Hydrocephalus

Front 1

What is the most common structural cause of hydrocephalus?

Back 1

An obstruction of normal CSF flow.

Front 2

What are the effects of hydrocephalus on the brain?

Back 2

Stretches periventricular white matter;

Reduces blood flow;

Build up of toxins;

Subcortical disconnection syndrome

Front 3

What are the 4 common types of congenital hydrocephalus?

Back 3

Spina bifida Myeomeningocele.

Aqueductal Stenosis

Dandy-Walker Syndrome

Prematurity IVH

Front 4

Compare internal vs. external hydrocephalus.

Back 4

Internal Hydrocephalus: obstructive hydrocephalus (usually foramen of Monro or Aqueductal Stenosis)

External Hydrocephalus: absorption hydrocephalus (usually caused by meningitis) that affects the subarachnoid spaces.

Front 5

What are the medical findings in Internal (Obstructive) Hydrocephalus?

Back 5

Increased ICP;

Ventricular Dilation;

Compression of the brain

Front 6

How is communicating hydrocephalus different from non-communicating hydrocephalus.

Back 6

Communicating hydrocephalus is NOT an obstructive process, but and ABSORPTION problem (i.e., external hydrocephalus). May or may not result in increased ICP.

Non-communicating hydrocephalus is due to an obstruction (also known as ex vacuo, arrested, or compensated hydrocephalus).

Front 7

What conditions can result in communicating hydrocephalus?

Back 7

Alzheimer disease;

Loss of brain tissue;

Meningitis

Front 8

Is communicating or non-communicating hydrocephalus typically associated with congenital hydrocdphalus?

Back 8

Non-communicating

(However, non-communicating hydrocephalus can also be developed by other obstructions, like cysts, tumors, etc.).

Front 9

What is the most common type of hydrocephalus in adults?

Back 9

Normal pressure hydrocephalus

Front 10

What are the classic clinical symptoms of normal pressure hydrocephalus?

Back 10

Patients are wet, whacky, and wobbly.

[Urinary incontinence, confusion, gait (often magnetic) abnormalities].

Front 11

What type of hydrocephalus is posttraumatic hydrocephalus normally classified as?

Back 11

Non-communicating (also acquired).

Front 12

What are the three types of congenital hydrocephalus associated with disorders of embryogenesis?

Back 12

Dandy-Walker Syndrome;

Spina Bifida Myeomeningocele;

Aqueductal stenosis

Front 13

What is a common acquired cause of congenital hydrocephalus?

(remember, congenital simply means early rather than genetic, per se).

Back 13

Premature IVH.

Front 14

What hydrocephalus classifications are associated with congenital hydrocephalus?

Back 14

Internal, obstructive, and non-communicating (these three classifications tend to go together).

Front 15

What is the most common cause of congenital hydrocephalus?

Back 15

Spina bifida Myeomeningocele;

Accounts for 70% of all congenital hydrocephalus

Front 16

How does Spina Bifida Myeomeningocele lead to hydrocephalus?

Back 16

Chiari II malformation where the posterior fossa is too small, allowing the malformed cerebellum to compress the 4th ventricle.

Front 17

What is the neuropathology of Aqueductal Stenosis?

Back 17

Narrowing of the aqueduct of Sylvius between the 3rd and 4th ventricles.

Front 18

How does Dandy-Walker Syndrome cause hydrocephalus?

Back 18

Cystic fourth ventricle. Also, the cerebellar vermis is not developed (complicating the interpretation of motor deficits).

Also, it has the opposite problem of Spina Bifida Myelomeningocele in that the posterior fossa is enlarged.

Front 19

How does premature IVH cause hydrocephalus?

Back 19

Bleeding from the germinal matrix obstructs blood flow.

Front 20

Does IVH related hydrocephalus progress?

Back 20

No. It is arrested.

Front 21

How are premature IVH graded?

