Intracranial Pressure Flashcards
1
Q
Interstitial fluid is produced in this
A
Parenchyma
2
Q
Is CSF low or high in protein?
A
Low
3
Q
Is CSF low or high in glucose (relative to plasma)?
A
Low
4
Q
Is CSF low or high in cellularity?
A
Low
(rare lymphs, no PMNs, no RBCs)
5
Q
CSF flows from the lateral ventricles into the third ventricle through this
A
Foramen of Monro
6
Q
CSF flows from lateral ventricles through the foramen of Monro into this
A
Third ventricle
7
Q
CSF flows from this, through the foramen of Monro into the third ventricle
A
Lateral ventricles
8
Q
CSF flows from the third ventricle to the fourth ventricle through this
A
Cerebral aqueduct
9
Q
CSF flows from the third ventricle through the cerebral aqueduct into this
A
Fourth ventricle
10
Q
CSF flows from this through the cerebral aqueduct into the fourth venctricle
A
Third ventricle
11
Q
CSF flows out of the fourth ventricle and exits into the subarachnoid space via these two foramen
A
Foramen of Magendie
Foramina of Luschka
12
Q
CSF glucose should be this percentage of serum glucose concentration
A
60%
13
Q
CSF is reabsorbed into dural venous sinuses by these
A
Arachnoid granulations
14
Q
This bathes brain cells with nutrients and removes waste
Is made by active transport across the blood brain barrier; regulates fluid composition
A
Interstitial fluid
15
Q
Are there lymphatics in CNS?
A
No
16
Q
Interstitial fluid is removed by exchange with this
A
CSF
17
Q
These two components of the neurovascular unit control the amount and components of interstitial fluid
A
Astrocyte and endothelial junctions
18
Q
Hydrocephalus is caused by an increase in this
A
CSF
19
Q
Cerebral edema is caused by an increase in this
A
Interstitial fluid
20
Q
Increased CSF causes this
A
Hydrocephalus
21
Q
Increased interstitial fluid causes this
A
Cerebral edema
22
Q
Form of cerebral edema that is due to loss of blood brain barrier integrity (infection, tumor)
A
Vasogenic edema
23
Q
Form of cerebral edema that is due to cellular damage and swelling (ischemia, hypoglycemia)
A
Cytotoxic edema
24
Q
Form of cerebral edema that is due to transependymal flow of CSF into interstitium
A
Interstitial edema
25
Infection and tumor can cause this type of cerebral edema
Vasogenic edema
(due to loss of blood brain barrier integrity)
26
Ischemia and hypoglycemia can cause this type of cerebral edema
Cytotoxic edema
(due to cellular damage and swelling)
27
Type of hydrocephalus that occurs due to impaired flow
AKA obstructive hydrocephalus
Non-communicating hydrocephalus
28
Type of hydrocephalus that occurs without impairment to CSF flow
AKA non-obstructive hydrocephalus
Communicating hydrocephalus
29
What are the three main sites of obstruction that can cause non-communicating hydrocephalus?
Foramen of Monroe
Cerebral aqueduct
Foramen of Magendi/Lushka
30
Tumor, edema, gliosis, and scar can cause this type of hydrocephalus
Non-communicating (aka obstructive) hydrocephalus
31
Non-communicating hydrocephalus due to foramen of Monro obstruction will cause this to be enlarged
Lateral ventricles
32
Gliosis due to infection can cause obstruction of this structure, leading to non-communicating hydrocephalus
Foramen of Monro
33
Are third and fourth ventricles enlarged in hydrocephalus due to foramen of Monro obstruction?
No - are normal
34
Are the lateral ventricles enlarged in hydrocephalus due to foramen of Monro obstruction?
Yes
35
Colloid cyst typically forms in this structure, causing non-communicating hydrocephalus
3rd ventricle
36
This is a benign congenital tumor of endodermal remnants
Slowly grows → non-communicating hydrocephalus
Usually presents in mid-adulthood
May have ball-valve effect (Positional headaches, confusion, etc)
Colloid cyst of 3rd ventricle
37
Colloid cyst of 3rd ventricle can slowly grow and cause this
Non-communicating (obstructive) hydrocephalus
38
Can CSF leave the ventricular system in communicating hydrocephalus?
