Hydrocephalus and Spinal Cord Disease

Question 1

What is hydrocephalus?

Answer 1

excessive volume of cerebrospinal (CSF) fluid within the ventricular system of the brain and is caused by an imbalance between CSF production and absorption

Question 2

Causes of infantile hydrocephalus

Answer 2

Arnold-Chiari Malformations
Stenosis of the aquaduct of Sylvius
Dandy-Walker syndrome

Question 3

Pathology behind Arnold-Chiari Malformation

Answer 3

Cerebellar tonsils descend into the cervical canal and fluid filled cyst may develop

Question 4

Pathology behind Dandy-Walker Syndrome

Answer 4

Cerebellar hypoplasia and obstruction to the 4th ventricle outflow foramina

Question 5

Subtypes of hydrocephalus

Answer 5

Non-communicating (obstructive) hydrocephalus
Communicating (non-obstructive) hydrocephalus

Question 6

What is a communicating hydrocephalus?

Answer 6

When the flow of CSF is blocked after it leaves the ventricles

Question 7

What is a non-communicating hydrocephalus?

Answer 7

When the flow of CSF is blocked in one of the narrow passageways connecting the ventricles

Question 8

Causes of obstructive hydrocephalus

Answer 8

Brain tumour
Acute haemorrhage (SAH, intraventricular haemorrhage)
Developmental abnormalities (eg. Aqueductal stenosis)

Question 9

Causes of non-obstructive hydrocephalus

Answer 9

Increased production of CSF (ie. Choroid plexus tumour)
Decreased absorption (eg. Meningitis or post Haemorrhagic)

Question 10

What is normal pressure hydrocephalus?

Answer 10

unique form of non-obstructive hydrocephalus characterised by large ventricles but normal intracranial pressure. The classic triad of symptoms is dementia, urinary incontinence and disturbed gait

Question 11

Signs of hydrocephalus in infants

Answer 11

Skull sutures that are not yet fused so rise in intracranial pressure will cause an increase in head circumference
The open anterior fontanelle will bulge and become tense
severe hydrocephalus also classically present with failure of upward gaze (‘sunsetting’ eyes) due to compression of the superior colliculus of the midbrain.
Problems with muscle tone and strength
Nausea and vomiting

Question 12

Gold standard investigation for hydrocephalus

Answer 12

CT head scan

Question 13

Treatment for hydrocephalus

Answer 13

An external ventricular drain (EVD) is used in acute, severe hydrocephalus and is typically inserted into the right lateral ventricle and drains into a bag at the bedside

A ventriculoperitoneal shunt (VPS) is a long-term CSF diversion technique that drains CSF from the ventricles to the peritoneum

In obstructive hydrocephalus, the treatment may involve surgically treating the obstructing pathology

Question 14

Aetiology behind Brown-Sequard syndrome

Answer 14

Hemisection of the spinal cord

Question 15

Tracts affected in Brown-Sequard Syndrome

Answer 15

Lateral corticospinal
Dorsal columns
Lateral spinothalamic tract

Question 16

Clinical features of Brown-Sequard Syndrome

Answer 16

Ipsilateral spastic paresis below lesion
Ipsilateral loss of proprioception and vibration sensation
Contralateral loss of pain and temperature sensation (1-2 segments beneath lesion)

Question 17

Investigation for Brown-Sequard syndrome

Answer 17

MRI

Question 18

Tracts affected with an anterior spinal artery occlusion

Answer 18

Lateral spinothalamic tracts
Lateral corticospinal tracts

Question 19

Clinical features of anterior spinal artery occlusion

Answer 19

Bilateral spastic paresis
Bilateral loss of pain and temperature sensation
NORMAL PROPRIOCEPTION

Question 20

What is Subacute combined degeneration of the spinal cord

Answer 20

Deficiency in B12 and E

Question 21

Tracts affected in Subacute combined degeneration of the spinal cord

Answer 21

1. Lateral corticospinal tracts
2. Dorsal columns
3. Spinocerebellar tracts

Question 22

Clinical features in subacute combined degeneration of the spinal cord

Answer 22

Bilateral spastic paresis
Bilateral loss of proprioception and vibration sensation
Bilateral limb ataxia