Video 11 CSF

Question 1

Which is the CSF circulation?

Answer 1

• Lateral ventricles.
• Third ventricle.
• Cerebral aqueduct.
• Fourth ventricle.

Question 2

Where is the CSF come from?

Answer 2

Choroid plexus of lateral ventricle.

Question 3

Which structure communicates lateral ventricles and third ventricle?

Answer 3

Foramen of Monro.

Question 4

Which structure communicates third ventricle and fourth ventricle?

Answer 4

Cerebral aqueduct (of Sylvius).

Question 5

Which are the name of the structures that communicate fourth ventricle to subarachnoid space?

Answer 5

1) Foramina of Luschka = Lateral.

2) Foramina of Magendie = Medial.

Question 6

Where is reabsorbed the CSF ?

Answer 6

It is reabsorbed by arachnoid granulation and then drains into dural venous sinuses.

Question 7

Which are the structures into the Carotid sheath?

Answer 7

1) Internal jugular vein.
2) Common carotid artery.
3) Vagus nerve.

Question 8

What is the definition of a Noncommunicating hydrocephalus?

Answer 8

Caused by structural blockage of CSF circulation within ventricular system (e.g., stenosis of aqueduct of Sylvius; colloid cyst blocking foramen of Monro).

Question 9

Which are the possibles consequences of a Noncommunicating hydrocephalus?

Answer 9

Headache, Papilledema, Uncalled herniation (eye down and out) and Death.

Question 10

Which are the characteristics of the communicating hydrocephalus?

Answer 10

1) Poor reabsorption of CSF at the arachnoid granulations.
2) Increased Intracranial Pressure.
3) Headache.
4) Papilledema.
5) Herniation.

Question 11

Urinary incontinence, Dementia, Ataxia belong to

Answer 11

Triad of the Normal pressure hydrocephalus. “Wet” “wacky” and “wobbly”.

Question 12

What is the pathology characterized by affects the elderly, CSF pressure elevated only episodically, expansion of ventricle sand distorts the fibers of the corona radiata?

Answer 12

Normal pressure hydrocephalus.

Question 13

What is the hydrocephalus ex vacuo?

Answer 13

Atrophied brain tissue around the ventricles, and ventricles appear enlarged by comparison.

Question 14

In which patients can we see an hydrocephalus ex vacuo?

Answer 14

Patients with Alzheimer disease, advanced HIV, pick disease. And Triad is not seen.

Question 15

What are the characteristic features in pseudotumor cerebri?

Answer 15

1) Young, obese woman.
2) Headache -daily (worse in the morning) pulsatile, possible nausea/vomiting, possible retroocular pain worsened by eye movement.
3) Papilledema.
4) CSF pressure elevated (>200 mmHg in non-obese, >250mmHg in obese patient).

Question 16

What is the most worrisome sequels of the pseudotumor cerebri?

Answer 16

It is vision loss.

Question 17

What can we see on the CT scan in a patient with pseudotumor cerebri?

Answer 17

Absence of ventricular dilation, no tumor or mass.

Question 18

What treatment options are available for managing pseudotumor cerebri?

Answer 18

1) Confirm absence of other pathology its CT and MRI of the head .
2) Discontinue any inciting agents(e.g., Vit. A, tetracyclines, corticosteroid withdrawal).
3) Weight loss in obese patients.
4) Acetazolamide - First line(Start 250mg qid or 500mg bid -> increase to 500mg qid to 1000mg qid).
5) Invasive treatment options: serial lumbar puncture, optic nerve sheath decompression and lumboperitoneal shunting (CSF shunt).

Question 19

What does CFS means?

Answer 19

CerebroSpinal Fluid

Question 20

Where is CSF generated?

Answer 20

Choroid plexus

Question 21

Where is CSF reabsorbed?

Answer 21

Arachnoid granulations (superior Sagittal sinus)

Question 22

What is the difference between communicating and Noncommunicating hydrocephalus?

Answer 22

Communicating hydrocephalus: Decreased absorption of CSF.

Noncommunicating hydrocephalus: Physical obstruction.

Question 23

What clinical features characterized normal pressure hydrocephalus?

Answer 23

Triad: 1)Urinary incontinence. 2)Dementia. 3)Ataxia.

Question 24

What are the 3W’s of normal pressure hydrocephalus?

Answer 24

Wet, wacky, and wobbly. For urinary incontinence, Dementia and ataxia.