CEREBROSPINAL FLUID
Dr. Roldigence Mhaku, DDS
12/13/2024 Cerebrospinal Fluid 1
INTRODUCTION
Cerebrospinal fluid (CSF) is a clear fluid similar
to blood serum with most of the proteins removed.
It bathes the brain and the spinal cord and
provides a protective cushion around the CNS.
CSF allows the brain to float within the cranial
cavity, so that it does not rest directly on the surface
of the skull or dura mater.
CSF is a part of Extracellular fluid (ECF).
12/13/2024 Cerebrospinal Fluid 2
PROPERTIES OF CSF
Volume: approximately 150 mL.
Rate of formation: approximately 0.4 mL/min.
Specific gravity: 1.005
Reaction: Alkaline.
12/13/2024 Cerebrospinal Fluid 3
COMPOSITION OF CSF
CSF is mainly composed of 99.13% of
water and 0.87% of solids.
Solids contains Organic and inorganic
substances.
12/13/2024 Cerebrospinal Fluid 4
SOLID COMPOSITION OF CSF …
Organic Substances Inorganic Substances
Proteins Sodium
Amino acids Calcium
Sugar Potassium
Cholesterol Magnesium
Urea Chlorides
Uric acid Phosphates
Creatinine Bicarbonates
Lactic acid Sulfates
12/13/2024 Cerebrospinal Fluid 5
FORMATION OF CSF
About 80-90% of the CSF is produced by
specialized ependymal cells within the lateral
ventricles.
CSF fills the ventricles, the subarachnoid space
of the brain and spinal cord, and the central
canal of the spinal cord.
Choroid plexuses is a collection of specialized
ependymal cells, support tissues and associated
blood vessels.
Choroid plexus are tuft of capillary projections
present inside ventricles and covered by pia
mater and Ependymal covering.
12/13/2024 Cerebrospinal Fluid 6
FORMATION OF CSF …
Choroidal formation involves two processes that
occur in series.
First is filtration across the choroidal capillary
wall, and
Second is secretion by the choroidal epithelium.
Within the choroid plexus, hydrostatic pressure of
the choroidal capillaries initiates the transfer of
water and ions to the interstitial fluid and then to
the choroidal epithelium.
12/13/2024 Cerebrospinal Fluid 7
FORMATION OF CSF …
Water and ions are then transferred into the
ventricles either by;
i. Intracellular movement across the epithelial
membranes,
ii. Intercellular movement across the apical tight
junctions between epithelial cells.
Both of these processes probably depend on ion
pumps.
12/13/2024 Cerebrospinal Fluid 8
FORMATION OF CSF …
Secretion of CSF results from the active transport
of sodium, which is dependent on the membrane-
bound, sodium-potassium activated ATPase present
at the apical (ventricular) surface of the choroidal
epithelium.
The presence of autonomic nerve terminals in the
choroid plexus suggests a neural control of CSF
secretion.
12/13/2024 Cerebrospinal Fluid 9
12/13/2024 Cerebrospinal Fluid 10
MECHANISM OF FORMATION OF CSF
CSF is formed by the process of secretion.
Active transport mechanism is involved in CSF secretion.
CSF is formed by the transport of water and solutes from
the blood through a variety of mechanisms.
The majority of the fluid enters the ventricles by
following a Na+ concentration gradient.
Ependymal cells of the choroid plexus actively transport
Na+ into the ventricles, and water passively follows.
Endothelial cells of the blood vessels in the choroid
plexuses, which are joined by the tight junctions, form the
blood-brain barrier, or the blood-cerebrospinal fluid
barrier.
12/13/2024 Cerebrospinal Fluid 11
FLOW OF CSF
The flow rate of CSF from its origin to the
point at which it enters the bloodstream is
about 0.4 mL/min.
About 23mL of CSF fills the ventricles and
117mL fills the subarachnoid space.
CSF from the lateral ventricles flows
through the intervertebral foramina to the
third ventricle.
CSF flows from the third ventricle through
the cerebral aqueduct to the fourth
ventricle.
12/13/2024 Cerebrospinal Fluid 12
12/13/2024 Cerebrospinal Fluid 13
EXIT OF CSF
CSF can exit the interior of the brain only from the
fourth ventricle.
One median aperture (foramen of Magendie), which
opens through the roof of the fourth ventricle.
Two lateral apertures (foramen of Luschka), which open
through the walls, allow CSF to pass from the fourth
ventricle to the subarachnoid space.
Some CSF continues to flow inferiorly into the central
canal of the spinal cord. However, parts of the central canal
are closed off in adults, so the amount circulating there is
very small.