Yes
39
Communicating hydrocephalus can be caused by impaired reabsorption of CSF at these
Arachnoid granulations
(due to subarachnoid hemorrhage or inflammation - mostly meningitis)
40
Communicating hydrocephalus can be caused by obstruction at this, due to basal brain mass
Tentorial notch
41
Communicating hydrocephalus can be caused by thrombosis here
Dural venous sinus
42
Communicating hydrocephalus may be rarely caused by increased CSF production, most of which is due to this neoplasm
Choroid plexus papilloma or carcinoma
43
Form of communicating hydrocephalus
CSF pressure is typically normal, but actually intermittently elevated
Causes stretching of corona radiata fibers
Normal pressure hydrocephalus
44
Gait disturbance (apraxia), memory loss, and urinary incontinence are the classic triad of this condition
Normal pressure hydrocephalus
45
What is the classic triad of Normal pressure hydrocephalus?
Gait disturbances (apraxia)
Memory loss
Urinary incontinence
46
A patient who is unable to lift their legs from the floor, but have intact motor strength, may have this condition
Normal pressure hydrocephalus
47
Subcortical dementia may be seen in this condition
Normal pressure hydrocephalus
48
Are deep tendon reflexes (DTRs) preserved in normal pressure hydrocephalus?
Usually intact/normal or minimally increased
49
What is the age of a typical patient with normal pressure hydrocephalus?
Elderly
50
Symptoms of this type of hydrocephalus are improved with lumbar puncture
Normal pressure hydrocephalus
51
Normal pressure hydrocephalus symptoms are improved with this procedure
Lumbar puncture
52
A patient with gait issues and memory loss that are relieved by lumbar puncture may have this condition
Normal pressure hydrocephalus
53
Type of hydrocephalus that is due to brain atrophy
Hydrocephalus ex vacuo
54
Hydrocephalus ex vacuo is enlargement of ventricular system due to shrinkage of this
Brain parenchyma
55
Hydrocephalus ex vacuo is enlargement of this due to shrinkage of brain parenchyma
Ventricular system
56
What is the typical age of a patient with Hydrocephalus ex vacuo?
Elderly
(may have neurodegenerative disorder)
57
Is Hydrocephalus ex vacuo typically symptomatic?
Mostly asymptomatic
58
An infant with increased head circumference and bulging fontanelles may have this
Hydrocephalus
59
Does hydrocephalus cause upper or lower extremity spasticity?
Lower
60
This may result when the cerebellar vermis is herniated below the level of the foramen magnum
Arnold-Chiari malformation
61
Arnold-Chiari malformation is when the cerebellar vermis is herniated below the level of the foramen magnum, and may cause this condition
Hydrocephalus
62
Diplopia, vomiting (especially without nausea), and Cushing triad if severe are signs and symptoms of this
Increased intracranial pressure
(may be seen in hydrocephalus)
63
Cause of cerebral edema that is due to cellular injury
Cytotoxic
64
Cause of cerebral edema that is due to vascular injury
Vasogenic
65
Cause of cerebral edema that is due to increased CSF and transependymal flow
Interstitial
66
Flattened gyri and narrowed sulci are findings of this condition
Cerebral edema
67
This is a possible sequelae of cerebral edema
Herniation
68
Vasogenic cerebral edema may occur through these 2 processes
Endothelial damage (loss of blood brain barrier integrity)
Neovascularization (leaky vascularization)
69
Cytotoxic cerebral edema occurs when cells are unable to maintain these
Energy dependent pumps
70
Cells unable to maintain energy dependent pumps can result in this type of cerebral edema
Cytotoxic
71
In cytotoxic cerebral edema, eventual cell death results in the release of DAMPs, which cause endothelial damage, leading to this
Vasogenic edema
72
Tumor, abscess, inflammation, and venous/sinus occlusion can cause this type of cerebral edema
Vasogenic
73
Ischemia, hypoglycemia, trauma, and toxin can cause this type of cerebral edema
Cytotoxic
74
Obstruction to CSF flow can cause this type of cerebral edema
Interstitial
75
This may occur with high pressure hydrocephalus when CSF enters ISF by transependymal flows
Interstitial cerebral edema
76
Opening pressure of a lumbar puncture is a measurement of this
Intracranial pressure (ICP)
77
Increased intracranial pressure can cause cranial nerve palsies, especially this one
CN VI (diplopia)
78
Child with increasing head size, headache, irritability, and lethargy may have this
Increased intracranial pressure
79
Diplopia, papilledema (swelling of optic nerve), new headache, vomiting, mental status changes, and Cushing's triad may occur with this
Increased intracranial pressure
80
Papilledema is swelling of the optic nerve, and occurs due to this
Increased intracranial pressure
81
What is Cushing's triad?
