CEREBROSPINAL FLUID(LIQUOR
CEREBROSPINALIS)
BY
ABDULMUJEEB
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Introduction
Entire CNS is bathed by a special fluid
called cerebrospinal fluid(liquor
cerebrospinalis)
A clear, colorless transparent, tissue
fluid
present in the cerebral ventricles, spinal
canal, and subarachnoid spaces.
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Formation of CSF
Site of formation:
-Choroid plexus of the ventricles of the brain
Choroid plexus:
-aggregated blood vessels
-selectively permeable-permissive Smaller
molecule(ions,water)
- impermeable(blood cells,etc)
-
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The Cerebrospinal Fluid
Rate of formation:
30-40 ml
About 20 -25 ml/hour within the
ventricles
550ml/day in adults
110-120 ml in the
subarachnoid
Turnover 3.7 times a space
day of which 75-80 ml in
spinal part and 25-30 ml in
Total quantity 150ml
the cranial part. 8
Properties of Cerobrospinal Fluid
A l k aline Ce
ll
ly
Slight 33) and m cou
(pH7. not m3 n
t:
does 0-
o a g u late 3
c /
t
en
ar
sp n
CSF
ra
id , t
flu ear
60- O pre
H2
Cl
150 ssu
mm re
of
Specific gravity
1.004-1.007
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Chemical contents of the
cerebrospinal fluid
Proteins = 20-40 mg/100 ml
Glucose = 50-65 mg/100 ml
Cholesterol = 0.2 mg/100 ml
Na+ = 147 meq/Kg H2O
Ca+ = 2.3 meq/kg H2O
Urea = 12.0 mg/100 ml
Creatinine = 1.5 mg/100 ml
Lactic acid = 18.0 mg/100 ml
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Production of the
Cerebrospinal Fluid
largely by choroid plexus of the lateral ventricles
and remainder in the third and fourth ventricles.
About 30% formed from the ependymal cells
lining the ventricles and other brain capillaries.
Small quantity from the brain itself through the
perivascular spaces surrounding the blood
vessels passing through the brain.
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Choroid Plexus and CSF Production
The choroid plexuses; net works of
capillaries and ependymal cells in
the ventricles.
CSF is formed primarily by
secretion and filtration
Choroid plexus actively secrete CSF
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Blood-cerebrospinal fluid (BCF)
barrier
Formed by the components of the
choroid plexus
Selectively permeable barrier
This Protects the brain and spinal cord
from harmful substances.
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Choroid plexus and BCF barrier
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MECHANISM OF
FORMATION
The choroid plexus, is covered by a thin
layer of epithelial cells(ependymal cell).
Secretion of CSF depends mainly on
active transport of ions(Na+,Cl-,HCO3)
from the blood
through epithelial cells lining the
outside of the plexus.
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MECHANISM OF
FORMATION
The Na+ in turn pull along large amounts
of Cl-
Osmotically active sodium chloride
increases
Almost immediate osmosis of water
through the membrane, thus providing
the fluid secretion 17
Active
MECHNISM OF transport of
CSF PRODUCTION
Na+
Na+
l c ells Cl- Electrovalent
elia attraction of
epith Na+ and Cl-
d
s an
C. P l exu Na+
Na+ -
Increased Cl Cl-
quantity of Na+
sodium chloride
in CSF
Na+ -
Cl
Osmosis of
water CSF
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CIRCULATION OF CSF
Choroid plexus
Fo
ram
en
of Lateral ventricles
m on
ro
Third ventricle
Cerebral aqueduct tricle
ven
th
F our
Foramina o
f luschka
Foramina o
f Megendi
e 19
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CIRCULATION OF CSF
CSF slowly moves through
cerebromedullary and pontine cisterns
flows superiorly through the interval in the
tentorium cerebelli
to reach the inferior surface of the
cerebrum.
It moves superiorly over the lateral aspect
of each cerebral hemisphere.
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ABSORPTION OF CSF THROUGH
ARACHNOID VILLI (I)
The arachnoidal villi;
fingerlike inward projections of the
arachnoidal membrane
villi form arachnoidal granulations can
protrude into the sinuses.
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The arachnoidal villi
endothelial cells covering the villi
have vesicular passages
large enough to allow relatively
free flow of cerebrospinal fluid
along with some dissolved proteins
and blood cells.
