Hydrocephalus Flashcards
what is the typical presentation for NOH?
Confusion/ dementia
gait disturbance
urinary incontinence
what is the typical presentation for obstructive hydrocephalus?
confusion
acute drop consciousness
signs of raised ICP
define hydorcephalus?
enlargement of cerebral ventricular system due to accumulation of CSF
can be due
- too much CSF production ( rare)
- blockage in CSF flow
- insufficient CSF being reabsorbed
subdivided into obstructive and non-obstructive or non-communicating and communicating
what are the causes of obstructive hydrocephalus?
non communicating-> impaired outflow of CSF from the ventricular system
- lesions of 3rd and 4th ventricle or aqueduct
- posterior fossa lesions ( tumour) compressing 4th ventricle
- cerebrla aqueduct stenosis
what are the causes of non- obstrucive ( Communicating) hydrocephalus?
inceased prodction ( eg carotid plexus papiloma) or impaired CSF reabsorption into the subarachnoid vili ( blocked flow after it exits the ventricles)
- tumours
- meningitis
- Normal Pressure Hydrocephalus - idiopathic chronic ventricular enlargement in response to acc of CSF so without significantly elevated CSF press. The long white matter tracts are damaged leading to gait and cognitive decline
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what is normal pressure hydrocephalus?
idiopathic ventricular enlargement in response to accumulation of CSF-> so without significantly increased CSF pressure
long white matter tracts are damaged-> leads to GAIT AND COGNITIVE DECLINE
summarise the epidemiology of hydrocephalus?
Bimodal age distribution
- YOUNG - congenital malformations and brain tumours
- ELDERLY - strokes and tumours
what is the triad of symptoms for normal pressure of hydrocephalus?
cognitive impairement: Mental slowing and memory impairement
Gait distrurbance: shuffling
urinary incontinence (faecal incontinence in advanced disease)
what are the presenting symptoms of obstructive hydrocephalus?
- Acute drop in conscious level
- Diplopia/ blurry vis
- Headache
- N+V
- Balance problems
- Incontinence
- Cognitive problems
- Sleepiness
- Irritability
what are the signs of obstructive hydrocephalus?
low GCS
papilloedema
6th nerve palsy-> results in diplopia
- 6th nerve has the longest intracranial path of all the cranial nerves and so is most susceptible to palsy due to raised ICP
NEONATES:
- Increased head circumference
- Sunset sign (downward conjugate deviation of the eyes)
what are the signs of normal pressure hydrocephalus on physical examination?
Cognitive impairment
Gait apraxia (shuffling)
what are the appropriate investigations for hydrocephalus?
CT Head/ MRI- FIRST LINE-> normal; or mild to moderate ventricular enlargement, periventricular leukomalacia (i.e., damage to the white matter around the cerebral ventricles), cerebral infarction, relative preservation of cortical gyri and sulci, aqueduct flow void, reduced diameter of the corpus callosum and decreased callosal angle
levodopa challenge to rule out parkinsons-> No improvementin gait symptoms if hydrocephalus
