2. Introduction
CSF is clear,colorless and transparent.
Circulates through cavity of the : brain,subarachnoid cord and central canal of spinal
cord
Part of etracellular fluid(ECF)
Properties :
Volume : Approximately 150 mL
Rate of formation : Approximately 0.3 mL/min
Specific gravity : 1.005
Reaction : Alkaline
4. 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.
Mechanism of formation
Formed by process of secretion.
Does not involve ultrafiltration or dialysis.
Uses energy.
Active transport mechanism is involved in secretion.
5. Collection of CSF
Collected by :
Cisternal puncture
Lumber puncture
In Cisternal puncture
- CSF is collected by passing needle between occipital bone and atlas, so enters
the cisterna magna.
In Lumber puncture
- The lumber puncture needle is introduced into the subarachnoid space in the
Lumber region between the third and fourth lumber spines.
Uses of Lumber puncture
- Collecting CSF for diagnostic purpose.
- Injecting drugs for spinal anesthesia analgesia and chemotherapy.
- Measuring pressure exerted by CSF.
6.
7. CSF Disorders
Hydrocephalus
- Abnormal accumulation of CSF in the skull with enlargement of head.
2 types of Hydrocephalus:
1. Non- Communicating(Internal Hydrocephalus) : Due to the obstruction of any of
the foramen through which CSF escapes results in dilation of ventricular cavity.
2. Communicating( External Hydrocephalus) : Due to blockage of Arachnoid Villi.
8. Symptoms:
Headache
Vomiting
Atrophy of brain
Mental weakness
Convulsions
Normal pressure Hydrocephalus
– Same as Communicating Hydrocephalus but it is
due to decreased CSF absorption.
Symptoms :
Gait instabiltiy
Urinary incontinence
Dementia
9. Electrodiagnosis
Is a filed of study that, by employing the science of electrophysiology, uses
electrical technology to study human neurophysiology.
Information needed to answer any questions regarding the nerve injury, muscle
injury, muscle disease, localization, and prognosis can be thus obtained through
the help of electrodiagnostic testings.
The information collected through the testing helps to focus treatment on the
exact site of injury.
This is accomplished via a variety of electrodiagnostic tests like:
- Electromyography(EMG)
- Nerve conduction velocity(NCV)
- Evoked potentials(EP)
10. Electromyography
An EMG, used in conjunction with a neurological examination, helps establish a diagnosis
and the extent of a problem by measuring the electrical activity of a muscle in response to
stimulation.
- An EMG may be used to evaluate a variety of problems, including the following:
Nerve damage from compression by a disk in the neck or the back
Nerve compression from carpal tunnel syndrome
Neuromuscular diseases such as amyotrophic lateral sclerosis (ALS), poliomyelitis,
myasthenia gravis and muscular dystrophy
Peripheral neuropathy caused by such conditions as diabetes, pernicious anemia and heavy
metal toxicity
Procedure:
The electrical activity detected by this electrode is displayed on an oscilloscope.
You may be asked to contract the muscle.
To perform intramuscular EMG, a needle electrode is inserted through the skin into the
muscle tissue. A trained medical professional observes the electrical activity while inserting
the electrode.
11. Nerve conduction velocity
A nerve conduction velocity (NCV) test is used to assess nerve damage and dysfunction.
Also known as a nerve conduction study, the procedure measures how quickly electrical
signals move through your peripheral nerves.
An NCV test can be used to diagnose a number of muscular and neuromuscular disorders,
including:
Guillain-Barre syndrome
carpal tunnel syndrome
Charcot-Marie-Tooth (CMT) disease
herniated disk disease
chronic inflammatory polyneuropathy and neuropathy
sciatic nerve problems
peripheral nerve injury
12. Procedure:
Two electrodes are placed on the skin over the nerve. One electrode stimulates the
nerve with a very mild electrical impulse and the other electrode records it. The
resulting electrical activity is recorded by another electrode. This is repeated for each
nerve being tested.
13. Evoked Potential test
Evoked potential tests measure the time it takes for the brain to respond to
sensory stimuli as a way of detecting and monitoring problems or irregularities
with how the nervous system is functioning.
The visual evoked response (VER) is the most commonly used evoked potential
test in the diagnosis of multiple sclerosis (MS). Conducting gel and electrodes are
applied to the scalp. The location will depend on the type of response being
recorded
Sensory evoked potentials studies measure electrical activity in the brain in
response to stimulation of sight, sound, or touch. When the brain is stimulated by
sight, sound, or touch, signals travel along the nerves to the brain. There,
electrodes detect the signals and display them for your doctor to interpret.
14. Antibodies
What is antibody?
Antibody, also called immunoglobulin, a protective protein produced by the
immune system in response to the presence of a foreign substance, called an
antigen. Antibodies recognize and latch onto antigens in order to remove them
from the body.
