ICP and Hydrocephalus

Question 1

hydrocephalus defination

Answer 1

obstruction to CSF

Question 2

what makes arterioles dilate

Answer 2

co2
lactic acid

Question 3

causes of increased icp

Answer 3

mass effect- oedema

brain swelling - decrease cpp

increase in central venous pressure

problems with csf flow

Question 3

Signs and Symptoms of raised ICP

Answer 3

headache
Pupillary dysfunction +/- papilloedema
changes in vision
Nausea and vomiting
↓ level of consciousness

Coma
Fixed, dilated pupils
Hemiplegia
Bradycardia → Cushing’s triad
Hyperthermia
↑ urinary output

Question 3

management of icp - supportive

Answer 3

Maintain head in midline to facilitate blood flow
Loosen tube ties, collars etc
HoB 30-45° elevation- prevent aspiration

Decrease environmental stimuli
Treat hyperthermia
Maintain fluid balance and normal electrolytes and co2

Question 3

Types of Hydrocephalus

Answer 3

obstruction

Choroid plexus papilloma- increases pressure

decreased absorption/communicating hydrocephalus - meningitis

Question 3

Medical/Surgical management of icp

Answer 3

Diuretics (mannitol, hypertonic saline, furosemide, urea)
Barbiturate coma- temporary coma with anaesthetic, can reduce cpp

Antiepileptics- for seizures

Surgical decompression

Question 4

communicating vs non communicating hydrocephalus

Answer 4

communicating is when ventricles are open- CSF can still flow between
lateral 3rd adn 4th ventricles enlargement

Non-communicating/obstructive hydrocephalus - occurs when the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles.
e.g. aqueductal stenosis
shunt

Question 4

treatment of hydrocephalus

Answer 4

Endoscopic Third Ventriculostomy - better as less risk of infection

shunt

Question 5

Normal pressure hydrocephalus

Answer 5

icp isn’t high
happens slowly over time

old people

Hakim’s triad: abnormal gait, urinary incontinence, dementia

Question 6

normal pressure hydrocephalus investigations

Answer 6

LP
Lumbar drain test
Lumbar infusion studies

Question 7

normal pressure hydrocephalus treatment

Answer 7

VP-shunt
ventriculoperitoneal

Medium-low or low-pressure valve
ETV

Question 8

Idiopathic Intracranial Hypertension

Answer 8

Mainly women of child-bearing age- hormones
Mainly Western civilisations
Overweight

Question 9

Idiopathic Intracranial Hypertension symptoms

Answer 9

Headache
Double vision
Visual blurring
tinnitus
radicular pain
Papilloedema

Question 10

Idiopathic Intracranial Hypertension investigations

Answer 10

LP
CT/MRI head

CT venous

fundoscopy - eyes

Question 11

Idiopathic Intracranial Hypertension treatment

Answer 11

Weight loss, possibly bariatric surgery

Carboanhydrase inhibitors (Acetazolamide, Topiramate)

Diuretics

CSF diversion
LP- or VP-shunt

Intracranial venous sinus plasty
Intracranial venous sinus stenting

ONSF- optic nerve sheath decompression