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Cerebrospinal fluid(csf)

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  • 1. Cerebrospinal Fluid(CSF)
    Saddam Ansari
    Tbilisi State Medical University
  • 2. Introduction
    CSF is clear, colorless and transparent
    Circulates through cavity of the:
    Brain
    Subarachnoid space
    Central canal of spinal cord
    Part of Extracellular fluid (ECF)
  • 3. Properties
    Volume : approximately 150 mL
    Rate of formation: approximately 0.3 mL/min
    Specific gravity : 1.005
    Reaction : Alkaline
  • 4. Composition
  • 5. 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.
  • 6. 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.
  • 7. Continued...
    Mechanism of formation
    Formed by process of secretion.
    Does not involve ultrafiltration or dialysis.
    Uses energy.
    Active transport mechanism is involved in secretion.
  • 8. 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.
  • 9. 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
  • 10.
  • 11.
  • 12. 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.
  • 13. 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.
  • 14. 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.
  • 15. Function of CSF
    Protective Function:
    Acts as buffer
    Protects the brain from shock
    If brain receives severe blow , countercoup injury may take place.
  • 16. 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.
  • 17. Continued…
    Medium of Exchange
    CSF is the medium through which substances like :
    Nutritive substances
    Waste materials
    are exchanged between blood and brain tissues.
  • 18. 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.
  • 19. 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.
  • 20.
  • 21. 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.
  • 22.
  • 23. Substances which can pass through Blood-Cerebrospinal Fluid Barrier
    Oxygen
    Carbon dioxide
    Water
    Glucose
    Amino acids
    Electrolytes
    Drugs such as L-dopa, 5-hydroxytryptamine sulfonamides, tetracycline and other lipid soluble drugs
  • 24. Continued…
    Anesthetic gases such as ether, nitrous oxide which are lipid soluble
    Other lipid soluble substances.
  • 25. 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.
  • 26. 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.
  • 27. CSF disorders
    Hydrocephalus
    Abnormal accumulation of CSF in the skull with enlargement of head.
    2 types of Hydrocephalus
    1. non-communicating
    2. communicating
  • 28. 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.
  • 29. Continued…
    Symptoms of Hydrocephalus:
    Headache
    Vomiting
    Atrophy of brain
    Mental weakness
    Convulsions
  • 30. Continued…
    Normal pressure Hydrocephalus
    Same as Communicating Hydrocephalus but it is due to decreased CSF absorption.
    Symptoms :
    Gait instabiltiy
    Urinary incontinence
    Dementia
  • 31. Thank you