Hydrocephalus

Question 1

What is the treatment for acute hydrocephalus (CH or NCH)?

Answer 1

External Ventricular Drain (EVD)

Question 2

What is the mainstay treatment for CH?

Answer 2

Ventriculo-peritoneal shunt

Others: Lumbar-peritoneal, ventricle-atrial

Question 3

In addition to surgical removal of obstruction in NCH, what shunt placements can be carried out?

Answer 3

Third ventriculostomy (to bypass cerebral aqueduct) with ventriculoperitoneal shunt

Question 4

What is the incidence of shunt failure in first year?

Answer 4

40%

5% every year after that

Question 5

What are indications to doing a lumbar puncture?

Answer 5

1. Meningitis
2. Subarachnoid hemorrhage
3. Meningoencephalitis
4. Idiopathic Intracranial Hypertension
5. Malignancy

Question 6

What are contraindications to doing a lumbar puncture?

Answer 6

1. Bleeding diathesis
2. Raised ICP
3. Localized skin/soft tissue infection over site
4. Patients with uncontrolled cardiovascular and respiratory conditions

Question 7

What are complications of a lumbar puncture?

Answer 7

1. Brainstem herniation
2. Headache (Intracranial hypotension)
3. Infection
4. Hematoma
5. Subarachnoid epidermal cyst formation
6. Back pain

Question 8

If a patient develops a headache post lumbar puncture, how do you manage the patient?

Answer 8

1. Patient should lie in supine position for at least 2 hours
2. IV or PO administration of caffeine
3. Epidural blood patch
4. Fluids (hydration)

Question 9

If a patient develops a nerve root irritation post lumbar puncture, how do you manage the patient?

Answer 9

1. If pain or motor weakness persists, start corticosteroids

2. Neurophysiological tests if pain persists

Question 10

If a patient develops brainstem herniation post lumbar puncture, how do you manage the patient?

Answer 10

1. Remove needle and elevate the bed 30-45degrees (improve venous return from brain)
2. Intubate and hyperventilate patient