Hydrocephalus Flashcards
Normal pressure hydrocephalus triad (Hakim’s triad)
Difficulty walking/abnormal gait
urinary incontinence
dementia
what does the skull contain
brain
blood
CSF
what is the normal range of ICP
7-15mmHg
pathway of CSF production and circulation
choroid plexus in lateral ventricles interventricular foramen of monro 3rd ventricle cerebral aqueduct 4th ventricle foramen of magendie and luschka subarachnoid space arachnoid granulation dural venous sinuses
what is the equation including ICP, MAP + CPP
CPP = MAP - ICP
MAP = DBP + _PP
1/3PP
does CPP = CBF
no
what is Cushing’s response
occurs in the case of raised ICP
features of Cushing’s response
hypertension
bradycardia
irregular breathing
over which BP ranges does autoregulation occur
50-150mmHg
raised CO2 causes cerebral vasodilatation/constriction
vasodilatation
hypo/hyperventilation causes raised CO2
hypoventilation increases CO2
low CO2 causes cerebral vasodilatation/constriction
vasoconstriction
hypo/hyperventilation causes low CO2
hyperventilation
causes of raised ICP
mass effect
oedema
impaired venous outflow
CSF / hydrocephalus
signs and symptoms of raised ICP
drowsy slow anisocoria (difference in pupil size) papilloedema Cushing's response N+V hyperthermia
supportive management of raised ICP
maintain head in midline head of bed at 30 degree angle treat hyperthermia maintain fluid and electrolyte balance maintain normocarbia
medical management of raised ICP
mannitol, hypertonic saline, furosemide, urea barbiturate induced coma (last line) anti epileptic drugs surgical decompression remove mass CSF shunt
list types of hydrocephalus
communicating non-communicating congenital acquired normal pressure
what is communicating hydrocephalus
CSF obstruction outwith ventricles
ALL ventricles are enlarged
what is non-communicating hydrocephalus
CSF obstruction within ventricular system
enlargement of lateral and 3rd ventricles only
normal 4th ventricle
what is a non-communicating hydrocephalus also known as
obstructive hydrocephalus
clinical features of obstructive/non-communicating hydrocephalus
swollen head
sunset eyes / upgaze paralysis
what is a colloid cyst
benign epitheliated cyst usually located at foramen on monro
hydrocephalus ex vacuo is a true hydrocephalus, true or false
false
it is as a result of brain atrophy
what is normal pressure hydrocephalus
idiopathic disease of the elderly
what is seen on a scan of someone with normal pressure hydrocephalus
large ventricles and large sylvian fissures
management of normal pressure hydrocephalus
lumbar drain test
lumbar infusion studies - less done
MoCA and MMSE done before and after lumbar drain for comparison
VP shunt with low pressure valve
what is idiopathic intracranial hypertension IIH also known as
pseudotumour cerebri
who is affected by IIH
young obese women of child bearing age
is there ventricular dilatation in IIH on imaging
no
imaging will look normal
signs and symptoms of IIH
debilitating headache double vision and blurring pulsatile tinnitus radicular pain papilloedema
investigations for IIH
LP
CT, MRI
CTV
fundoscopy and ophthalmology
management of IIH
weight loss acetozolamide (carbonic anhydrase inhibitor) topiramate diuretics VP shunt
