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Neurology > Hydrocephalus > Flashcards

Flashcards in Hydrocephalus Deck (40)
1

What is hydrocephalus?

Excess CSF within the intracranial space & ventricular system causing dilation of the ventricles

2

Where is the majority of CS produced? How?

Choroid plexus
Actively via Na pump

3

How much CSF is produced/ day?

450-600cc

4

Hoe often does the CSF turnover each day?

3/4 times

5

Where does the CSF move after leaving the ventricular system?

Subarachnoid space

6

Where is CSF reabsorbed?

Arachnoid granulations

7

Where does CSF move from the arachnoid villi? How?

Venous sinuses
Passively

8

What are the 2 major types of hydrocephalus?

Communicating (CoH)
Non-communicating (NCH)

9

What is communicating hydrocephalus also known as?

Non-obstructive

10

What is non-communicating also known as?

Obstructive

11

In CoH, where is the problem observed?

Most commonly due to CSF resorption rather than over production of CSF

12

What are some of the signs & symptoms observed in CoH?

In infants - increase in head
Headache
Nausea & vomiting
Papillodema
6th nerve palsy
Focal neurological deficit

13

What are some of the causes of CoH?

Subarachnoid haemorrhage
Head trauma
Infective (bacterial meningitis)

14

When does NCH occur?

When there is any physical obstruction to normal CSF flow

15

What are some of the causes of NCH?

Aqueductal stenosis
Tumours
Cysts
Infection
Haemorrhage
Congenital malformations

16

What is the earliest imaging evidence of hydrocephalus?

Dilation of the temporal horn of lateral ventricles

17

What is the treatment for hydrocephalus?

External Ventricular Drain (EVD) - drains the CSF from the ventricular system

18

What is the mainstay of treatment for CoH?

Shunt placement (Ventriculo-peritoneal shunt)

19

How can NCH be treated?

Removal of the obstructing lesion
Shunt placement
Thrid ventriculoectomy

20

What is one of the downsides of VP shunts?

They can fail, disconnection or cause infection

21

What is the mneumonic for the classic triad of NPH?

Wet, Wobbly & Wacky

22

What is one of the reversible causes of dementia?

Normal Pressure Hydrocephalus

23

What are the symptoms described by Wet Wobbly & Wacky in NPH?

Urinary incontinence
Gait disturbance
Dementia

24

What investigations would you do in CoH?

CT/MRI
LP - symptoms improve with CSF removal

25

What is the treatment for patients with NPH?

VP shunt placement

26

What are LPs used in the diagnosis of?

Meningitis
SAH
Malignancy
Meningoencephalitis
Infusion of drugs

27

What are some contraindications for LP?

Increased ICP
Bleeding disorder
Infection at site

28

What needle helps to reduce spinal shock in LP?

Atraumatic

29

At what level do you perform LP?

L3-4 (L4/5)

30

What position should the patient lie at?

Lateral Decubitus Position

31

Which way should the bevel face when performing LP?

Up to keep parallel with nerve/ ligament fibres

32

What ligament will you pierce when performing LP?

Ligamentum flavum

33

How can you assess opening pressure in LP?

Attach manometer

34

How many vials do you take when doing an LP? What are they for?

3
1: Culture & gram stain
2: Glucose & protein
3: Cell count & differential

35

What are some complications of LP?

Back pain
Spinal headache
Bleeding or fluid leak
Infection
Nerve trauma
Brainstem herniation

36

What is the most common complication of LP?

Spinal headache

37

How can you reduce the complications including spinal headache?

Supine position
Caffeine
Hydration

38

In coning or tonsillar herniation, what are the presenting signs?

Altered mental status
Cranial nerve abnormalities
Cushing triad - bradycardia

39

How would you manage a patient who presents with coning?

Raise bed
Mannitol or 3% saline
Intubate patient

40

If you are sending sample for xanthochromia what are you testing for? and what should the sample be contained in?

Blood
Brown paper envelope