Hydrocephalus: General Aspects Flashcards
Hydrocephalus (HCP) is abnormal accumulation of CSF within ventricles of brain. What is the most common cause of communicating hydrocephalus in pediatric population?
● A. Chiari type 2 malformation with MMC
● B. Chiari type 1 malformation without MMC
● C. Periaqueductal stenosis
● D. Infection
● E. Post hemorrhagic
D. Infection
A 2-month-old child presents with irritability, N/V, and poor head control. On examination, he/she has bulging fontanelle, engorged scalp veins, setting sun sign, and positive Macewan’s sign. MRI of brain showed periaqueductal gliosis in this patient. Following are the causes of congenital hydrocephalus in pediatric population except?
● A. Chiari type 2 with MMC
● B. Chiari type 1 without MMC
● C. Secondary aqueductal gliosis
● D. Dandy Walker malformation
● E. Colloid cyst blocking CSF flow at aqueduct
E. Colloid cyst blocking CSF flow at aqueduct
Occipital frontal circumference is used to monitor head growth and to assess possible pathological process causing change in head measurement from normal. Active hydrocephalus, subdural hematoma, or subdural effusion is signified by which of the following?
● A. Progressive upward deviation from the normal curve
● B. Continued head growth of more than 1.25 cm/wk
● C. OFC measuring 2 standard deviations above normal
● D. Head circumference out of proportion to body length or weight
● E. All of the above
E. All of the above
Pregeniculate blindness is because of lesion anterior to the lateral geniculate body while postgeniculate blindness is because of lesion posterior to the lateral geniculate body. Following are the causes of blindness from hydrocephalus except?
● A. Occlusion of posterior cerebral arteries (caused by downward transtentorial herniation)
● B. Diffuse hypoxic injury to occipital lobes caused by hypotension
● C. Chronic papilledema causing injury to optic nerve at optic disk
● D. Dilatation of third ventricle with compression of optic chiasma
● E. Compression of PCA caused by upward herniation of cerebellum
B. Diffuse hypoxic injury to occipital lobes caused by hypotension
Following are the specific radiologic criteria for the diagnosis of hydrocephalus except?
● A. Evans ratio (FH/BPD) more than 0.3 shows hydrocephalus
● B. Size of both temporal horns > 2 mm shows HCP
● C. Slit third ventricle
● D. Periventricular low density on plain CT of brain and hyperintensity on MRI of brain
● E. Ballooning of lateral and frontal ventricles
C. Slit third ventricle
Following are features indicative of chronic hydrocephalus except?
● A. Beaten copper cranium
● B. Third ventricle herniating into sella
● C. Erosion of sella turcica
● D. The temporal horns are markedly prominent
● E. Atrophy and upward bowing of corpus callosum
D. The temporal horns are markedly prominent
Pseudohydrocephalus refers to conditions that may mimic hydrocephalus but are not due to inadequate CSF absorption. Which of the following can be called as pseudohydrocephalus?
● A. Hydrocephalus ex vacuo due to cerebral atrophy
● B. Developmental anomalies like agenesis of corpus callosum, septo-optic dysplasia, or hydranencephaly
● C. Otic hydrocephalus
● D. External hydrocephalus
● E. All of the above
E. All of the above
A 4-month-old child presents with macrocrania and frontal bossing. Plain CT of brain showed enlarged subarachnoid spaces over the cortical sulci of frontal poles. Basal cisterns and anterior hemispheric fissure are also seen to be enlarged. A diagnosis of external hydrocephalus or benign external hydrocephalus is made. What is the most appropriate treatment for this condition?
● A. Usually resolves spontaneously before 2 years of age
● B. Parents may need to periodically reposition the head while the child is sleeping
● C. Shunt may be needed for cosmetic reasons in severe macrocrania
● D. Parents are reinsured that this is not cortical atrophy
● E. All of the above are correct
E. All of the above are correct
A disconnected ventriculoperitoneal shunt may continue to function through an endothelialized subcutaneous tract. Which of the following statements is true regarding repair or removing of a VP shunt?
● A. Indications for shunt repair are marginally functioning shunt with signs and symptoms of increased ICP
● B. Most of the patients with spina bifida or aqueductal stenosis are not shunt dependent
● C. If a shunt is nonfunctioning and the patient is not shunt dependent then the shunt should be removed regardless of shunt infection or not
● D. A patient with nonfunctioning shunt with no symptoms does not need to be followed up
● E. All of the above are correct
A. Indications for shunt repair are marginally functioning shunt with signs and symptoms of increased ICP
A patient above 60 years of age presents with gait disturbance (wide based, short shuffling steps like glued to the ground), dementia with slowing of thoughts (bradyphrenia), and urinary incontinence with urgency. On examination, there is no papilledema, hyperreflexia, or lateralizing signs. LP was done which showed normal pressure. MRI showed ventricular enlargement without any blockage. Following are features that correlate with favorable response to shunt in this condition except?
● A. Periventricular low density on plain CT of brain and high intensity on T2WI MRI
● B. Compression of convexity sulci
● C. Rounding of the frontal horns
● D. Dilated subarachnoid spaces in high convexity
● E. Upward bowing and thinning of corpus collosum
D. Dilated subarachnoid spaces in high convexity
Which of the following is a component of iNPH Radscale?
● A. Evans ratio increased
● B. Tight high convexity
● C. Sylvian fissure enlargement
● D. Decrease of callosal angle
● E. All of the above are true
E. All of the above are true
Which of the following is true regarding treatment of normal pressure hydrocephalus?
● A. Positive response on tap test increase the likelihood of responding to shunting
● B. VP shunt is the procedure of choice with use of medium pressure valve
● C. ETV has been advocated by some authors
● D. Most likely symptom to improve with shunting is incontinence then gait disturbance and then dementia
● E. All of the above
E. All of the above
