Your SlideShare is downloading. ×
  • Like
Cerebrospinal fluid
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Cerebrospinal fluid

  • 5,318 views
Published

 

Published in Health & Medicine
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
5,318
On SlideShare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
363
Comments
0
Likes
3

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. CEREBROSPINAL FLUID CSF DR. U. RATHNA KUMARI MD – Post Graduate IPEM
  • 2. Liquor cerebrospinalis
    • A clear, colorless fluid that surrounds and permeates the CNS.
    • Offers support, protection and nourishment.
    • In essence, the brain "floats" in it.
  • 3.
    • Cerebrospinal fluid (CSF) is a clear fluid present in the ventricles of the brain, the central canal of the spinal cord, and the subarachnoid space.
    • CSF is produced in the brain by modified  ependymal cells in the  choroid plexus  (approx. 50-70%), and the remainder is formed around blood vessels and along ventricular walls. 
  • 4. Functions of CSF
    • Protects, lubricates the brain
    • Provides nutrients, removes waste
    • 90-150 ml adult
    • 10-60 ml in newborn
    • Modulates pressure changes ( Buoyancy)
    • Serves as a chemical buffer to maintain constant ionic environment
    • Serves as a transport medium for nutrients and metabolites, endocrine substances and even neurotransmitters
  • 5.  
  • 6. Location of CSF
    • Two lateral ventricles
    • Third ventricle
    • Fourth ventricle
    • Spinal cord central canal
    • Subarachnoid space
    • Continuous with extracellular fluid of brain parenchyma
  • 7.
    • CSF flows through the subarachnoid space between the arachnoid and pia mater
    • 20 ml of fluid produced every hr in choroids plexus and reabsorbed by arachnoid villi
  • 8.  
  • 9. Formation of CSF
    • Choroid plexuses of lateral, third and fourth ventricles
    • Ependymal lining of ventricular system
    • Pia-glial membrane
    • Blood vessels
    • Cells are believed to actively secrete Na + into the ventricular system in exchange for K + . Sodium ions electrically attract Cl - and osmotically draw water from the blood vascular system to constitute the CSF.
  • 10.  
  • 11. Circulation of CSF
    • Lateral ventricles
    • interventricular foramen of Monroe
    • third ventricle
    • mesencephalic aqueduct
    • (aqueduct of Sylvius)
    • fourth ventricle
    • spinal cord central canal;
    • also, out the lateral apertures to the subarachnoid space to the venous system
  • 12.
    • foramina of Magendie  (Median aperture) and  foramina of Luschka (Lateral apertures);
    • Circulates,
    • Due to pulsation of blood in choroid plexus
    • Due to pulsation of ependymal cells
  • 13. Circulation of CSF
  • 14. Absorption of CSF
    • Through the arachnoid villi, a protrusion of arachnoid membrane into the central venous sinus and other sinuses
    • A valve opens when CSF pressure exceeds venous pressure
    • Absorption by veins and capillaries of CNS
  • 15. arachnoid granulation
  • 16.
    • It is suggested that CSF flow along the  cranial nerves  and spinal nerve roots allow it into the lymphatic channels.
    • plays a substantial role in CSF reabsorbtion, in the  neonate , where arachnoid granulations are sparsely distributed.
    Absorption of CSF
  • 17. Composition of CSF
  • 18. Normal CSF
    • Thin, colourless, clear fluid
    • Pressure 90-180mm WATER (10-100 neonates)
    • 0-5 WBC’s /mm 3 (neonates 0-30/ mm 3 )
    • (Lymphocytes & monocytes)
    • Occasional ependymal or choroid plexus cells
    • Protein 15-45mg/dl
    • Glucose 50-80mg/dl
    • Chloride 113-130 mEq/L
    • Sterile
  • 19. CSF GLUCOSE
    • Glucose enters the CSF by selective transport across the blood-brain barrier.
    • normal value 60 – 70 percent that of the plasma glucose.
    • The diagnostic significance.
    • low CSF glucose can be considerable diagnostic value in determining the causative agents in meningitis.
  • 20. Clinical significance of elevated protein values
    • Elevated total protein values are most frequently seen in pathologic conditions.
    • elevated CSF protein due to damage to the blood brain barrier.
  • 21.
    • CSF GLUTAMINE
