Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology > Lecture 32 CSF, Hydrocephalus, Lumbar Puncture > Flashcards

Lecture 32 CSF, Hydrocephalus, Lumbar Puncture Flashcards

1
Q

Define Hydrocephalus

A

Excess CSF within the intracranial space specifically interventricular spaces and causes dilation of ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is majority of CSF produced

A

Choroid plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of process is CSF production

A

Metabolically active
Requires ATP
Sodium is pumped into the subarachnoid space and water follows from the blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is the choroid plexus located in the ventricles

A

Lateral- temporal horn roofs
3rd- posterior roof
4th- caudal roof

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The average adult produces how much CSF everyday

A

450-600 cc’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

At any given moment how much CSF is present in the average adult

A

150 cc’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How much of the CSF present at any given time is in the brain ventricles

A

25 cc’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the CSF pathway

A
  1. Lateral ventricle
  2. Foramen Munro
  3. 3rd ventricle
  4. Aqueduct of Sylvius/Cerebral aqueduct
  5. 4th Ventricle
  6. Medial-Magendie
  7. Lateral-Luschka
  8. Subarachnoid space
  9. Arachnoid villi (Arachnoid granulations) along dural venous sinuses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where are arachnoid villi locaed

A

Arachnoid granulations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the function of the arachnoid villi

A

Pressure dependent one way valves that open when the ICP is 3 to 5 cm greater than dural venous sinus pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of process if CSF resorption

A

Passive

Driven by the pressure gradient between the ICP and venous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 2 categories of Hydrocephalus

A

Non-communicating- obstructive

Communicating- non-obstructive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the main problem in communication Hydrocephalus

A

Problem with CSF resorption or less commonly overproduction of CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the name of the disease that causes overproduction of CSF

A

Choroid plexus Papilloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name signs and symptoms seen in communicating hydrocephalus is young children

A

o Disproportional increase in head circumference compared to rest of body
o Failure to thrive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name signs and symptoms seen in communicating hydrocephalus is adults

A 
Increased ICP
Papilledema
Gait disturbances
CN VI nerve palsy
Upgaze difficulty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the aetiology of communication hydrocephalus

A

Infection-bacterial meningitis
Post-operative
Head trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the main problem in non-communicating hydrocephalus

A

Physical obstruction at any point along the interventicular pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the causes of non-communication hydrocephalus

A
  • Aqueductal stenosis
  • Tumors/Cancers/Masses
  • Cysts
  • Infection
  • Hemorrhage/hematoma
  • Congenital malformations/conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the likely cause of non-communicating hydrocephalus if the symptoms are gradual

A

Mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the likely cause of non-communicating hydrocephalus id the symptoms are acute and there is rapid mental decline

A

Intraventicular bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What would you see during radiography to suggest the patient had hydrocephalus

A

Dilation of the temporal horns of the lateral ventricles- normally not visible in younger people
3rd ventricle necked ballooned

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What calculations are used to see whether someone has Ventriculomegaly

A

Evans ratio

Ventricular index

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What ratio suggests vetriculomegaly

A

Ratio greater than 3

25
Q

Treatment for Hydrocephalus

A

External Ventricular Drain

Shunt

26
Q

How would you treat communicating hydrocephalus

A

Shunt placement
Ventricle-peritoneal
Lumbar-perioneal
Ventricular-atrial

27
Q

How would you treat non-communicating hydrocephalus

A

Removal of obstructing lesion
Shunt
Third ventriculostomy

28
Q

A colloid cyst at anterior 3rd ventricle would cause obstruction where

A

Foramen of Monro

29
Q

A pineal region tumour causes compression where

A

Cerebral aqueduct

30
Q

An ependymoma would cause blockage where

A

4th ventricular CSF outlets

31
Q

VP shunts can fail due to

A 
o	Mechanical failure from occlusion/disconnection
o	Migration
o	Over drainage/underdrainage
o	Infection
o	Skin erosion
32
Q

Describe Normal pressure hydrocephalus

A

• Rare preventable/reversible causes of dementia

33
Q

Presentation of Normal Pressure Hydrocephalus

A

• Classic Triad (Wet, Wobbly and Wacky)
o Urinary incontinence
o Gait disturbances (wide stance, short, shuffling steps)
o Quickly progressive dementia

34
Q

What would you discover from LP in Normal Pressure Hydrocephalus

A

o Normal opening pressure
o Symptoms improve with CSF removal
o Gait assessment (time walk and turns) and MMSE

35
Q

What is the treatment for NPH

A

VP shunt

LP shunt tends to lead to over drainage and are difficult to assess and revise

36
Q

What is the prognosis of NPH

A
  • Chance of outcome is improved if symptoms have been present for shorter period of time
  • Meaning that failure to recognize these patients delays their treatment and lessens their chances
  • Most likely symptom to improve is gait>incontinence>memory
37
Q

