Week 1 Hydrocephalus- Krafts/Trachte

Question 1

Two kinds of cerebral edema?

Answer 1

Vasogenic
Cytotoxic
-causes brain to look “flat”/ swell

Question 2

What causes Vasogenic edema?

Answer 2

• Increased vascular permeability (damage to junctions)
• fluid shifts into intercellular spaces in brain
• localized or generalized

Question 3

What causes cytotoxic edema?

Answer 3

• Cell membrane injury (swelling of endotheilal cells)
• Increased intracellular fluid
• Typically seen in hypoxia or with metabolic damage

Question 4

Treatment for vasogenic cerebral edema?

Answer 4

1. Steroids

2. Mannitol

Question 5

How does steroids treat vasogenic cerebral edema?

Answer 5

Steroids- reduce water permeability of tight junctions - blocks phospholipase A2, need strong agent!

Question 6

How does manitol treat vasogentic cerebral edema?

Answer 6

osmotic diuretic
sugar that stays in blood
pulls water out of CSF

Question 7

How do you treat cytotoxic cerebral edema?

Answer 7

Resistance to any known medical treatment

Question 8

Hydrocephalus

Answer 8

Accumulation of CSF in ventriclar system

• if baby, skull not closed, and head gets bigger
• In adult, skull closed, creates pressure

Question 9

Non-communicating

Answer 9

Blockage in ventricular system by

• mass
• abscess
• tumor

Question 10

Communicating hydrocephalus

Answer 10

Block in subarachnoid space
Entire ventricular system is enlarged
Causes
-meningitis
-subarachnoid hemorrhage
-Dural sinus thrombosis

Question 11

Ex Vacuo Hydrocephalus

Answer 11

• NO BLOCK
• Ventricular system is dilated due to BRAIN ATROPHY (shrinking)
• Due to degenerative diseases of the brain (Alzheimer)

Question 12

Hydrocephalus due to increased CSF

Answer 12

uncommon

Caused by Tumor in choroid plexus

Question 13

Normal Pressure Hydrocephalus

Answer 13

-Maybe a form of communicating hydrocephalus
-Elderly patient with
gait disturbance
urinary incontinence
dementia
-Often misdiagnosed as Alzheimer disease

-symptoms may be reversible!!!

Question 14

Treatment for Hydrocephalus

Answer 14

1. Get fluid out- surgery to remove tumor/blockage, shunt to redirect CSF drainage
2. Decrease CSF production by Acetazolamide, Furosemide

Question 15

What drugs decrease CSF production and how?

Answer 15

1. Acetazolamide - carbonic anhydrase inhibitor (not commonly used, many adverse effects)
2. Furosemide- Na/K/ CL pump inhibitor

Question 16

Symptoms of increased intracranial pressure?

Answer 16

• can be caused by edema or hydrocephalus
• Headache, papilledema (swelling of optic disc), decreased level of consciousness
• CAN LEAD to herniation of brain

Question 17

Symptoms of Herniation fo brain

Answer 17

-One part of brain gets pushed into another compartment
-Symptoms
Focal neurologic symtoms
“Brainstem” symptoms (respiratory and cardiac arrest, coma)
FATAL OFTEN

Question 18

Subfalcine Herniation

Answer 18

Expansion of one hemisphere displaces cingulate gyrus under the falx

Question 19

Transtentorial Herniation

Answer 19

Temporal lobe compressed against tentorium

affects
Third cranial nerve
Posterior Cerebral arter
Brainstem
Contralateral cerebral peduncle

Question 20

Tonsillar Herniation

Answer 20

Displacement of the cerebellar tonsils through the foramen magnum

• compresses medulla, compromising vital respiratory and cardiac centers
• LIFE THREATENING!!!!