Back 21

Grade 1- Bleeding from the Germinal Matrix,but not into the ventricles.

Grade 2- Bleeding from the Germinal Matrix, and into the ventricles.

Grade 3- Bleeding with enlarged ventricles (i.e., hydrocephalus)

Grade 4- Bleeding into periventricular tissue, and ventricular enlargement (i.e., hydrocephalus).

HYDROCEPHALUS IS ONLY ASSOCIATED WITH GRADE 3&4.

Front 22

What age increases risk of NPH?

Back 22

65 or older.

Front 23

What differences in the skull have implications for NPH vs. congenital hydrocephalus?

Back 23

In NPH, the skull is formed and there is nowhere for brain to go.

In congenital hydrocephalus, the skull is not formed. In fact, Dandy-Walker Syndrome and Aqueductal Stenosis are often notable because the infant's head is "like an orange on a toothpick"

Front 24

What is the most common shunt placement site in the brain?

Back 24

Right posterior ventricle that then drains into the peritoneal cavity.

Front 25

What is a third ventriculostomy?

Back 25

When a perforation is placed in the floor of the third ventricle in order to drain CSF into a subcistern.

(NOTE: Often used when shunts cannot; and primarily to treat Aqueductal stenosis).

Front 26

What are common cognitive symptoms of congenital Hydrocephalus?

Back 26

FINE MOTOR SKILL IMPAIRMENTS;

Posterior inattention

Timing;

Hypersocial

Front 27

What symptoms or associated features of NPH are associated with poorer cognitive outcomes following shunting?

Back 27

Severe gait difficulties are negatively associated with outcomes.

NPH related to dementia or stroke is also indicative of poor outcomes.

Front 28

What type of academic problems is most negatively affected by hydrocephalus?

Back 28

Math

Followed by reading comprehension and writing.

Front 29

What academic abilities are intact in hydrocephalus?

Back 29

Word reading and spelling.

Front 30

How will a patient with hydrocephalus tend to preform on the WAIS-IV?

Back 30

Better VCI than PRI.

Slowed motor and processing speed affecting tests with those components (e.g., Block Design)

Front 31

What are the primary attention problems in congenital hydrocephalus? How do they differ from ADHD?

Back 31

Problems with the posterior attention system (i.e., orienting and engaging), but stable engagement once oriented and engaged.

Differs from ADHD in that, ADHD patients have more problems with the anterior attention system (i.e., self-regulation, maintaining stable engagement).

Front 32

How is processing speed in hydrocephalus?

Back 32

Terrible.

Front 33

Describe language functioning in hydrocephalus.

Back 33

Problems with "higher" language functions of comprehension, prosodics, and pragmatics

BUT

Intact raw functions of vocabularly, grammar, and expressive language.

Front 34

Visuospatial functioning in hydrocephalus is...

Back 34

impaired for complex configurational skills, but categorical perception is intact.

Front 35

Describe executive functioning in hydrocephalus

Back 35

Primarily due to attention and motor problems. Performance on executive functioning tests is characterized by improvements across trials.

Front 36

What are typical motor problems in hydrocephalus?

Back 36

Upper extremity motor deficits.

Gait problems in NPH.

Front 37

Describe the emotional/relational considerations in hydrocephalus

Back 37

Hypersocial;

Overly talkative at times;

Intrusive with poor perception of social cues.

BUT

Can have strong interpersonal skills.

Front 38

Do stimulants work for attention problems in hydrocephalus?

Back 38

Not really...at least, not beyond the benefits any of us enjoy on stimulants. This is because it is a posterior attention problem.

Front 39

How do children with congenital hydrocephalus tend to perform on verbal compared to non-verbal memory measures?

Back 39

Comparatively poor on nonverbal

Front 40

In which direction does hydrocephalus progress in terms of thinning the ventricles?

Back 40

Posterior to anterior

Helps explain the PRI being worse that the VCI, too.