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Old 03-07-2012
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Neuro Increasing Head Circumference after Myelomeningocele

A 6-month-old girl is brought to the physician for a routine health maintenance examination. She was born with a lumbosacral myelomeningocele which was successfully repaired at 2 days of age. The anterior fontanelle is 6 x 8 cm and bulging, and the posterior fontanelle is 3 x 4 cm and bulging. She has severe motor and sensory deficits involving both lower extremities. A head growth chart shows the following values:
Age
Head circumference (cm)

Birth
34.2
1 month
36.6
2 months
38
4 months
44
6 months
47

Which of the following is the most likely cause of increased intracranial pressure?

A) Acute cerebral edema
B) Decreased absorption of cerebrospinal fluid
C) Dilation of cerebral arteries
D) Intracranial mass lesion
E) Obstruction of lateral sinus
F) Obstruction of superior vena cava
G) Obstruction of cerebrospinal fluid flow
H) Overproduction of cerebrospinal fluid
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Old 03-07-2012
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its arnold chiari malformation type 2 ......so its obstructon of csf flow
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Old 03-07-2012
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Warning!

since she was operated... i think operations such as these involve a shunt procedure...so may be its a blocked shunt

so OBSTRUCTION of CSF is correct ans i think
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Old 03-07-2012
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yeah.. meningomyeloele almost always associated with Arnold-Chiari- brainstem/cerebellar herniation and so Obstruction of CSF outflow...
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Old 03-07-2012
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please can somebody tell me how to calculate head circumference according to age. it will help me understand the ans to the question.
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Old 03-07-2012
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THE ANS IS G. obstruction of cerebrospinal fluid flow. this is Type II Arnold Chiari malformation. it is symptomatic in neonatal period and its severe, presenting with difficulty swallowing, dysphonia, stridor, apnea, there is lumbar myelomeningocele which leads to leg paralysis if not corrected.
Type I Arnold Chiari is less severe but manifest with headache and cerebellar ataxia in adult.
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