Raised intracranial pressure and hydrocephalus

Question 1

What is hydrocephalus

Answer 1

an excessive accumulation of CSF within the head, caused by a disturbance of formation, flow or absorption. High pressure and ventricular dilatation result

Question 2

Symptoms of hydrocephalus - decompensated

Answer 2

Headache
Cognitive impairment
Ataxia
Symptoms of raised ICP (headache (morning), vom, etc)

Question 3

Symptoms of raised intracranial pressure

Answer 3

Headache - worse on waking/coughing 
Vomiting (initially without nausea)
Unilateral pupil dilation. ptosis etc
Raised blood pressure 
Changes in mental state - irritable, lethargy, slow to make decisions

Question 4

Causes of hydrocephalus

Answer 4

Posterior fossa/brainstem tumours - obstructing aqueduct/4th ventricle outflow
Subarachnoid haemorrhage, head injury, meningitis (tb) obstruct flow/reabsorption

(3rd ventricle colloid cyst, choroid plexus papilloma - CSF producing tumour)

Question 5

Treatment for symptomatic hydrocephalus

Answer 5

Ventriculoperitoneal shunt

Question 6

What is the triad of symptoms seen in normal pressure hydrocephalus

Answer 6

Gait apraxia
Urinary incontinence
Dementia/cognitive impairment

Ventriculoperitoneal shunting may be required - if LP’s help it probs will

Question 7

Causes of raised intracranial pressure

Answer 7

Traumatic haematoma (intracerebral, subdural, extradural)
tumours
abscess
focal oedema (from trauma, infarct, tumour)
obstructive hydrocephalus
venous sinus blockage - thrombosis/depressed fracture

Diffuse brain oedema or swelling: encephalitis, meningitis, diffuse head injury, subarachnoid haemorrhage, Reye’s syndrome, lead encephalopathy, water intoxication, near drowning

Question 8

Name an intravascular osmotic agent which can be given to help raised ICP

Answer 8

mannitol