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Cerebrospinal fluid(csf)

Cerebrospinal fluid(csf)






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    Cerebrospinal fluid(csf) Cerebrospinal fluid(csf) Presentation Transcript

    • Cerebrospinal Fluid(CSF)
      Saddam Ansari
      Tbilisi State Medical University
    • Introduction
      CSF is clear, colorless and transparent
      Circulates through cavity of the:
      Subarachnoid space
      Central canal of spinal cord
      Part of Extracellular fluid (ECF)
    • Properties
      Volume : approximately 150 mL
      Rate of formation: approximately 0.3 mL/min
      Specific gravity : 1.005
      Reaction : Alkaline
    • Composition
    • Continued…
      As CSF is part of ECF therefore it contain more amount of Sodium than Potassium.
      Contains some lymphocytes.
      CSF secreted by ventricles does not contain any cell.
      The lymphocytes are added when it flows in the spinal cord.
    • Formation of CSF
      Site of formation
      Formed by the choroid plexus situated within the ventricles.
      The choroid plexus are tuft of capillary projections present inside ventricles and covered by:
      Pia mater
      Ependymal covering.
    • Continued...
      Mechanism of formation
      Formed by process of secretion.
      Does not involve ultrafiltration or dialysis.
      Uses energy.
      Active transport mechanism is involved in secretion.
    • Continued…
      Substances affecting the formation of CSF
      Pilocarpine, ether and extracts of pituitary gland stimulates the secretion of CSF by stimulating choroid plexus.
      Injection of isotonic saline also stimulates CSF formation.
    • Continued…
      Injection of hypotonic saline
      Causes greater rise in capillary pressure and intracranial pressure,
      Fall in osmotic pressure leading to increase in CSF formation.
      Hypertonic saline
      Decreases CSF formation
      Decreases CSF pressure
    • 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.
      Normally, 500 mL of CSF is formed everyday and equal amount is absorbed.
    • 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.
    • Pressure exerted by CSF
      Varies in different position:
      Lateral recumbent position = 10-18 cm of H2O
      Lying position = 13 cm of H2O
      Sitting position = 30 cm of H2O
      Coughing and crying increases the pressure by decreasing the absorption.
      Compression of internal jugular vein also raises the CSF pressure.
    • Function of CSF
      Protective Function:
      Acts as buffer
      Protects the brain from shock
      If brain receives severe blow , countercoup injury may take place.
    • Continued…
      Regulation of Cranial Content Volume
      Is very essential because
      When substances are absorbed into the venous sinuses, intracranial pressure is raised,
      Intracranial pressure in turn interferes with the cerebral circulation causing Asphyxia.
      It is prevented by greater absorption of CSF to give space for increasing cranial contents.
    • Continued…
      Medium of Exchange
      CSF is the medium through which substances like :
      Nutritive substances
      Waste materials
      are exchanged between blood and brain tissues.
    • Collection of CSF
      Collected by :
      Cisternal puncture or
      Lumbar puncture
      In Cisternal puncture
      CSF is collected by passing needle between Occipital bone and Atlas, so it enters the cisterna magna.
    • Continued…
      In Lumbar puncture
      The Lumbar puncture needle is introduced into the subarachnoid space in the Lumbar region , between the third and fourth Lumbar spines.
      Uses of Lumbar puncture
      Collecting CSF for diagnostic purpose.
      Injecting drugs for spinal anesthesia, analgesia and chemotherapy.
      Measuring pressure exerted by CSF.
    • Blood–Cerebrospinal Fluid Barrier
      Barrier between the blood and cerebrospinal fluid .
      Exists at the Choroid plexus.
      Similar to Blood-Brain Barrier(BBB)
      Allows the movement of only those substances, which are allowed by BBB.
    • Substances which can pass through Blood-Cerebrospinal Fluid Barrier
      Carbon dioxide
      Amino acids
      Drugs such as L-dopa, 5-hydroxytryptamine sulfonamides, tetracycline and other lipid soluble drugs
    • Continued…
      Anesthetic gases such as ether, nitrous oxide which are lipid soluble
      Other lipid soluble substances.
    • Substances which can’t pass through Blood-Cerebrospinal Fluid Barrier
      Injurious chemical agents.
      Pathogens such as bacteria.
      Drugs such as Penicillin and the Catecholamines.
      Dopamine also can’t pass therefore Parkinsonism is treated with L-dopa instead of dopamine.
    • Continued…
      Bile pigments
      However barrier is not well developed in infants.
      The bile pigments enter the brain tissues .
      During jaundice in infants, the bile pigments enter the brain and causes damage of Basal ganglia leading to Kernicterus.
    • CSF disorders
      Abnormal accumulation of CSF in the skull with enlargement of head.
      2 types of Hydrocephalus
      1. non-communicating
      2. communicating
    • Continued…
      Non-communicating Hydrocephalus or Internal Hydrocephalus
      Due to the obstruction of any of the foramen through which CSF escapes results in dilation of ventricular cavity.
      Communicating Hydrocephalus or External Hydrocephalus
      Due to blockage of Arachnoid villi.
    • Continued…
      Symptoms of Hydrocephalus:
      Atrophy of brain
      Mental weakness
    • Continued…
      Normal pressure Hydrocephalus
      Same as Communicating Hydrocephalus but it is due to decreased CSF absorption.
      Symptoms :
      Gait instabiltiy
      Urinary incontinence
    • Thank you