Neurology Flashcards
What is it important to ask about in history of seizures?
Do the seizures occur when the child is awake or asleep
Could be benign sleep myoclonus - not an epileptic seizure and will disappear with age; no change in colour, saturations, otherwise well
Was the child in distress before the episode?
= breath holding spells, reflex anoxic seizures
What is epilepsy?
Umbrella term - tendency to have seizures - which are transient episodes of abnormal electrical activity in the brain
What are the types of seizures?
Tonic-clonic Focal seizures Absence seizures Atonic seizures Myoclonic seizures Infantile spasms
Febrile convulsions
What is seen in a tonic clonic seizure?
loss of consciousness, tonic muscle tensing, clonic muscle jerking
Associated tongue biting, incontinence, irregular breathing
Drowsy post-octal period
What is seen in a focal seizure?
start in temporal lobe Affect hearing, speech, memory, emotions Hallucinations Memory flashbacks Deja vu Doing strange things on autopilot
What is the management of tonic clonic seizures?
First line - sodium valproate
Second line - lamotrigine or carbamazepine
What is the management of focal seizures?
First line: carbamazepine or lamotrigine
Second line: sodium valproate, levetiracetam
What are absence seizures?
Patient becomes blank
Stares into space then abruptly returns to normal
During episode unaware of surroundings
Lasts 10-20 seconds
What is the management of absence seizures?
First line - sodium valproate or ethosuximide
What are atonic seizures?
Drop attacks
Brief lapses in muscle tone
Usually don’t last more than 3 minutes
May be indicate of Lennox-Gastaut syndrome?
What is lennox-gastaut syndrome?
rare type of severe childhood-onset epilepsy
associated with gene mutations, perinatal injuries, brain tumours, malformations
treatment does not tend to end seizure recurrence
What is the treatment of atonic seizures?
First line sodium valproate
Second line lamotrigine
What are myoclonic seizures?
Sudden brief muscle contractions like a sudden jump
Patient usually awake during
Typically happen as part of juvenile myoclonic epilepsy
What is the management of myoclonic seizures?
First line - sodium valproate
Other options - lamotrigine, levetiracetam, topiramate
What is West syndrome?
Infantile spasms
Clusters of full body spasms
Difficult to treat
First line prednisolone or vigabatrin
What are febrile convulsions?
Seizures in children whilst they have a fever
Not caused by epilepsy or underlying neurological pathology
Occur only in children between the ages of 6 months - 5 years
Slightly increases risk of developing epilepsy in future
What are the investigations for epilepsy?
Good history, type of seizure
EEG
MRI brain - first seizure in under 2, focal seizures, no response to first line drugs
ECG to exclude heart problems
Blood electrolytes
Blood glucose - hypoglycaemia and diabetes
Blood cultures, urine cultures, LP - infection
What general advice is key in those with epilepsy?
Take showers rather than baths
Be cautious with swimming unless seizures well controlled and closely supervised
Cautious with heights
Cautious with traffic
Cautious with heavy, hot or electrical equipment
Likely will avoid driving
What is the effect of sodium valproate?
Increasing GABA
Teratogenic
Liver damage, hepatitis
Hair loss
Tremor
What are some of the side effects of carbamazepine?
Agranulocytosis
Aplastic anaemia
Induces P450 system
What are some of the side effects of phenytoin?
Folate and Vit D deficiency
Megaloblastic anaemia
Osteomalacia - Vit D def
What are some of the side effects of lamotrigine?
Stevens Johnson syndrome
Leukopenia
What is the management of a seizure?
Safe position
Recovery position if possible
Something soft under head
Remove obstacles that could lead to injury
Record start and end time
Call ambulance if lasts more than 5 mins, or first seizure
What is the definition of status epilepticus?
Seizures lasting more than 5 minutes
More than 3 seizures in one hour
What is the management of status epilepticus?
Secure airway High conc oxygen Assess cardiac and respiratory function Check blood glucose levels Gain IV access IV lorazepam repeated after 10 mins if continues
If still persists - infusion of IV phenobarbital or phenytoin
Then intubation, ventilation
What are the medical options in the community for status epilepticus?
Buccal midazolam
Rectal diazepam
What questions need to be asked about episodes - fits, faints or funny turns?
Freq - how many in day, week, month
Timing - certain time of day or behavioural states
Relationship to sleep - on falling asleep, during sleep, waking
Triggers - tired, travel, excitement, exercise
Warnings beforehand
Duration - if clustered how long between episodes
Colour change - pallor, early cyanosis
Alterations in conscious level
Motor phenomena - act it out
Recovery and symptoms after
Family history
What defines epilepsy?
At least two unprovoked seizures occurring more than 24 hours apart
One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures occurring over next 10 years
Diagnosis of an epilepsy syndrome
What are acute asymptomatic seizures?
Result of acute insults
e.g. hypoglycaemia, hypoxia, electrolyte derangements, infection, trauma
What are the common paediatric epilepsy syndromes?
West Syndrome - infantile spasms Age 4-7 Sudden jerks of neck, trunk Shortly after wakening, or when falling asleep, clustered Cries at end Loss of visual alertness
Benign epilepsy with Centro-temporal spikes
3-12 years, spontaneous remission by adolesence
From sleep, focal onset
Sensory or motor
Tingling, drooling, aphasia
Childhood absence epilepsy 4-8 years, more common in girls Brief arrest of speech, activity Perioral, periocular flickering Unrousable, rapid recovery Can be induced by hyperventilation
Juvenile myoclonic epilepsy
12-18 years
Present with first generalised tonic-clonic seizure
Awareness retained during jerks
What are examples of non-epileptic paroxysmal episodes which can occur during sleep?
Benign neonatal sleep myoclonus
Myoclonic movements not involving the face
Occur in infants few wks old
Parasomnias Sleep paralysis Confusional arousal Sleep walking Night terrors
What are examples of non-epileptic paroxysmal episodes which can occur during feeding?
GORD/Sandifer syndrome
GORD can cause apnoea and dystonic posturing of the head, neck and back
Associated with feeding is Sandifer syndrome
What are examples of non-epileptic paroxysmal episodes which can occur during fevers?
Febrile seizures
Brief, generalised convulsions
6 months to 6 years
Vaso-vagal syncope
In older children
Triggers e.g. intercurrent illness, heat, low food and water intake, prolonged standing
Prodromal pallor, nausea, visual greying, dizziness
What are examples of non-epileptic paroxysmal episodes which can occur due to pain, shock or startles?
Reflex asystolic syncope/reflex anoxic seizure:
Sudden unexpected pain or discomfort e.g. headbanging
Child becomes pale, hypotensive, loses consciousness
May have limb stiffening, clonic jerking, vagally mediated
Cyanotic breath holding
End expiratory apnoea following crying
Hyperekplexia:
Whole body stiffening in response to sudden noises, being touched or handled
Severe neonatal form can result in life threatening apnoea - forcible flexion of the neck can terminate it
What are examples of non-epileptic paroxysmal episodes which can occur due to boredom, tiredness, stress?
Self gratification behaviour: Self comforting Can occur in older children with a neurological disability Adducted, crossed legs Unresponsive to interruption
Tics:
Compulsive movements
Gestures
Occur in isolation, or may have vocal tics or Tourette’s
Daydreaming
What are examples of non-epileptic paroxysmal episodes which can occur due to excitement?
Shuddering spells
Excitement from toy or food - provokes shivering as if chilld
Benign
Cataplexy Strong emotion e.g. laughter provokes sudden loss of tone Temporary Brief sagging of the legs Associated with sleep-wake fragment
What are the types of primary headaches?
Migraine
Tension type headache
Cluster headache and other trigeminal autonomic cephalagias
other primary headaches
What are causes of secondary headaches?
Headaches due to an underlying pathology Head or neck trauma Intracranial haemorrhage Vascular malformation Substance or withdrawal Infection Disorder of homeostasis Psychiatric disorder
What are tension headaches?
Mild ache across forehead
Pain or pressure in band like pattern
Come on and resolve gradually
Children become quiet, stop playing, turn pale, tired
Resolve quicker
Triggers include stress, fear, discomfort Skipping meals dehydration infection
What is the management of tension headaches in children?
Reassurance
Analgesia
Regular meals
Avoid dehydration, stress
What are the types of migraine?
Migraine with aura Migraine without aura Silent migraine - migraine with aura but no headache Hemiplegic migraine Abdominal migraine
What is an abdominal migraine?
May occur in younger children before they develop traditional migraines
Episodes of central abdominal pain lasting more than one hour
Examination normal
May have associated N&V, anorexia, headache, pallor
In child with possible migraines, ask about history of recurrent central abdominal pain as a child
What may be the presentation of migraine?
Unilateral
More severe
Throbbing
Take longer to resolve
Associated with visual aura
Photophobia, phonophobia
Nausea and vomiting
Abdominal pain
What is the management of migraines in children?
Rest, fluids, low stimulus environment Paracetamol Ibuprofen Sumatriptan Antiemetics e.g. domperidone unless contraindicated
What are options for migraine prophylaxis?
Propranolol - but avoid in asthma
Pizotifen - causes drowsiness
Topiramate - girls with child bearing potential need good contraceptive as teratogenic
What are options for migraine prophylaxis?
Propranolol - but avoid in asthma
Pizotifen - causes drowsiness
Topiramate - girls with child bearing potential need good contraceptive as teratogenic
How can infections cause a headache in a child?
Sinusitis causes headaches with inflammation of ethmoidal, maxillary, frontal or sphenoidal sinuses
Viral URTI, otitis media, sinusitis, tonsillitis
How might a headache suggest a space occupying lesion?
Worse when lying down
Morning vomiting
Night time wakening
Change in mood, personality
Visual field defects Cranial nerve abnormalities Abducens often affected - squint with diplopia Abnormal gait Torticollis - tilting of head Growth failure Papilloedema - late feature Cranial bruits
What are other causes of funny turns to consider in a child?
Cardiac arrhythmia - prolonged QT interval Non epileptic attack disorder Pseudoseizures - child feigns seizures Fabricated Paroxysmal movement disorders
What are the types of muscular dystrophies?
Umbrella term for genetic conditions causing gradual weakening and wasting of muscles
Duchennes Beckers Myotonic dystrophy Fascioscapulohumeral Limb-girdle Emery-Dreifuss
What is Gower’s sign?
Standing up from a lying position - using hands on their legs to help them stand up
Shift weight backwards
Muscles around the pelvis not strong enough to keep upper body erect without arms
What is the management of muscular dystrophy?
No curative treatment
Aid quality of life
Occupational therapy, physio, medical appliances e.g. wheelchairs, braces
Management of complications e.g. spinal scoliosis, heart failure
What is the inheritance of Duchennes?
Defective gene for dystrophin on the X chromosome
X-linked recessive
If mother is carrier with one faulty gene - 50% chance being carrier as female, 50% chance of having condition if male
What is the presentation of Duchennes?
Waddling gait
and/or language delay
Mount stairs slowly
Psuedohypertrophy of the calves, due to replacement of muscle fibres with fat and fibrous tissue
Progressive muscle atrophy and weakness No longer ambulant by 10-14 Respiratory failure Associated cardiomyopathy Scoliosis
What is the management of Duchennes?
Exercise to maintain muscle power and mobility
Passive stretching and night splints prevent contractures
Orthoses for walking
Truncal brace for scoliosis
CPAP or NIPPV for nocturnal hypoxia, due to weakness of intercostal muscles
Oral steroids shown to slow progression of weakness
Creatine supplementation
What is Beckers muscular dystrophy?
Similar to Duchennes
Dystrophin gene less severely affected
Clinical course less predictable, starts later
What is myotonic dystrophy?
Type of muscular dystrophy Progressive muscle weakness Prolonged muscle contractions e.g. unable to let go after shaking hand, cannot release grip Cataracts Cardiac arrhythmias
Usually presents in adulthood
What is facioscapulohumeral muscular dystrophy?
Presents in childhood Weakness around face Progresses to shoulders and arms Sleeping with eyes open Weakness pursing lips Cannot blow cheeks out without air leaking
What is oculopharyngeal muscular dystrophy?
Presents in late adulthood Weakness of ocular muscles Weakness around pharynx Bilateral ptosis Swallowing problems
What are the central movement control centres?
Motor cortex in the pre-central gyrus which passes down corticospinal tracts to basal ganglia
Basal ganglia - stores patterns of movement
Cerebellum
What are examples of corticospinal tract disorders?
Cerebral dysgenesis Global hypoxia ischaemia Cerebral tumour Hemiplegic migraine Arterial ischaemic stroke
What are examples of basal ganglia disorders?
Acquired brain injury e.g. CO poisoning, ischaemia, post cardiopulmonary bypass chorea
Wilson disease
Huntington’s
What are examples of cerebellar disorders?
Medication, drugs
Post viral
Medulloblastoma
Genetic and degenerative disorders e.g. ataxia-telangiectasia
How might a child present with a neuromuscular disorder?
Weakness - progressive or static Floppiness Delayed motor milestones Muscle weakness Unsteady-abnormal gait Fatiguability Muscle cramps - metabolic myopathy
How may a myopathy present?
Waddling gait or positive Gowers
Gowers positive is normal up until the age of 3
What are examples of neuromuscular disorders?
Disorders of anterior horn:
Poliomyelitis
Spinal muscular atrophy
Disorders of peripheral nerve:
Hereditary motor sensory neuropathies
Acute post-infectious polyneuropathy - Guillan-Barre
Bell’s
Disorder of neuromuscular transmission: myasthenia gravis
Muscle disorders: Muscle dystrophies Inflammatory myopathies e.g. benign acute myositis, polymyositis Myotonic disorders Metabolic myopathies Congenital myopathies
What are the investigations for a myopathy?
Serum creatine phosphokinase elevated in Duchenne and Becker’s, and in inflammatory myopathies
Muscle biopsy
DNA testing
USS or MRI of muscles
What are the investigations for a neuropathy?
Nerve conduction studies
DNA testing
Nerve biopsy (rare)
EMG - electromyography e.g. shows fatiguability in repetitive nerve stimulation in myasthenia
What is spinal muscular atrophy?
Rare autosomal recessive condition
Progressive loss of motor neurones and progressive muscular weakness
Affects lower motor neurones in spinal cord - LMN signs:
fasciculations, reduced muscle bulk, reduced tone and power
Reduced or absent reflexes
What are the types of SMA?
1 - onset in first few months of life, death within 2 years
2 - onset within first 18 months, most never walk, survive to adulthood
3 - onset after first year of life, most walk without support
4 - onset in 20s, retain ability to walk short distances, tasks are tiring, rest muscles and life expectancy not affected
What is the management of spinal muscular atrophy?
Supportive with MDT
Physio to maximise muscles
Retain resp function
Use of splints, braces, wheelchairs
Resp support with NIPPV to prevent hypoventilation and resp failure, part in sleep
SMA 1 may need tracheostomy and mechanical ventilation
Percutaneous endoscopic gastrostomy PEG tube if weak swallow
What are signs of SMA Type 1?
Lack of antigravity power in hip flexors
Absent deep tendon reflexes
Intercostal recession
Fasciculation of the tongue
What is Guillain Barre syndrome?
Acute post infectious polyneuropathy
2-3 weeks after URTI or campylobacter gastroenteritis
Fleeting abnormal sensory symptoms in legs
Ascending symmetrical weakness, loss of reflexes
Involvement of bulbar muscles can lead to difficulty chewing
Difficulty swallowing
Recovery can take up to 2 years
Management supportive
Resp support
What is Bell’s palsy?
Isolated lower motor neurone paresis of facial nerve
Probably post infectious
Corticosteroids can reduce oedema in first week
Main complication conjunctival infection due to inability to close eye
What is a key differential of Bell’s palsy?
If symptoms of vestibulocochlear nerve paresis present; due to compressive lesion
Herpes virus can invade geniculate ganglion, cause facial palsy treated with aciclovir
HTN excluded as Bell’s palsy can be associated with coarctation of the aorta
Bilateral facial weakness can be due to sarcoidosis or Lyme disease
What is juvenile myasthenia?
Similar to adult autoimmune myasthenia
Due to binding of antibodies to acetylcholine receptors on post synaptic membrane
Reduces no. of functional receptors
Presentation usually after 10 Ophthalmoplegia, ptosis Loss of facial expression Difficulty chewing Facial weakness
Diagnosis confirmed with acetylcholine receptor antibody tests or anti muscle specific kinase antibodies.
What is the treatment for myasthenia gravis/juvenile myasthenia?
Anti-muscarinic drugs neostigmine or pyridostigmine
Immunosuppressive therapy with prednisolone, azathioprine
What are metabolic myopathies and causes?
Metabolic conditions can affect muscles
Lead to floppy infant
Or child with muscle weakness or cramps on exercise
Glycogen storage disorders
Disorders of lipid metabolism
Mitochondrial cytopathies
What is found on examination of a floppy infant?
Hang like a rag doll
Marked head lag
Central hypotonia associated with poor truncal tone, but preserved limb tone
Dysmorphic features suggest genetic cause
Lower motor neurone lesions - frog like posture, poor antigravity movements and absent reflexes
What are causes of a central hypotonic infant (floppy)?
Cortical:
Hypoxic ischaemic encephalopathy
Cortical malformations
Genetics:
Down’s
Prader-Willi
Metabolic:
Hypothyroidism
Hypocalcaemia
What are the causes of a peripheral hypotonic infant?
Spinal muscular atrophy
Myopathy
Myotonia
Congenital myasthenia
What is Friedreich ataxia?
Autosomal recessive condition Presents with worsening ataxia Distal wasting in legs Absent lower limb reflexes Extensor plantar responses due to pyramidal involvement Pes cavus - high arch Dysarthria
Kyphoscoliosis and cardiomyopathy can worsen with age, cause death at 40-50
What is ataxia telangiectasia?
Autosomal recessive
Mild delay in motor development
Oculomotor problems
Incoordination
Difficulty with balance and coordination
Dystonia, cerebellar signs
Telangiectasia in conjunctiva, neck and shoulders
Increased susceptibility to infection
Develop malignant disorders
Raised AFP
Increased white cell sensitivity to irradiation
What are causes of cerebellar ataxia?
Medication, drugs
Varicella infection
Tumours
Degenerative disorders - ataxic cerebral palsy, Freidreich ataxia, ataxia telangiectasia
What is an extradural haemorrhage?
Follows direct head trauma
Skull fracture and tearing of middle meningeal artery
What is the presentation of an extradural haemorrhage?
Lucid interval
Then consciousness drops
Seizures secondary to increasing size of haematoma
Focal neurological signs may be present - dilatation of ipsilateral pupil, paresis of contralateral limbs.
In young child, may be anaemic and in shock
What is the diagnosis and management of an extradural haemorrhage?
CT scan
Correct hypovolaemia
Urgent evacuation of haematoma, arrest bleeding
What is a subdural haematoma?
Tearing of veins as they cross subdural space
Retinal haemorrhages present
Characteristic non-accidental injury e.g. shaking or direct trauma
What is a subarachnoid haemorrhage and its presentation?
Less common in kids Acute onset of head pain Neck stiffness Occasional fever Retinal haemorrhage Seizures and coma may occur
What are the investigations and treatment for a subarachnoid haemorrhage?
CT scan identifies blood in CSF
LP in acute situation avoided - haemorrhage may then extend following releasing of ICP
Cause often aneurysm or arteriovenous malformation identifiable with MR angiography, CT or conventional angiography
Treatment with neurosurgery or interventional radiography
What are causes of rising intracranial pressure?
Meningoencephalitis Head injury Subdural/extradural bleeds - NAI? Hypoxia e.g. near drowning Ketoacidosis Tumours Thrombosis Reye's
What are the sections of children’s coma scale?
Best motor response
Best verbal response
Eye opening
What are the signs of raised intracranial pressure?
Irritable Drowsy Headache Diplopia Vomiting Tense fontanelle Level of responsiveness
If unconscious look for: pupil changes (ipsilateral dilatation) abnormal posturing, Cushing’s triad warns of imminent coning
What are the types of abnormal posturing?
Decorticate - arms flexed over chest
Decerebrate - arms extended at sides, and head and back arched backward
What is Cushing’s triad?
Slow pulse, widened pulse pressure
Raised BP
Breathing pattern abnormalities
What is the management of rising ICP?
Prevent ischaemia - keep head in midline elevated at 25 degrees Give O2 Treat any hypoglycaemia Control seizures Don't do LP - risk of coning Intubate, dexamethasone Fluid restriction and diuresis
What is the main rule of visual field defects?
Pre-chiasmal lesions cause ipsilateral monocular defect
Post-chiasmal leads to homonymous visual field defects on contralateral side
What do lesions at the optic chiasm cause?
Bitemporal hemianopia
Why is there sparing of the macula in the occipital lobe?
As there is dual blood supply in the anterior portion of the visual centre - PCA and MCA
Homonymous hemianopia
What are typical lesions of the optic nerve?
Optic neuritis
Amaurosis fugax
Trauma
Retrobulbar optic neuropathy
Leads to ipsilateral monocular blindness
What are typical lesions of the central portion of the optic chasm?
Pituitary adenoma
Suprasellar aneurysm
Leads to bitemporal hemianopia
What are typical lesions of the optic tract?
MCA stroke
Tumours
Contralateral homonymous hemianopia
What are typical lesions of the optic radiations?
MCA stroke
Tumour
Trauma
Contralateral homonymous quadrantopis
What are causes of acquired spinal cord injury?
Trauma
Inflammatory - post infectious, abscesses, tuberculous
Vascular - acute anterior spinal artery infarction - sparing of dorsal cord leads to preservation of dorsal column - vibration, joint position, sensation
Compression - SOL, paraspinal neuroblastoma, syringomyelia
What is the acute management of a spinal cord injury?
Neurosurgical evaluation High dose steroids Ventilatory support for high lesions Urinary catheterisation, management of constipation Aggressive contracture prevention
What is autonomic dysreflexia?
Important problem of complete lesions above T6
Stimuli below this level, e.g. even full bladder and not aware can lead to increased reflex sympathetic activity, HTN, vasoconstriction
This is sensed by CNS above lesion, causing increased vagal tone and bradycardia so vasodilation above lesion leads to pounding headache and sweating
Needs emergency treatment, relief of cause, sit upright
What are long term complications of a spinal cord injury?
Motor Weakness, spasticity, contractures Spinal deformity Chest infection Postural abnormalities Pathological fractures
Sensory
Skin breakdown due to lack of pain sensation from pressure
Scalds, hot weather etc
Sphincters
Incontinence, bladder dysfunction
Unsafe bladder not well managed - renal failure
Emotional
Lack of independence, depression, sexual dysfunction
What is syringomyelia?
Reversible cause
Expansion of central cavity of cord due to abnormal CSF flow and pressure
Loss of pain, pinprick and temperature
What are some causes of vision loss pre-chiasmatic/chiasmatic?
Cornea - scarring, vit A deficiency, keratoconus (Trisomy 21)
Lens - cataract
Macula - damage, dystrophy
Retina - trauma, NAI, detached retina, intraocular tumour
Optic nerve - inflammation, optic neuritis, optic atrophy
Compression; raised ICP, trauma, bone disease, infection, hypertension
Ischaemia, optic glioma
Chiasm - tumour
What are examples of neural tube defects?
Anencephaly - failure of most of cranium and brain
Encephalocele - extrusion of brain and meninges through midline skull defect
Spina bifida:
Spina bifida occulta - vertebral arch does not fuse properly, underlying tethering of cord causes neurological defects
Meningocele - sac of fluid, meninges herniate but nervous system remains undamaged
Myelomeningocele - spinal cord protrudes out as well as meninges containing it
What problems is myelomeningoceles associated with?
Variable paralysis Muscle imbalance Dislocation of hips, talipes Sensory loss Bladder dernervation Bowel denervation Scoliosis Hydrocephalus
What is seen in spina bifida occulta?
Associated overlying skin lesion
Tuft of hair, lipoma, birth mark
Small dermal sinus
What is the criteria for immediate request of CT head in children?
LOC more than 5 mins
Amnesia more than 5 mins
Abnormal drowsiness
Three or more discrete episodes of vomiting
Clinical suspicion of NAI
Post traumatic seizure but no hx of epilepsy
GCS <14 or if less than 1 <16
Suspicion of open or depressed skull injury, tense fontanelle
Any sign of basal skull fracture
Focal neurological deficit
Presence of bruise, swelling, laceration >5cm on head if less than 1 year
Dangerous mechanism of injury
What are some of the causes of microcephaly?
Normal variation, familial Congenital infection Perinatal brain injury e.g. hypoxic ischaemic encephalopathy Fetal alcohol syndrome Patau's Craniosynostosis
What is hydrocephalus?
CSF building up abnormally within the brain and spinal cord
Either due to overproduction or problem draining and absorbing
What is normal CSF physiology?
Four ventricles - two lateral, third and fourth
Ventricles contain CSF
Created in four choroid plexuses passes through to arachnoid granulations where it is absorbed
What are congenital causes of hydrocephalus?
Aqueductal stenosis - stenosed connection in cerebral aqueduct between third and fourth ventricle so there is a build up in third and lateral ventricles
Arachnoid cysts can block outflow
Arnold-Chiari malformation, seen in spina bifida - cerebellum herniates downwards towards foramen magnum causing blockage
Chromosomal abnormalities and congenital malformations
What is the presentation of hydrocephalus?
Outward pressure on cranial bones if sutures not fused
They fuse at 2 years
Enlarged and rapidly increasing head circumference
Bulging anterior fontanelle
Poor feeding and vomiting
Poor tone
Sleepiness
What is a VP shunt?
Drains CSF from ventricles into another body cavity
Usually peritoneal cavity as plenty of space, easily reabsorbed
What are the complications of a VP shunt?
Infection
Blockage
Excessive drainage
Intraventricular haemorrhage during shunt related surgery
Outgrowing them - typically need replacing every 2 years
