Topic 6 - hydrocephalus

Question 1

Hydrocephalus is caused by …

Answer 1

an abnormal accumulation of cerebral spinal fluid in the intracranial ventricles under inappropriate pressure

Question 2

Where is CSF produced?

Answer 2

in the choroid plexus

Question 3

The ventricular system plays many important roles in healthy brain functioning, such as:

Answer 3

1. CSF acts as a buffer between the brain and the skull (protects the brain during TBI)
2. CSF acts as a protective padding between the brain and the surrounding skull and bony protrusions
3. CSF can also reduce overall pressure on the brainstem, by creating buoyancy
4. CSF allows waste and neurotransmitters to be filtered out of the system as well as transporting agents such as hormones

Question 4

What is the old hydrocephalus classification?

Answer 4

• communicating / obstructive

- non-communicating / absorptive

Question 5

Why is the old classification of hydrocephalus misleading?

Answer 5

because all forms of hydrocephalus involve some obstruction.

Question 6

What is the new hydrocephalus classification?

Answer 6

intraventricular: involves obstruction at the aquaduct or foramina of the fourth ventricle
extraventricular: involves scarring of subarachnoid spaces or failure of absorption by the villi

Question 7

How is the shunting procedure done in individuals with hydrocephalus?

Answer 7

shunting involves the placement of a small tube into the lateral ventricle often via the right frontal parietal lobe that allows excess or obstructed CSF to drain outside the cavity of the brain often into the peritoneal cavity in the abdomen

Question 8

How is IQ in congenital hydrocephalus?

Answer 8

Full scale IQ is often documented to be below normal peers by 1 to 1.5 SD

Question 9

What may underlie the intellectual deficit in hydrocephalus?

Answer 9

Frontal dysfunctions rather than right hemispheric dysfunction may actually underlie the intellectual deficit in hydrocephalus

Question 10

What is known about the attention deficit in children with hydrocephalus

Answer 10

Most research found higher susceptibility for distraction.
problems arise on tasks requiring focus and shifting of attention
parents tend to note disinhibition and mental inflexibility

Question 11

What executive functions are impaired in children with hydrocephalus?

Answer 11

planning and organization (during the Reys complex figure test)

Question 12

What kind of memory impairments do children with hydrocephalus display?

Answer 12

learning and memory deficits

Question 13

What language problems do children with hydrocephalus have?

Answer 13

children with hydrocephalus show speech disturbances reflecting a cocktail party syndrome
Intact linguistic skills but they experience problems with semantic-pragmatic aspects of language

Question 14

What kind of motor deficits are there in children with hydrocephalus?

Answer 14

motor deficits range from fine motor deficits to paraplegia and gross gait abnormalities depending on etiology

Question 15

What kind of mood disorders are seen in children with hydrocephalus?

Answer 15

higher rates of depression, anxiety and attention difficulties: ADHD

Question 16

What is the overall profile of congenital hydrocephalus?

Answer 16

• IQ 1 sd below peers
• verbal and visual memory difficulties
• encoding of retrieval based problem (intact consolidation)
• EF: problems with attention, response inhibition, WM and planning deficits
• language impairments tends to e subtle affecting semantic and pragmatic aspects of language
• visuospatial deficits have been found
• motor problems
• depression and anxiety along with inattentiveness

Question 17

What is normal pressure hydrocephalus?

Answer 17

a type of communicating hydrocephalus in which accumulated CSF is not in balance with absorption, so that ICP is elevated and CSF may reach a high level

Question 18

What is the Hakim triad?

Answer 18

historically, idiopathic normal pressure hydrocephalus has been thought of as a rapidly presenting clinical triad of incontinence, gait instability and mental status changes

Question 19

Idiopathic normal pressure hydrocephalus grading scale

Answer 19

0. normal
1. complaints of amnesia or inattention but no objective memory or attention impairment
2. existence of amnesia or inattention but no disorientation of time and place
3. existence of disorientation of time and place but conversation is possible
4. disorientation for the situation or meaningful conversation impossible

Question 20

How is endoscopic third ventriculostomy (ETV)

Answer 20

it involves a perforation of the floor of the anterior third ventricle creating an internal bypass of aquaductal obstruction

Question 21

The cause of cognitive dysfunction in children with hydrocephalus appears to be related to ..

Answer 21

ventricular enlargement and subsequent disruption or poor myelination along with reduced gray matter volume