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Neurology > Hydrocephalus and increased ICP > Flashcards

Hydrocephalus and increased ICP Flashcards

1
Q

Which structures exert pressure onto the brain?

A

Brain tissue
CSF
Intracranial circulating blood volume

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2
Q

What can physiologically cause the ICP to fluctuate?

A

Valsalva manouvre

Bending over

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3
Q

What is a normal ICP?

A

7-15 mmHg

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4
Q

What are the bodies immediate compensatory mechanisms for increased ICP?

A

Decrease CSF by moving it out of the foramen magnum

Decrease in blood volume by increasing venous outflow via the sinuses

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5
Q

What are the delayed compensatory mechanisms for increased ICP?

A

Decrease in ECF; brain swelling

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6
Q

How is cerebral perfusion pressure calculated?

A

MAP - ICP

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7
Q

What occurs to CPP in hypotension?

A

CPP will fall

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8
Q

What CPP is compatible with consciousness?

A

20; below this and you will be comatose

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9
Q

How is cerebral blood flow autoregulated?

A

Pressure; arterioles dilate or constrict in response to changes in BP or ICP
Metabolic; arterioles dilate in response to chemicals such as lactic acid or Co2

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10
Q

What is the action of CO2 on cerebral blood flow?

A

Potent dilator
Increased Co2 or increased BP = vasodilation
Decreased CO2 or hypotensive = vasoconstriction

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11
Q

What is a short term mechanism for decreasing ICP?

A

Hyperventilation, blow off Co2 and therefor vasoconstrict the blood vessels

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12
Q

What can cause an increased ICP?

A

Mass effect
Brain swelling
Increased CVP

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13
Q

What can cause a mass effect within the brain?

A 
Tumour
Infarct
Contusion
Haematoma
Abscess
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14
Q

What can cause swelling within the brain?

A 
Ischaemia
Anoxia
Acute liver failure
Encephalopathy
IIH 
Hypercarbia
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15
Q

What can cause increased CVP?

A

Venous sinus thrombosis
Heart failure
Obstruction of jugular veins
High abdo pressure (ICP tends to be higher in pregnancy)

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16
Q

What can cause non-communicating (obstructive) hydrocephalus?

A

Masses
Chiari Syndrome (ectopia of cerebellar tonsils)
Increased production; choroid plexus papilloma

17
Q

What can cause communicating hydrocephalus?

A

SAH
Meningitis
Malignant meningeal disease

18
Q

What are the early signs of increased ICP?

A 
Decreased consciousness
Headache
Pupillary dysfunction +/- papilloedema
Changes in vision; decreased visual acuity, tunnel vision
N+V
19
Q

What are the late signs of increased ICP?

A 
Coma
Fixed, dilated pupil
Hemiplegia
Bradycardia; cushing's reflex
Hyperthermia; dysfunctional hypothalamus
Increased urinary output
20
Q

What are the goals of therapy in managing patients with raised ICP?

A

Maintain CPP

Prevent ischaemia and brain compression

21
Q

What is the management for increased ICP?

A

Maintain head in midline to facilitate maximal venous outflow
Loosen tube ties, cervical collars
HoB 30-45 degrees elevation
Avoid gagging, coughing etc
Decrease environmental stimuli
Treat hyperthermia
Maintain fluid balance and normal electrolytes
Maintain normocarbia; short term can hyperventilate to decrease ICP and increase CPP

22
Q

What is the medical management for an increased ICP?

A

Diuretics; mannitol, hypertonic saline, furosemide, urea
Barbiturate coma; phenobarb
Antiepileptics
Surgical decompression

23
Q

What surgical treatment can be performed to decreased ICP?

A

Remove mass lesion; if abscess evacuate within 24 hours

CSF diversion; VP shunt

24
Q

What is communicating hydrocephalus?

A

Dilatation of ventricles throughout all the ventricular systems within the brain

25
Q

What is non-communicating hydrocephalus?

A

Obstructive; commonly at the cerebral aqueduct

26
Q

What are the different types of congenital hydrocephalus?

A

Aqueductal stenosis
Colloid cyst
Intraventricular haemorrhage

27
Q

What are the hallmarks of normal pressure hydrocephalus?

A

Elderly population
Hakim’s triad: abnormal gait (wide based, shuffling gait_, urinary incontinence (lack of frontal disinhibition), dementia

28
Q

What are the differential diagnosis of normal pressure hydrocephalus?

A 
All other forms of dementia
Cervical myelopathy
All urinary problems 
PD 
Senile depression
29
Q

What can be seen on the scans of those with normal pressure hydrocephalus?

A

Large ventricles
Brain atrophy
Large sylvian fissures
Disproportionately large subarachnoid spaces
Angle between ventricles less than 90 degrees

30
Q

What investigations should be done for normal pressure hydrocephalus?

A 
MOCA/ MMSE/ adam brooke
Physio assessment of walking; 10m walk test
LP; opening pressure 
Lumbar drain test; let out 30ml 
Lumbar infusion studies
31
Q

What is the treatment for normal pressure hydrocephalus?

A

VP shunt

Medium-low or low-pressure valve

32
Q

What is IIH?

A

Idiopathic intracranial hypertension

Increased opening pressure on LP

33
Q

Will there be ventricular dilatation in IIH?

A

NO - if you see dilatation then it is NOT IIH

34
Q

What are risk factors for developing IIH?

A 
Women of child-bearing age
Overweight 
CSF imbalance
Hormonal 
Venous pressure; transverse/sigmoid sinus stenosis
35
Q

What are the signs and symptoms of IIH?

A

Headache; photophobia, don’t like looking up
Double vision
Visual blurring; field defects to result in tunnel vision
Tinnitus
Radicular pain
Papilloedema

36
Q

What is the treatment for IIH?

A 
Weight loss
Possible bariatric surgery 
Carboanhydrase inhibitor; acetazolamide 
Topiramate
Diuretics
CSF diversion; LP or VP shunt 
Interventional radiology; intracranial venous sinus plasty, intracranial venous sinus stenting 
ONSF (optic nerve sheath fenestration)
37
Q

What are the differentials of IIH?

A

Any other type of pain, any other reason for ICP

Cervical radiculopathy

38
Q

What investigations should be done in IIH?

A

LP
CT/MRI head
CTV/MRV to look at venous stenosis
Fundoscopy +/- ophtho review

Neurology (48 decks)

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