Treatment of Hydrocephalus Flashcards
Diuretic therapy may be tried in premature infants with bloody CSF as long as there is no evidence of active hydrocephalus, and satisfactory control is reported in about half of the infants. What is the initial dose of acetazolamide in mg/kg/d in divided doses?
● A. 1
● B. 5
● C. 10
● D. 25
● E. 50
D. 25
A 4-year-old child was admitted with hydrocephalus and tectal glioma. He had no previous surgery. What is the ETV success score?
● A. 10
● B. 20
● C. 30
● D. 60
● E. 80
E. 80
What is the most common cause of shunt malfunction?
● A. Proximal end blockade
● B. Distal end blockade
● C. Shunt fracture
● D. Silicone allergy
● E. Streptococcus viridians infection
A. Proximal end blockade
Upward gaze palsy or setting sun sign is associated with which of the following?
● A. Parinaud’s syndrome
● B. Pulfrich syndrome
● C. Anton’s syndrome
● D. Ridoch’s phenomenon
● E. Weber syndrome
A. Parinaud’s syndrome
Contrast medium commonly used for X-ray shuntogram is what?
● A. Gadolinium
● B. Iohexol
● C. 99m-technetium pertechnetate
● D. Gadopentate dimeglumine
● E. Ferric ammonium citrate
B. Iohexol
What is the shunt malfunction rate in percentage during the first year of placement in the pediatric population?
● A. 1
● B. 3
● C. 7
● D. 17
● E. 49
D. 17
What is the treatment of choice for short-term symptoms of intracranial hypotension due to over-shunting of a VP shunt?
● A. Antibiotics
● B. Steroids
● C. Antisiphon device
● D. Shunt removal
● E. Y connector shunt
C. Antisiphon device
What do the three dots visible on the shunt valve on X-ray represent?
● A. Very low pressure
● B. Low pressure
● C. Medium pressure
● D. High pressure
● E. Very high pressure
D. High pressure
Diuretic therapy is used in premature infants for bloody CSF with no evidence of active hydrocephalus as an adjunct to definitive treatment or as a temporizing measure. Satisfactory control of hydrocephalus can also be achieved in children less than 1 year of age with stable vital signs, normal renal function, and no symptoms of elevated ICP (apnea, lethargy, vomiting) using diuretic therapy. Following are true regarding diuretic therapy except?
● A. Acetazolamide is started at 25 mg/kg/d with simultaneous start of furosemide at 1 mg/kg/d
● B. To counteract acidosis, tricitrate is used at a dose of 4 mL/kg/d
● C. There is no need to measure electrolytes along with diuretic therapy
● D. Weekly ultrasound or CT of brain is performed and ventricular shunt is inserted if ventriculomegaly occurs
● E. This therapy is used for 6 months and then dosage is tapered over 2 to 4 weeks
C. There is no need to measure electrolytes along with diuretic therapy
Surgical methods to control hydrocephalus include third ventriculostomy, various shunting methods, eliminating the obstruction like tumor, and choroid plexectomy. What is the goal of surgery in such patients?
● A. Normal sized ventricles
● B. Opened basal cisterns
● C. Optimum neurologic function and good cosmetic result
● D. Opened subarachnoid spaces
● E. Both A and B
C. Optimum neurologic function and good cosmetic result
Endoscopic third ventriculostomy is an endoscopic method of dealing with hydrocephalus. Which of the following is an indication of endoscopic third ventriculostomy?
● A. It is used in patients with obstructive hydrocephalus
● B. In managing shunt infection as a means to remove all hardware without subjecting the patient to increased ICP
● C. It is also proposed as an option for patients who developed subdural hematomas after shunting in which the shunt is removed before ETV is performed
● D. It is also indicated for slit ventricle syndrome
● E. All of the above are indications of ETV
E. All of the above are indications of ETV
During ETV complications can occur such as injury to basilar artery, PCom, or PCA, injury to pituitary stalk and hypothalamus, or transient 3rd and 6th nerve palsies. ETV has low success rate in infants because of which of the following?
● A. There are higher chances of complications to occur
● B. It is difficult to do ventriculostomy in infants
● C. Mortality in infants in high after ETV
● D. They may not have a normally developed subarachnoid space
● E. All of the above
D. They may not have a normally developed subarachnoid space
ETV success score is used to predict the likelihood of success of ETV. Scores less than 40% correlate with very low chance of success while scores more than 80% show better chance of success compared to shunting. A child 3 years of age with tectal tumor and no history of previous shunt has ETV success score of what?
● A. 60%
● B. 70%
● C. 80%
● D. 90%
● E. 50%
C. 80%
There are various types of shunts including ventriculoperitoneal shunt (VP), ventriculoatrial shunt (VA), Torkildsen shunt (shunts ventricles to CSF space), ventriculopleural shunt, and
lumboperitoneal shunt. VP shunt is the most commonly used shunt in modern era. What are indications of VA shunt instead
of VP shunt in a patient?
● A. Extensive abdominal surgery
● B. Peritonitis
● C. Morbid obesity
● D. In patients who have had NEC
● E. All of the above
E. All of the above
What is the most common complication of a shunt?
● A. Obstruction
● B. Disconnection at a junction or breakage at any point
● C. Infection
● D. Seizures
● E. Extraneural metastasis of certain tumors
A. Obstruction
