Hydrocephalus & Shunt Malfunction Flashcards

1
Q

What symptoms are associated with normal pressure hydrocephalus (NPH)?

A

Gait disturbances, incontinence, dementia

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2
Q

A lumbar puncture is performed on a patient. The pathology report describes the CSF as xanthochromic. What does this mean?

A

The CSF is red/orange/yellow in color. This indicates that blood was within the CSF and heme has begun to be broken down to bilirubin.

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3
Q

This type of congenital hydrocephalus is associated with a genetic anamoly.

A

Syndromic hydrocephalus. Non-syndromic hydrocephalus is congenital, but is not associated with gene abnormalities

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4
Q

At what level should a lumbar puncture be performed?

A

Below L2 - L3/4 or L4/5

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5
Q

Where is CSF produced?

A

Choroid plexus of each ventricle

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6
Q

What is hydrocephalus ex-vacuo?

A

A hydrocephalus-like condition. There appears to be excess CSF, however, tissue surround the ventricles has shrunk/died and CSF filled the space

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7
Q

How is hydrocephalus typically diagnosed in infants and adults?

A

Ultrasound is used to diagnose hydrocephalus in fetuses and infants. MRI is commonly used to diagnose adults

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8
Q

What is the first step in treating non-communicating hydrocephalus?

A

Create a pathway for the flow of CSF to decrease pressure.

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9
Q

A patient is diagnosed with hydrocephalus, but there was not an obstruction in CSF flow. What is the type?

A

Communicating hydrocephalus - patent pathways, but accumulation of CSF

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10
Q

Where is most CSF found within the CNS?

A

Nearly half of CSF is within the ventricles

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11
Q

Hydrocephalus results from excessive CSF in the ventricles. How is it possible for CSF to accumulate?

A

Obstruction of normal flow, poor reabsorption of CSF by arachnoid granulations, excess production of CSF by the choroid plexus (rare)

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12
Q

Eyes that are fixed downward, called sun setting, may be an indication of hydrocephalus in what population?

A

Neonates

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13
Q

What are the treatment options for hydrocephalus?

A

Ventricular shunt or third ventriculostomy

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14
Q

Describe the production, flow, and reabsorption of CSF.

A

CSF is produced by the choroid plexus in the lateral ventricles.

From here, CSF flows through the intraventricular foramina to the third ventricle and then the cerebral aqueduct to the fourth ventricle. Each ventricle has a choroid plexus that produces more CSF. CSF exits the fourth ventricle to fill the subarachnoid space to surround the brain and spinal cord.

CSF is reabsorbed by arachnoid villi within the sagittal sinus.

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15
Q

What type of spina bifida is easier to treat and does not involve neuronal elements?

A

Meningocele

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16
Q

How is CSF reabsorbed?

A

By arachnoid villi

17
Q

What type of spina Bifida involves neuronal elements within the external fluid-filled cavity?

A

Myelomeningocele

18
Q

What is normal pressure hydrocephalus (NPH)?

A

There is an accumulation of CSF, however, the rate of accumulation is slow enough that tissues around the ventricles shrink to prevent an increase in pressure

19
Q

True/False. The total volume of the brain, CSF, and blood is constant within the skull.

A

True. If there is an increase in the volume of one, the volume of the others must be reduced to accommodate. A failure of this accommodation leads to hydrocephalus.

20
Q

What is the normal range for CSF pressure?

A

70-180 mmH2O

21
Q

Where do CSF obstructions most commonly occur?

A

Foramina Monro, Aqueduct of Sylvius, fourth ventricle, foramen magnum

22
Q

What is a ventriculostomy?

A

A hole is created in the floor of the third ventricle to help drain CSF

23
Q

This type of hydrocephalus results from a blockage that obstructs the flow of CSF.

A

Non-communicating hydrocephalus

24
Q

Shunts may be used to treat hydrocephalus. What are the common reasons why these devices fail?

A

Mechanical failure or infection

25
Q

True/False. CSF is composed of ions, proteins, glucose, and leukocytes.

A

False. CSF should not have leukocytes or blood, only ions, proteins, and glucose.