Severe hypertension
Bradycardia
Irregular respiration
82
Severe hypertension, Bradycardia, and Irregular respiration are this triad
Cushing's triad
83
Is increased intracranial pressure associated with hypo- or hypercapnia?
Hypercapnia
84
Why does bradycardia occur with increased intracranial pressure?
Is compensatory for the increased blood pressure
85
In increased intracranial pressure with Cushing's triad, increased BP causes decreased heart rate, which results in the lowering of this
Diastolic BP (causes widened pulse pressure)
86
A widened pulse pressure (large difference between systolic and diastolic BP) is seen when this is increased
Intracranial pressure
87
Displacement of brain tissue past dural folds or through skull openings due to increased intracranial pressure
Herniation
88
Herniation is due to this
Increased intracranial pressure
89
This type of herniation can cause ACA occlusion
Subfalcine (aka cingulate) herniation
90
Subfalcine (aka cingulate) herniation can cause occlusion of this artery
ACA
91
This type of herniation is a herniation of cingulate gyrus across falx cerebri
Subfalcine (cingulate) herniation
92
Motor deficits of lower extremity, stupor, drowsiness and decreased arousal may occur with this type of herniation
Subfalcine (cingulate) herniation
93
Uncinate herniation occurs when there is local pressure at this
Tentorium
94
In uncinate herniation, cerebral hemisphere swelling can cause displacement of this against tentorium
Medial temporal lobe
95
In uncinate herniation, cerebral hemisphere swelling can cause displacement of medial temporal lobe against this
Tentorium
96
In uncinate herniation, the uncus compresses this nerve
Ipsilateral CN III
97
This is the earliest sign of CN III palsy
Pupillary dilation
98
Does pupil dilation or ophthalmoplegia (loss of EOMs) occur first in CN III palsy?
Dilation first
99
What causes loss of consciousness in uncinate herniation?
Compression of reticular activating system of midbrain
100
What causes ipsilateral paralysis in uncinate herniation?
Compression of contralateral cerebral peduncle
101
Does the compression of the ipsilateral or contralateral cerebral peduncle cause ipsilateral paralysis in uncinate herniation?
Contralateral
102
Is ipsilateral or contralateral paralysis seen in uncinate herniation?
Ipsilateral
103
This is an indentation and compression of contralateral cerebral peduncle
Seen in uncinate herniation
Kernohan notch
104
Kernohan notch is seen in this type of herniation
Uncinate
105
With an uncinate hernation, is motor loss ipsilateral or contralateral to Kernohan's notch?
Contralateral
(but ipsilateral to herniating uncus)
106
Duret Hemorrhages of pons (linear, flame-shaped; pons and midbrain) are seen in this type of herniation
Uncinate and Central
107
With uncinate herniation, there is downward pressure to the brainstem, possibly compressing this artery
PCA
108
In an uncinate herniation, downward pressure to brainstem can cause an ischemic infarct along PCA distribution, affecting this lobe
Occipital lobe
(leading to visual defects)
109
With an uncinate herniation, is the ipsilateral or contralateral eye non-reactive with dilated pupil?
Ipsilateral
110
With an uncinate herniation, is hemiparesis and hyperreflexia ipsilateral or contralateral?
Ipsilateral
111
With an uncinate herniation, are ipsilateral or contralateral visual field fibers affected?
Ipsilateral
112
This is a bilateral herniation through tentorium
Central herniation
113
Bilateral pupillary dilation, flaccidity, coma, and Duret hemorrhages are seen in this type of herniation
Central herniation
114
Central herniation is a bilateral herniation through this
Tentorium
115
Bilateral pupillary dilation is characteristic of this type of herniation
Central
116
Is pupil dilation ipsilateral or bilateral in uncinate herniation?
Ipsilateral
117
Is pupil dilation ipsilateral or bilateral in Central herniation?
Bilateral
118
This type of herniation occurs with posterior fossa mass/pressure
Tonsillar herniation
119
This type of herniation compresses the brainstem reticular activating substance, resulting in depressed consciousness, coma, death
Tonsillar herniation
120
This type of herniation may occur acutely with lumbar puncture in setting of increased ICP
Tonsillar herniation
