Section 3 - Ventricles, Meninges, and Brain Blood Supply

Question 1

What are the symptoms and increased intracranial pressure? (seems like we probably ought to know these…)

Answer 1

Vomiting/nausea, lethargy, headache. (possible papilledema)

Question 2

Generally, what is fetal hydrocephalus?

Answer 2

CSF flow block leads to enlargement of ventricular system upstream and bones of the skull move apart –> significant head enlargment.

Question 3

How do we treat fetal hydrocephalus?

Answer 3

Shunting of CSF.

Question 4

Infection or developmental defect can lead to glial scarring, which can lead to occlusion of ______

Answer 4

Cerebral aqueduct. Leads to buildup in 3rd ventricle and lateral ventricles.

Question 5

Tumors of the ______, such as ______, can compress midbrain and occlude aqueduct (any time in life).

Answer 5

Midbrain; pinealoma

Question 6

What is a colloid cyst?

Answer 6

Type of glioma in interventricular foramen that blocks CSF flow –> enlarged lateral ventricles, thinning of corpus callosum.

Question 7

What are symptoms of a colloid cyst?

Answer 7

Headache, nausea, vomiting, mental change, gait disturbances.

Question 8

What is a calcified glomus indicative of?

Answer 8

White spots on CT. Shifts in position of glomus indicative of alterations to ventricle system or a lesion. (The glomus is in the atrium).

Question 9

List some potential causes of hemorrhage into the ventricles:

Answer 9

• Cerebral hemorrhage (into substance of brain)
• Intracranial aneurysm rupture
• Severe head trauma
• Arteriovenous malformations
• Tumor invasion

Question 10

A choroid plexus tumor in the IV foramen would cause enlargement of the ______

Answer 10

lateral ventricle on the side with signs/symptoms (vomiting, lethargy, headache, maybe papilledema…not to beat the dead horse)

Question 11

Choroid plexus papillomas are usually benign and more common than carcinomas - most common in ______

Answer 11

fourth ventricle

Question 12

Patients with choroid plexus tumors can present with:

Answer 12

increased intracranial pressure (and accompanying symptoms…which you ought to know by now), hydrocephalus, and nerve signs (3, 4, 6) - eye movements

Question 13

Treatment for choroid plexus papilloma:

For the carcinoma:

Answer 13

• surgical

- chemo, surgery, chemo/radiation

Question 14

Where is a lumbar puncture done?

Answer 14

between L3,4 or L4,5 into the dural sac (lumbar cistern)

Question 15

What is a traumatic tap?

Answer 15

Blood in the CSF due to bleeding from the procedure (like hit an artery)

Question 16

How do you differentiate between a traumatic tap and blood in the CSF?

Answer 16

Draw 3 tubes - third tube shouldn’t have blood if it was a traumatic tap. Blood in every one could indicate subarachnoid hemorrhage.

Question 17

Lumbar puncture (LP) in bacterial meningitis or brain abscess will have:

Answer 17

predominate neutrophils, elevated protein

Question 18

LP in syphilitic meningitis, viral meningitis, encephalitis will have:

Answer 18

predominate lymphocytes

Question 19

LP in MS will have:

Answer 19

increased IgG, mononuclear cells

Question 20

LP in subarachnoid hemorrhage will have:

Answer 20

numerous RBC, elevated protein

Question 21

TP in tumor will have:

Answer 21

elevated protein (if metastastized)

Question 22

Obstructive hydrocephalus

Answer 22

blockage of CSF flow

Question 23

Aqueductal stenosis

Answer 23

can be caused by tumor near midbrain (pinealoma, meningioma) or cell debris after interventricular hemorrhage, infection. Often called TRIVENTRICULAR HYDROCEPHALUS

Question 24

Communicating hydrocephalus

Answer 24

low or impaired absorption to the venous system (poorly-developed arachnoid villi, blockage by RBCs or high protein). Could also be from overproduction of CSF, subarachnoid hemorrhage, inflammation.

Question 25

Hydrocephalus ex vacuo

Answer 25

Due to brain atrophy, little evidence of pressure increase. Larger ventricles, loss of white matter. Not a true hydrocephalus.

Question 26

Idiopathic intracranial hypertension

Answer 26

Increased intracranial pressure in obese women of childbearing age with little CT/MRI evidence. Headache, tinnitus, pulsatile intracranial noise, visual defects from papilledema. Treatment is weight loss, medication, lumboperitoneal shunting

Question 27

Normal-pressure hydrocephalus

Answer 27

Elderly with unclear hydrocephalus, elevated pressure and enlarged ventricle characterized by wax and wane of pressure over time –> GAIT DISTURBANCE, URINARY INCONTINENCE, DEMENTIA (characteristic triad). Treatment is shunting.