Antibodies are Y-shaped proteins that are produced by the immune system to
help stop intruders from harming the body. When an intruder enters the body,
the immune system springs into action. These invaders, which are called
antigens, can be viruses, bacteria, or other chemicals.
There are five immunoglobulin classes (isotypes) of antibody molecules found in
serum: IgG, IgM, IgA, IgE and IgD. They are distinguished by the type of heavy
chain they contain.
15. Autoimmune Disorders:
An autoimmune disease is a condition in which your immune system mistakenly
attacks your body. The immune system normally guards against germs like
bacteria and viruses. When it senses these foreign invaders, it sends out an army
of fighter cells to attack them.
The exact cause of autoimmune disorders is unknown. One theory is that some
microorganisms (such as bacteria or viruses) or drugs may trigger changes that
confuse the immune system. This may happen more often in people who have
genes that make them more prone to autoimmune disorders.
Common Autoimmune Disorders :
Rheumatoid arthritis, Systemic lupus erythematosus, Inflammatory bowel disease,
Multiple sclerosis, Type 1 diabetes mellitus, Guillain-Barre syndrome, Chronic
inflammatory demyelinating polyneuropathy, Psoriasis and Autoimmune
Encephalitis.
16. Autoimmune encephalitis (AE)
Autoimmune encephalitis (AE) is a type of brain inflammation where the body's
immune system attacks healthy cells and tissues in the brain or spinal cord.
Autoimmune encephalitis may be associated with antibodies to proteins on the
surface of nerve cells, or within nerve cells. Some of these proteins are involved in
passing signals between nerve cells. In some cases it occurs in association with
cancer. Research regarding why specific antibodies attack the body's healthy cells
is ongoing. Autoimmune encephalitis generally occurs sporadically, in people with
no family history of the condition.
17.
18. Symptoms
cognitive impairment
memory difficulties
seizures
involuntary movements
slowed or loss of ability to speak
behavioral changes such as agitation
loss of inhibition
hallucinations (visual or auditory)
paranoid thoughts
severe anxiety
sleep disruption including severe insomnia
decreased level of consciousness – to the point of unresponsiveness, catatonia or
coma
weakness or numbness of part of the body
loss of balance
vision changes
19. Diagnosis :
testing typically used to aid in the diagnosis of AE includes MRI of the brain with
contrast, electroencephalogram (EEG), blood and cerebrospinal fluid analysis for
markers of inflammation. Your doctors may specifically look for antibodies which
the immune system to attack the brain causing encephalitis. These antibodies may be
found both in the blood and cerebrospinal fluid, so testing both is necessary in most
cases.
Treatment :
First line treatment :
removal of a teratoma (if present) that could be triggering the autoimmune response;
use of anti-inflammatory drugs (ie. steroids);
use of plasmapheresis to remove harmful antibodies from blood; and
treatment with intravenous immunoglobulin (IVIG); to increase removal of antibodies,
inhibit binding of the harmful antibodies, and decrease the inflammatory response to
antibodies.
The three most common “second line” drugs used for AE are:
Rituximab
CellCept
Cytoxan (cyclophosphamide).
20. MRI
Magnetic resonance imaging (MRI) is a medical imaging technique used in
radiology to form pictures of the anatomy and the physiological processes of the
body. MRI scanners use strong magnetic fields, magnetic field gradients, and
radio waves to generate images of the organs in the body.
MRI can detect a variety of conditions of the brain such as cysts, tumors,
bleeding, swelling, developmental and structural abnormalities, infections,
inflammatory conditions, or problems with the blood vessels. It can determine if a
shunt is working and detect damage to the brain caused by an injury or a stroke.
MRI is sensitive to changes in cartilage and bone structure resulting from injury,
disease, or aging. It can detect herniated discs, pinched nerves, spinal tumors,
spinal cord compression, and fractures.
23. Advantages of MRI
No ionizing radiation.
Variable thickness in any plane.
Better contrast resolution.
Many details without IV contrast.
24. Disadvantage of MRI
Very expensive.
Dangerous for patient with metallic device placed within the body.
Difficult to be performed on claustrophobic patient.
Movement during imaging can cause blur.
RF transmitter can cause severe burns if mishandled.
25. Principle:
MRI makes use of magnetic properties of certain atomic nuclei.
Hydrogen nucleus present in water molecule and therefore in all body tissues.
The hydrogen nuclei partially aligned by a strong magnetic field in the scanner.
Components of MRI:
Scanner
Computers
Recording Hardware
26. Who can’t have an MRI scan
A cardiac pacemaker
Certain clips in your head from brain operation
A cochlear implant
A metallic foreign body in your eye
Had surgery in the last 8 weeks
If you are pregnant
Who can be diagnosed by an MRI scan
Most ailments of the brain, including tumours.
Most spinal injuries/Conditions
ENT conditions
Hydrocephalus