Neurology > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

(42 cards)

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1
Q

What is normal intracranial pressure?

A

7-15mmHg

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2
Q

Where in the brain is CSF produced?

A

Choroid plexus - 500ml/day

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3
Q

State three compensatory mechanisms for maintenance of intracranial pressure

A
  • decrease in CSF volume through foramen magnum
  • decrease in blood volume through sinuses
  • decrease in extracellular fluid
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4
Q

State the equation for cerebral perfusion pressure

A

MAP - ICP = CPP

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5
Q

What should CPP normally be?

A

MAP - ICP = CPP
90 - 10 = 80
Anything above 70 is normal

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6
Q

What happens to ICP in pain or injury? How does this impact CPP?

A

ICP increases in response to pain or injury, hypotension often occurs in trauma so as a result CPP falls

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7
Q

State the equation for cerebral blood flow

A

CBF = CPP/vascular resistance

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8
Q

Over what range of blood pressure does CBF remain constant?

A

50-150mmHg

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9
Q

Name three autoregulatory mechanisms which maintain CBF

A
  • pressure (BP/ICP changes cause dilation/constriction)
  • metabolic (chemical stimuli cause dilation)
  • carbon dioxide (acts as a potent vasodilator)
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10
Q

State the causes of increased ICP

A
  • mass effect
  • brain swelling
  • increased venous pressure (can be physiological)
  • obstruction (chiari syndrome)
  • increased production (choroid plexus papilloma)
  • decreased absorption (SAH/meningitis)
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11
Q 
For the following age groups state the normal ICP
adults 
newborn 
kids 
older kids
A

Adults 7-15mmHg
Newborn 1.5-6mmHg but can be less than 0
Young kids 3-7mmHg
Older children 10-16mmHg

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12
Q

What are the early signs/symptoms of increased ICP?

A
  • Loss of consciousness
  • headache due to fluid on brain
  • papillary dysfunction/papilloedema
  • visual changes and upgaze abnormality
  • nausea and vomiting
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13
Q

What are the late signs/symptoms of increased ICP?

A
  • coma
  • fixed, dilated pupils
  • hemiplegia
  • bradycardia (Cushings triad)
  • hyperthermia
  • increased urinary output (very late brainstem death)
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14
Q

What are the two main types of hydrocephalus?

A

Communicating

Non-communicating

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15
Q

What is the difference between communicating and non-communicating hydrocephalus?

A

Communicating - enlargement of 3rd and 4th ventricle

Non-communicating - aqueductal stenosis

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16
Q

What is the goal of increased ICP management?

A

Maintain CPP and prevent ischaemia/compression

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17
Q

What non-medical interventions help in raised ICP?

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A

Maintain head in midline - 30-45 degrees
Avoid gagging, coughing, loosen tubes/collars
Decrease environmental stimuli
Maintain normothermia, fluid and electrolytes, normocarbia

18
Q

Describe the medical management for increased ICP

Study These Flashcards
A

Diuretics - hypertonic saline requires lower volumes
Barbiturate coma
Antiepileptics to avoid seizures which may further increase ICP

19
Q

What surgical treatment can be used in increased ICP?

Study These Flashcards
A

Bifrontal decompression
Remove mass lesion
CSF diversion

20
Q

Describe a VP shunt

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A

Ventriculoperitoneal shunt goes from the right ventricle (non-dominant side) and travels under the skin behind the ear to the peritoneum where it drains and is absorbed back into the venous system.

21
Q

Name some alternative drainage sites

Study These Flashcards
A
  • pleura (risk of pleural effusion)

- SVC (directly into the heart)

22
Q

What causes normal pressure hydrocephalus?

Study These Flashcards
A

Idiopathic disease of the elderly

23
Q

State the typical symptoms of normal pressure hydrocephalus

Study These Flashcards
A

Hakim’s triad

  • abnormal gait
  • urinary incontinence
  • dementia
24
Q

What will MRI of normal pressure hydrocephalus show?

Study These Flashcards
A

Enlarged 3rd and 4th ventricles out of proportion to the cortical sulcal enlargement

25
How is normal pressure hydrocephalus investigated?
LP LP drain test LP infusion studies
26
What is the treatment for normal pressure hydrocephalus?
VP shunt with appropriate pressure valve
27
What is thought to cause idiopathic intracranial hypertension?
Unknown - CSF imbalance, hormones, venous pressure (stenosis) may be involved
28
Who typically gets idiopathic intracranial hypertension?
Overweight western women of child bearing age
29
What condition is IIH associated with?
PCOS
30
State the signs and symptoms of IIH
- headache - double vision/blurred vision - tinnitus - radicular pain - papilloedema
31
How is IIH investigated?
``` LP CT/MR head CT venogram Fundoscopy/ophthalmology review Must rule out other pathologies ```
32
How is IIH treated?
Weight loss Carbonanhydrase inhibitors - acetazolamide and topiramate Diuretics CSF diversion Interventional radiology (venous sinus plasty/stenting) Optic Nerve Sheath Fenestration
33
What is the problem with venous stenting?
It is permanent and cannot be removed and 50% go on to need a shunt
34
What is acetazolamide used for?
Raised ICP but also altitude sickness among other diseases
35
Where do coloid cysts arise from?
99% foramen of munro - usually asymptomatic but can cause obstruction or hydrocephalus
36
What is Cushing's triad?
Decreased HR Increased BP Irregular respiration
37
Describe the compensation of CPP when ICP increases
MAP - ICP = CPP | CPP increases so therefore MAP increases by vasoconstriction to reduce CPP
38
Name the congenital causes of hydrocephalus
Aqueductal stenosis - chiari malformation - spina bifida - Dandy walkers syndrome
39
What malformation occurs in Chiari I?
Caudal displacement of cerebellar tonsils
40
What malformation occurs in Chiari II?
Central displacement of cerebellum and medulla | Herniation of the fourth ventricle
41
How will chiari I present?
Headache, downbeat nystagmus, central cord symptoms (teenage years)
42
How will chiari II present?
Severe brainstem dysfunction in infants and weakness that may progress to quadriplegia
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