    • Glutamine is produced in the CNS by the brain cells from ammonia and alpha-ketoglutarate.
    • removes the toxic metabolic waste product ammonia from the CNS.
    • Normal concentration of ammonia is 8-18 mg/dl.
    • Elevated levels associated with liver disorders.
  • 22.
    • CSF LACTATE
    • Aid in the diagnosis and management of meningitis cases
    • Destruction of tissue within the CNS owing to oxygen deprivation (hypoxia) causes the production of increased CSF lactic acid levels.
  • 23. Blood-Brain Barrier (BBB)
    • physiological barrier to flow of substances from blood to brain tissue
    • The BBB functions to preserve a stable environment for neurons of the CNS
  • 24. Blood-Brain Barrier (BBB)
  • 25. Brain capillary
    • Tight junctions
    • Surrounded by astrocytes
    • Carrier mediated transport of glucose and amino acids
  • 26. Blood-Brain Barrier
    • Lipid soluble molecules will cross easily.
    • High CO 2 /low O 2 produce vasodilation and decrease resistance of BBB
    • Injury or inflammation
    • decreases the resistance of BBB (allows some antibiotics to be used for treatment)
  • 27. Circumventricular organs (CVO)
    • Selected brain areas are not protected by the BBB – the circumventricular organs (CVO) bordering on the 3 rd and 4 th ventricles
      • parts of the hypothalamus - median eminence
      • neurohypophysis
      • pineal gland
      • area postrema
      • subfornical organ
      • subcommissural organ
  • 28. Hydrocephalus
    • An abnormal increase in the volume of CSF
    • Symptoms: sleep changes, spastic paresis, papilledema, bulging of skull in young, seizures, cranial nerve deficits, depression.
  • 29. Hydrocephalus
  • 30.  
  • 31. CAUSES OF HYDROCEPHALUS
    • Meningitis: pneumococcal, TB
    • Intrauterine infections
    • IVH
    • Lesions, Tumors or malformations of the posterior fossa
    • PATHOLOGY
    • AQUEDUCTAL STENOSIS:
      • Abnormally narrow aqueductus of sylvius.
  • 32. Hydrocephalus
    • Communicating
    • – due to excessive formation of CSF or lack of absorption
    • Non-communicating – due to obstruction of flow through ventricle system
  • 33. Ventriculo-peritoneal shunts
  • 34. Jugular compression maneuver (Queckenstedt maneuver)
    • Compress jugular veins in neck - increases CSF pressure at the cerebellomedullary cistern and the lumbar cistern (normal)
    • Decreased pressure at lumbar cistern indicates blockage of spinal central canal
  • 35. Lumbar puncture
    • a  lumbar puncture  (or  LP , and colloquially known as a  spinal tap )
    • is a  diagnostic   procedure that is performed in order to collect a sample of  cerebrospinal fluid  (CSF) for  biochemical , microbiological , and  cytological  analysis
  • 36.  
  • 37. lumbar puncture
  • 38.
    • Spinal cord terminates at L1; needle entry must occur distal to this location
  • 39.
    • Proper angle of entry through the L3-L4 interspace
  • 40.  
  • 41. full flexion
  • 42.  
  • 43. Level of entry
  • 44. Spinal needle
  • 45. Spinal needle
  • 46. Under strict aseptic precautions.,
  • 47. Lp - layers
    • 1- Skin 2- Facia and SC fat 3- Surpaspinous ligament 4- Interspinous ligament 5- Ligamentum flavum 6- Epidural space (epidural anesthesia needle stops here) 7- Dura 8- arachnoid
    • Right after that the needle pops into the subarachnoid space where the CSF is.
  • 48.  
  • 49.  
  • 50. The opening pressure 
  • 51. Collecting the CSF
  • 52. Appearance of CSF
    • clear and colourless (normal);
    • bright red - This indicates the presence of blood. The appearance of fresh blood in all three tubes supports the diagnosis of a subarachnoid hemorrhage.
    • xanthochromic (yellow) - jaundice
    • xanthochromic (yellow) - suggests a subarachnoid hemorrhage has recently occurred
    • turbid - This indicates the presence of white cells and is suggestive of a CNS infection.
  • 53. Cell counts
    • increased neutrophils - This indicates a bacterial meningitis, cerebral abscess,
    • increased lymphocytes - This indicates a viral meningitis, tuberculosis, syphilis, fungal and parasitic infections.
    • Degenerative diseases of the CNS, such as multiple sclerosis, will also generate elevated lymphocyte counts.
  • 54.