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ABSORPTION OF CSF THROUGH
ARACHNOID VILLI (II)
the arachnoid villi
Accumulation of CSF within the
extending into the
subarachnoid space
dural venous sinuses
increase in pressure within the
arachnoid villi.
a conduit for a one-
way flow of excess
CSF to be returned
This pressure exceeds the pressure
of blood in the venous [Link] the blood within
the dural venous
sinuses. 26
FUNCTIONS OF CSF
Bouyancy
Weight of human brain in air; about 1500g, while
in CSF; about 50g
A shock absorber
A mechanical buffer via its cushioning effects
between the brain and cranium
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FUNCTIONS OF CSF
Reservoir and regulates the contents
of the cranium
Medium for nutritional exchange in
CNS
Transport hormones and hormone
releasing factors
Removes the metabolic waste
products through absorption
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CSF AND PROTEINS
Marked Increase in CSF protein (up to 500 mg/dl)
in bacterial meningitis.
A more moderate increase (150-200 mg/dl) occurs
in inflammatory diseases of meninges (meningitis,
encephalitis), intracranial tumors, subarachnoid
hemorrhage, and cerebral infarction.
A more severe increase occurs in the Guillain-Barré
syndrome and acoustic and spinal schwannoma.
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Multiple Sclerosis
CSF protein is normal or mildly increased.
Increased IgG in CSF, but not in serum
90% have oligoclonal IgG bands in the CSF only
not in the serum.
The CSF often contains myelin fragments and
myelin basic protein (MBP).
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CSF AND LOW GLUCOSE
suppurative tuberculosis
Fungal infections
Sarcoidosis
Meningeal dissemination of tumors.
Glucose is consumed by leukocytes and tumor
cells.
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Xanthochromia [blonde color] of the
CSF
following subarachnoid hemorrhage
is due to oxyhemoglobin which
appears in 4 to 6 hours and bilirubin
which appears in two days.
Xanthochromia may also be seen
with hemorrhagic infarcts, brain
tumors, and jaundice.
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CSF AND TUMOUR CELLS
Tumor cells indicate dissemination of metastatic or
primary brain tumors in the subarachnoid space.
The most common among the latter is
medulloblastoma.
They can be best detected by cytological examination.
A mononuclear inflammatory reaction is often seen in
addition to the tumor cells.
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LUMBAR PUNCTURE
A lumbar puncture also called a spinal tap
is a procedure where a sample of
cerebrospinal fluid is taken for
examination.
CSF is mainly used to diagnose meningitis
[an infection of the meninges] and other
conditions of the brain and spinal cord.
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Patient usually lie on a bed on side with knees
pulled up against the chest.
It may also done with sitting up and leaning
forward on some pillows. Sterilize the area.
push a needle through the skin and tissues
between two vertebra into the space around
the spinal cord which is filled with CSF.
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LUMBAR PUNCTURE
CSF leaks back through the needle and is
collected in a sterile container.
As soon as the required amount of fluid is
collected the needle is taken out and a plaster
is put over the site of needle entry.
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LUMBAR PUNCTURE
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CEREBROSPINAL FLUID
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CEREBROSPINAL FLUID
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CEREBROSPINAL FLUID
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CEREBROSPINAL FLUID
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CEREBROSPINAL FLUID
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LUMBAR PUNCTURE
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HYDROCEPHALUS
Hydrocephalus" means excess water in the
cranial vault.
This condition is frequently divided into
communicating hydrocephalus and
noncommunicating hydrocephalus.
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HYDROCEPHALUS
In communicating hydrocephalus fluid
flows readily from the ventricular system
into the subarachnoid space,
in non-communicating hydrocephalus fluid
flow out of one or more of the ventricles is
blocked.
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HYDROCEPHALUS
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Decreased CSF
Pressure
• Spinal-subarachnoid block
• Dehydration
• Circulatory collapse
• CSF leakage
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Elevated CSF Pressure
• Congestive heart failure
• Meningitis
• Superior vena cava syndrome
• Cerebral edema
• Mass lesion
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The blood-brain barrier
• BBB is a concept derived from dye-
exclusion studies rather than a
specific anatomic structure.
• Certain substances in the CSF are
tightly regulated by specific
transport systems.
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BLOOD BRAIN BARIER
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Blood Brain Barrier (BBB)
A restrictive barrier around blood vessels in
the brain (created by astrocytes).
Prevents most blood-borne toxins from
entering the brain but not an absolute
barrier.
Nutrients such as O2, and glucose can pass.
Plus CO2, alcohol, nicotine, and anesthetics.
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Tha
you nks fo
r r
att
ent
ion!
!!
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