12/13/2024 Cerebrospinal Fluid 14
12/13/2024 Cerebrospinal Fluid 15
CSF and BLOODSTREAM
Presence of clusters of fingerlike protrusions of
arachnoid tissue called arachnoid villi form
arachnoid granulations, which penetrate into
dural venous sinuses, especially the superior
sagittal sinus.
CSF passes into the blood-filled dural venous
sinuses through these granulations.
From the dural venous sinuses, the blood
drains into the internal jugular veins to enter
the veins of the general circulation.
12/13/2024 Cerebrospinal Fluid 16
12/13/2024 Cerebrospinal Fluid 17
12/13/2024 Cerebrospinal Fluid 18
ABSORPTION OF CSF
Mostly absorbed by the Arachnoid villi into
Dural sinuses and spinal veins.
Small amount is absorbed along the perineural
spaces into cervical lymphatics and in to the
perivascular spaces.
12/13/2024 Cerebrospinal Fluid 19
Mechanism of Absorption of CSF
By filtration due to pressure gradient between
hydrostatic pressure in the subarachnoid space
fluid and the pressure that exists in the Dural
sinus blood.
The colloidal substances pass slowly and
crystalloids are absorbed rapidly.
12/13/2024 Cerebrospinal Fluid 20
FUNCTIONS OF CSF
i. Protects the brain from mechanical injury:
The brain has a higher specific gravity than CSF.
Therefore, the brain floats freely in the CSF.
Protects the brain from minor injuries during day-to-day
activities, and impact of major injuries is greatly diminished.
12/13/2024 Cerebrospinal Fluid 21
FUNCTIONS OF CSF …
ii. Cushion effect:
CSF supports the brain; cushion-like effect.
iii. Provides microenvironment for brain cells:
Serves as a fluid buffer; buffers changes in the blood
and brain interstitial fluid. Therefore, ensures
constancy in the external environment of neurons.
iv. Removal of proteins and waste products of
metabolism:
CSF serves the function of lymphatics in the CNS,
as lymphatics are absent in the CNS.
12/13/2024 Cerebrospinal Fluid 22
FUNCTIONS OF CSF …
v. Play role in homeostasis:
Changes in blood gases in the CSF.
Chemoreceptors sense and regulate respiration and
blood pressure.
vi. Blood-CSF barrier
vii. Helps to diagnose diseases and abnormalities
in composition, like meningitis, encephalitis.
viii. It provides some nutrients to CNS tissues.
12/13/2024 Cerebrospinal Fluid 23
APPLIED ASPECTS
LUMBAR PUNCTURE
HYDROCEPHALUS
12/13/2024 Cerebrospinal Fluid 24
LUMBAR PUNCTURE
Is a process by which CSF is taken from spinal
subarachnoid space for study.
A Lumbar Puncture needle is introduced usually
between 3rd and 4th lumbar spines with subject lying
on his side.
Is applicable for CSF analysis and drug delivery.
12/13/2024 Cerebrospinal Fluid 25
12/13/2024 Cerebrospinal Fluid 26
12/13/2024 Cerebrospinal Fluid 27
HYDROCEPHALUS
Pathological accumulation of CSF within brain
spaces.
There are two types:
Communicating (external)
Non communicating (internal)
12/13/2024 Cerebrospinal Fluid 28
HYDROCEPHALUS …
Communicating (external): Excess fluid in
subarachnoid space with the rate of formation
greater than absorption.
Occurs when the flow of CSF is blocked after it
exits the ventricles.
The word “communicating” refers to the fact that
CSF can still flow between the ventricles, which
remain open.
12/13/2024 Cerebrospinal Fluid 29
HYDROCEPHALUS …
Non communicating (internal): Excess fluid
accumulation in ventricular system proximal to
block.
Also called obstructive hydrocephalus: Occurs
when the flow of CSF is blocked along one or more
of the narrow passages connecting the ventricles.
One of the most common causes is aqueduct
stenosis, a narrowing of the aqueduct of Sylvius, a
small passage between the third and fourth
ventricles in the middle of the brain.
12/13/2024 Cerebrospinal Fluid 30
12/13/2024 Cerebrospinal Fluid 31
12/13/2024 Cerebrospinal Fluid 32
References
SEELEY’S ANATOMY & PHYSIOLOGY, 10TH EDITION, 2014
MICHAEL P. Mc KINLEY, ANATOMY AND PHYSIOLOGY: AN
INTEGRATIVE APPROACH, 2013
12/13/2024 Cerebrospinal Fluid 33
