Hydrocephalus

Question 1

Normal pressure hydrocephalus triad (Hakim’s triad)

Answer 1

Difficulty walking/abnormal gait
urinary incontinence
dementia

Question 2

what does the skull contain

Answer 2

brain
blood
CSF

Question 3

what is the normal range of ICP

Answer 3

7-15mmHg

Question 4

pathway of CSF production and circulation

Answer 4

choroid plexus in lateral ventricles
interventricular foramen of monro
3rd ventricle 
cerebral aqueduct
4th ventricle 
foramen of magendie and luschka 
subarachnoid space
arachnoid granulation 
dural venous sinuses

Question 5

what is the equation including ICP, MAP + CPP

Answer 5

CPP = MAP - ICP

Question 6

MAP = DBP + _PP

Answer 6

1/3PP

Question 7

does CPP = CBF

Answer 7

no

Question 8

what is Cushing’s response

Answer 8

occurs in the case of raised ICP

Question 9

features of Cushing’s response

Answer 9

hypertension
bradycardia
irregular breathing

Question 10

over which BP ranges does autoregulation occur

Answer 10

50-150mmHg

Question 11

raised CO2 causes cerebral vasodilatation/constriction

Answer 11

vasodilatation

Question 12

hypo/hyperventilation causes raised CO2

Answer 12

hypoventilation increases CO2

Question 13

low CO2 causes cerebral vasodilatation/constriction

Answer 13

vasoconstriction

Question 14

hypo/hyperventilation causes low CO2

Answer 14

hyperventilation

Question 15

causes of raised ICP

Answer 15

mass effect
oedema
impaired venous outflow
CSF / hydrocephalus

Question 16

signs and symptoms of raised ICP

Answer 16

drowsy
slow 
anisocoria (difference in pupil size)
papilloedema 
Cushing's response
N+V
hyperthermia

Question 17

supportive management of raised ICP

Answer 17

maintain head in midline
head of bed at 30 degree angle 
treat hyperthermia 
maintain fluid and electrolyte balance
maintain normocarbia

Question 18

medical management of raised ICP

Answer 18

mannitol, hypertonic saline, furosemide, urea
barbiturate induced coma (last line)
anti epileptic drugs 
surgical decompression 
remove mass 
CSF shunt

Question 19

list types of hydrocephalus

Answer 19

communicating
non-communicating 
congenital 
acquired
normal pressure

Question 20

what is communicating hydrocephalus

Answer 20

CSF obstruction outwith ventricles

ALL ventricles are enlarged

Question 21

what is non-communicating hydrocephalus

Answer 21

CSF obstruction within ventricular system
enlargement of lateral and 3rd ventricles only
normal 4th ventricle

Question 22

what is a non-communicating hydrocephalus also known as

Answer 22

obstructive hydrocephalus

Question 23

clinical features of obstructive/non-communicating hydrocephalus

Answer 23

swollen head

sunset eyes / upgaze paralysis

Question 24

what is a colloid cyst

Answer 24

benign epitheliated cyst usually located at foramen on monro

Question 25

hydrocephalus ex vacuo is a true hydrocephalus, true or false

Answer 25

false | it is as a result of brain atrophy

Question 26

what is normal pressure hydrocephalus

Answer 26

idiopathic disease of the elderly

Question 27

what is seen on a scan of someone with normal pressure hydrocephalus

Answer 27

large ventricles and large sylvian fissures

Question 28

management of normal pressure hydrocephalus

Answer 28

lumbar drain test lumbar infusion studies - less done MoCA and MMSE done before and after lumbar drain for comparison VP shunt with low pressure valve

Question 29

what is idiopathic intracranial hypertension IIH also known as

Answer 29

pseudotumour cerebri

Question 30

who is affected by IIH

Answer 30

young obese women of child bearing age

Question 31

is there ventricular dilatation in IIH on imaging

Answer 31

no | imaging will look normal

Question 32

signs and symptoms of IIH

Answer 32

``` debilitating headache double vision and blurring pulsatile tinnitus radicular pain papilloedema ```

Question 33

investigations for IIH

Answer 33

LP CT, MRI CTV fundoscopy and ophthalmology

Question 34

management of IIH

Answer 34

``` weight loss acetozolamide (carbonic anhydrase inhibitor) topiramate diuretics VP shunt ```