CSF, Hydrocephalus and Lumbar Puncture Flashcards Preview

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Flashcards in CSF, Hydrocephalus and Lumbar Puncture Deck (16)
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1

Where is CSF found?

Subarachnoid space

2

Where is the choroid plexus located?

Floor of lateral ventricles

3

What is the aetiology of hydrocephalus?

Aqueductal stenosis
Dandy- Walker malformation
Meningitis
Post-haemorrhagic
Cerebellar stroke
Benign or malignant neoplasia
Chiari malformation

4

What are the symptoms of hydrocephalus in infants?

Cranial enlargement
Splaying of cranial sutures
Irritable
Poor feeding
Engorged scalp veins
Fontanelles full and bulging
Exaggerated reflexes
Respiratory problems
Perinaud's syndrome

5

What are the symptoms of hydrocephalus in older children and adults?

Increased ICP
Headaches worse in morning and on coughing
Papilloedema
Visual disturbances
Gait abnormality
Loss of upgaze or abducens palsy
Impaired consciousness

6

What is the treatment for hydrocephalus ?

Acetazolamide (carbonic anhydrase inhibitor)
External ventricular drain (emergency)
CSF diversion with shunt
Endoscopic ventriculostomy

7

What are the complications of shunting?

Over drainage (low pressure headaches, subdural haematoma)
Under drainage
Blockage
Infection
Seizures
Disconnection
Distal end problems (abdominal hernias, cardiac arrhythmias)

8

What is an endoscopic ventriculostomy?

Fistula created between 3rd ventricle and subarachnoid spaces/ basal cisterns

9

What are the clinical features of non pressure hydrocephalus?

Dementia (potentially reversible)
Gait disturbances
Urinary incontinence

10

What are the clinical features of idiopathic intracranial hypertension?

Headaches and visual disturbance

11

What is the treatment of idiopathic intracranial hydrocephalus?

Loose weight
Acetazolamide
CSF diversion -VP or LP shunt
Optic nerve sheath fenestration

12

What are the indications for lumbar puncture?

Obtain CSF for analysis
Measurement of pressure
CSF drainage for raised pressure
Diagnostic test for normal pressure hydrocephalus

13

What is checked before a lumbar puncture?

Awake and conscious patient
No focal neurological deficit (6th nerve palsy)
CT/MRI (rule out intracranial mass lesion)
Ensure patients not on anticoagulants

14

What are the risks of a lumbar puncture?

Bleeding
Infection
Nerve root injury
Retroperitoneal/ intraabdominal injury
Brainstem herniation

15

How would CSF indicate meningitis?

Cloudy, turbid
Lots of WBC
Protein >1g/L
Low glucose

16

When is CSF described as being xanthochromic?

Yellow due to blood breakdown products, commonly seen in SAH