Indications for Lumbar Puncture

A
  • Meningitis
  • Meningoencephalitis
  • Subarachnoid hemorrhage
  • Malignancy – diagnosis and treatment
  • Idiopathic Intracranial Hypertension
  • Other neurologic syndromes
  • Infusion of Drugs or contrast
38
Q

Contraindications for Lumbar Puncture

A
  • Unstable patient with cardiovascular or respiratory instability
  • Localized skin/soft tissue infection over puncture site
  • Evidence of unstable bleeding disorder-increased chance of spinal haematoma
  • Platelets < 50,000 or clotting factor deficiency
  • Increased intracranial pressure
39
Q

Equipment for Lumbar Puncture

A

Anaesthetic: Topical (EMLA, Elamax, Zylocaine ) or Injection (Lidocaine 25 gauge needle)
• Drapes, gauze, and bandages
• Manometer, stopcock and tubing in non-infant kits
• Spinal needle, usually 22 gauge
o 1.5 in for < 1 yr
o 2.5 in for 1 year to middle childhood
o 3.5 in for older children and adolescents
o Larger for large adolescents
• Atraumatic needles, less spinal headaches (pencil point)

40
Q

Describe the Lateral Decubitus Position

A

L3-L4 or L4-L5

Widens gap between spinous process

41
Q

What do you use to cleanse the skin before a lumbar puncture

A

Iodine

Radially out to 10cm and allow to dry

42
Q

How do you insert the needle for a lumbar puncture

A

• Aim towards umbilicus directing needle slightly cephalad
• Hold needle firmly
• A “pop” of sudden decrease in resistance indicates that ligamentum flavum and dura are punctured
• Remove stylet and check for flow of spinal fluid
• If no fluid, then:
o Rotate needle 90°
o Reinsert stylet and advance needle slowly checking frequently for CSF

43
Q

When measuring Manometry what pressure would suggest a possible herniation

A

> 25cm of water

44
Q

How many tubes do you collect of CSF during a lumbar puncture and how long for

A

3 1ml each
o Tube 1: culture & gram stain
o Tube 2: glucose, protein
o Tube 3: cell count & differential

45
Q

What are the 2 positions a patient can sit during a Lumbar Puncture

A

Sitting position
Lateral Decubitus Position
Paramedian (Lateral) Approach

46
Q

When is the Paramedian (lateral) approach used during lumbar punctures

A

• Use for patients who have calcifications from repeated LPs or anatomic abnormalities
• Needle passes through erector spinae muscles, and ligamentum flavum
o Bypasses supraspinal and interspinal ligaments
• Less incidence of spinal headache

47
Q

What causes spinal headaches

A

CSF leakage

48
Q

What are the complications of a Lumbar Puncture

A 
Headache
Apnea
Back pain
Bleeding
Fluid leak
Infection, pain, hematoma
Subarachnoid epidermal cyst
Ocular muscle palsy (transient)
Nerve Trauma
Brainstem herniation
49
Q

Whats the most common complication of a lumbar puncture

A

Spinal headache

50
Q

What are the risk factors for a spinal headache

A 
Female
18-30 yrs
Lower BMI
history of headaches
Prior spinal headaches
51
Q

How is a spinal headache managed

A

Hydration
Caffeine
Epidural blood patch

52
Q

How can spinal headaches be prevented

A

o Passing needle bevel parallel to longitudinal fibers of dura
o Replacing stylet before removing needle
o Using small diameter needles
o Using atraumatic needles

53
Q

What are the features of nerve root trauma/irritation

A

Electric shocks
Dysesthesias
Back pain
Disc Herniation

54
Q

if Nerve Root Trauma/Irritation persists what can be done

A

Start corticosteroids

• Electromyogram/nerve conduction velocity studies should be scheduled if pain persists

55
Q

Clinical features of Herniation

A
  • Manifests initially as altered mental status, followed by cranial nerve abnormalities and Cushing triad (Irregular, decreased respirations (caused by impaired brainstem function) Bradycardia. Systolic hypertension (widening pulse pressure))
  • May be rapidly fatal.
56
Q

How do you manage Herniation

A
  • Immediately remove needle and raise the head of bed to 30-45° improve venous return from the brain.
  • Mannitol or 3% Saline
  • Intubate patient and hyperventilate
  • Emergent neurosurgical consult
57
Q

What is the cause of an Epidermal Inclusion Cyst

A

• Occurs when a core of skin is driven into spinal or paraspinal space with hollow needle

58
Q

If Lumbar Puncture fails what can be done

A
  • Have someone else try
  • Anesthesia
  • Neurology
  • Bedside ultrasound for difficult LPs
  • Radiographic guided procedure
  • Fluoroscopy
  • Ultrasound
  • CT
  • Cisterna Magna tap

Neurology (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions