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Neurology > Raised ICP and Hydrocephalus > Flashcards

Raised ICP and Hydrocephalus Flashcards

1
Q

what is the normal range for intracranial pressure

A

5-15mmHg

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2
Q

what is cerebral perfusion pressure

A

net pressure gradient that supports cerebral blood flow

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3
Q

list some causes of raised ICP

A 
brain tumour 
haemorrhage 
cerebral oedema 
dural sinus thrombosis 
hypoxia and hypercapnia 
hydrocephalus 
idiopathic intracranial hypertension
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4
Q

describe the headache associated with raised ICP

A

severe headache that is worse in the morning/on bending over and coughing
may wake patient up from sleep

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5
Q

what are the other features of raised ICP other than headache

A

nausea and vomiting
blurred vision
papilloedema
focal neurological symptoms

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6
Q

what drugs can help manage raised ICP

A

mannitol reduces ICP

dexamethasone to prevent cerebral oedema

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7
Q

what surgical interventions are used to reduce ICP

A

burr hole craniotomy

craniotomy

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8
Q

describe a subfalcine herniation and how it presents

A

the frontal lobe is pushed under the falx cerebri to the opposite side
present with lower limb weakness

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9
Q

describe an uncal herniation and how it presents

A

temporal lobe moves under the falx cerebelli as a lateral mass pushes the brain medially
presents with third nerve palsy/blown pupil

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10
Q

describe tonsilar herniation and how it presents

A

herniation of the cerebellar tonsils though the foramen magnum
presents with ataxia, 6th nerve palsy and positive babinski sign
can be a life threatening herniation as the brainstem is compressed

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11
Q

describe tentorial herniation

A

compression of the 3rd nerve affecting parasympathetic fibres

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12
Q

describe transcalvarium herniation

A

herniation of the brain contents through a hole in the skull and dura

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13
Q

what is hydrocephalus

A

accumulation of excess CSF within the ventricular system of the brain

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14
Q

outline some of the main causes of hydrocephalus

A

obstruction to CSF flow
decreased resorption
overproduction of CSF - rare, due to choroid plexus tumour

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15
Q

what is non-communicating hydrocephalus

A

obstruction to flow of CSF occurs within the ventricular system

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16
Q

what is communicating hydrocephalus

A

obstruction to flow of CSF occurs outwith the ventricular system eg in subarachnoid space or at arachnoid granulations

17
Q

what are some examples of communicating hydrocephalus

A

subarachnoid haemorrhage

meningitis

18
Q

what is hydrocephalus ex vacuo

A

dilatation of ventricular system and compensatory increase in CSF volume which is secondary to loss of brain parenchyma
occurs in the context of Alzheimers

19
Q

what are some of the features of hydrocephalus seen in infants

A

increase in head circumference as sutures have nnot fused
dilated scalp veins and tense fontanelles
setting sun sign
Macewans sign

20
Q

what is setting sun sign

A

ocular globes deviated downwards and upper lids are retracted - feature of hydrocephalus

21
Q

what are some features of hydrocephalus seen in children and adults

A 
large head due to raised ICP
sixth nerve palsy 
unsteady gait due to spasticity in legs 
cognitive decline 
nausea and vomiting, blurred vision 
incontinence
22
Q

what is the main investigation for hydrocephalus

A

CT brain

23
Q

what are the findings on CT of communicating hydrocephalus

A

generalised enlargement of lateral, third and fourth ventricles

24
Q

how does aqueduct stenosis present on CT

A

dilated 3rd and lateral ventricles with normal 4th ventricle

25
Q

how does a posterior fossa mass present on CT

A

dilated 3rd and lateral ventricles with abnormal looking 4th ventricle

26
Q

what is the pharmacological management of hydrocephalus

A

acetazolomide to reduce CSF production

27
Q

how is hydrocephalus managed surgically

A

insertion of ventricular catheter to drain excess CSF into peritoneum or right atrium

28
Q

what are some of the complications of hydrocephalus shunt

A

infection
subdural haematoma
shunt obstruction
low pressure state

29
Q

who is commonly affected by normal pressure hydrocephalus

A

elderly people, idiopathic in origin

30
Q

what is the triad of symptoms seen in normal pressure hydrocephalus

A

abnormal wide based gait
urinary incontinence
dementia

31
Q

what are the main risk factors for developing idiopathic intracranial hypertension

A

obese female in third decade
endocrine abnormalities such as PCOS, Cushings
use of OCP, tetracyclines, nitrofurantonin and steroids

32
Q

how does idiopathic intracranial hypertension present

A

same as all raised ICP diseases with pulsatile tinnitus

diagnosis of exclusion as no underlying cause for raised ICP

33
Q

how is IIH controlled

A

lifestyle such as weight loss
drugs - acetazolomide, prednisolone, loop diuretics
surgical - LP shunt if drugs don’t reverse papilloedema

Neurology (19 decks)

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