haemorrhage

17
Q

What are the two broad underlying processes which can cause communicating hydrocephalus?

Which of these two is commoner?

A

Overproduction (choroid plexus tumour)

Decreased absorption (meningitis, haemorrhage)

Decreased absorption is far commoner as choroid plexus tumours are rare

18
Q

Classic symptoms in normal pressure hydrocephalus?

A

Gait disturbance
Dementia
Incontinence

19
Q

How do you diagnose normal pressure hydrocephalus

A

MRI (dilated ventricles)

Tap test, drain some CSF and test gait and memory after draining (should improve)

20
Q

How do you treat normal pressure hydrocephalus?

A

Shunt

21
Q

Patient has increased ICP without dilatation of the ventricles.

What would you expect this patient to be like?

A

Young obese female

idiopathic intracranial hypertension

22
Q

What is idiopathic intracranial hypertension?

A

Increased ICP without dilatation of the ventricles

23
Q

How do you manage idiopathic intracranial hypertension?

A

Weight loss (first line)

Acetazolamide (second line)

Shunt (third line)

Subtemporal decompression (last line)

24
Q

Patient presents with headache worse on standing up and galactorrhea.

Diagnosis?

What is this condition?

A

spontaneous intracranial hypotension

CSF leak in spinal cord secondary to connective tissue disease or trauma

25
Q

Patient present with involuntary movements and hyperhidrosis

Diagnosis?

What is this condition?

A

Syringomyelia

Rare CSF filled cyst from dilated central canal

26
Q

What are syringomyelia associated with?

A

Trauma

Chiara malformation

27
Q

Name given to dilated ventricles caused by cortical atrophy?

A

Hydrocephalus ex vacuo

Neurology (11 decks)

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