CSF simple example

1. CEREBROSPINAL
FLUID
Prepared by:
Shaimaa sayed , Salma Yahya , Ghada Farah

2. CONTENTS …
Introduction
Physical properties
Functions
Formation
Circulation
CSF analysis
Hydrocephalus

3. CSF

4. CSF IS…
 Clear colorless and transparent fluid.
 Circulates through cavity of the :-
-brain
-subarachnoid space
-central canal of spinal cord
 Part of extracellular fluid (ECF)

5. CSF IS…
 Covered by : -
1. Pia meter (Inner membrane)
2. Arachnoid meter (center membrane)
3. Dura meter (Outer membrane)

6. THE MEMBRANS !!

7. CSF IS …
 Rate of formation :-
About 0.3 ml/min
And Normally 500ml of CSF is formed everyday
and equal amount is absorbed .

8. LOCATION OF CSF..
Two lateral ventricles
Third ventricle
Fourth ventricle
Spinal cord central canal
Subarachnoid space
Continuous with extracellular fluid
of brain parenchyma.

9. PHYSICAL PROPERTIES ….
1-Total volumes
 Adults :140 – 170 ml
Children : 10 – 60 ml

10. PHYSICAL PROPERTIES …
2-Spacific gravity : 1.005
3- ph : 7.28 - 7.32
4- appearance : clear
5-composition

11. PHYSICAL PROPERTIES…
For appearance : -
- clear & colorless is Normal
- bright red indicate presence of
blood
- turbid indicate presence of white
cells

13. FUNCTIONS OF CSF ..
Protects & lubricates the brain
Provides nutrients ,remove waste
Modulates pressure changes
 serves as a chemical buffer to maintain
constant ionic environment
Serves as a transport medium for
nutrients and metabolites ,endocrine
substansis and even neurotransmitters

14. FORMATION OF CSF ..
 The CSF is formed mainly in the brain
ventricles, and that the majority of the
remaining CSF is probably produced by
the ependymal surface of ventricles.
 It is generally accepted that CSF flows
unidirectional from the brain ventricles
to the subarachnoid space with the
exchange of various substances
between the CSF and interstitial
compartments.

15. FORMATION OF CSF ..
Choroid plexuses are the main site of
CSF production.
Then.. The passage of the plasma ultra
filtrate through the endothelium ,
facilitated by hydrostatic pressure.
Then.. Passes into the ventricles
An active metabolic process which
transforms the ultra filtrate into
secretion CSF.

17. CSF CIRCULATION ..

18. CSF CIRCULATION ..
The amount of CSF formation in the
day equal
to the amount of absorption.
Vf = Va

19. CSF CIRCULATION ..

20. CSF ANALYSIS

21. WHY?
CSF analysis can accurately distinguish
between a wide range of CNS diseases.
 Conditions found by CSF analysis can be
placed into four main categories:
1- infectious diseases.
2- hemorrhaging.
3- immune response disorders.
4- tumors.

22. CSF analysis may be ordered when a
patient has one or more of the following
symptoms :
 severe, unremitting headache
 stiff neck
 light sensitivity
 dizziness
 speaking difficulties
 trouble walking or poor coordination
 fatigue, lethargy, muscle weakness

23. How to colect the
sample to make
analysis ??
It’s easy by
Lumber Puncture

24. LUMBER 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 .

28. APPEARANCE OF CSF
In normal cases, CSF is clear and
colorless.
In cases of malady, the appearance
change according to the case.
We will discuss some of these in the
following:

29. 1- Xanthochromic :
(Bright red or yellow)
This indicates the presence of blood.
The appearance of fresh blood in all
tubes supports the diagnosis of a
subarachnoid hemorrhage.
2- Turbid :
This indicates the presence of white cells
and is suggestive of a CNS infection.

30. CELL COUNTS
1- Increased Neutrophils in CSF
This indicates a bacterial meningitis,
cerebral abscess.

31. 2- Increased Lymphocytes in CSF:
 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.

32. CSF DISORDERS
1- CSF Glucose:
 CSF glucose is derived from blood glucose
hence, ideally CSF glucose level should be
compared with fasting plasma glucose level
for adequate clinical interpretatio
 Decrease duo to hypoglycemia , tuberculosis.
Increase duo to high blood sugar.

33. 2- CSF Pressure:
Increase duo to increases intra cranial
pressure
Decrease due to shock ,fainting or
diabetic coma.
3- CSF Protein :
Increase duo to blood in CSF ,tumor.
Decrease duo to rapid CSF production.

34. Hydrocephalus
(water on brain)

36. HYDROCEPHALUS
 The term hydrocephalus is derived from the
Greek words "hydro" meaning water and
"cephalus" meaning head.
 It is an abnormal collection of cerebrospinal
fluid (CSF) resulting in abnormal widening of
spaces in the brain.
 Causes of “Hydrocephalus” may be:
-Excessive production
-Decreased absorbtion
-Obstruction

39. TYPES OF HYDROCEPHALUS
Communicating and Non-
communicating
Acute and chronic
Congenital and acquired

40. (A)1- Non-communicating (obstructive):
 CSF circulation is blocked at or proximal to fourth
ventricular outlet foramina.(enlargement of
ventricles proximal to the block)
2- Communicating (non-obstructive):
 due to excessive formation of CSF or lack of
absorption
 the obstruction of CSF flow is in the
subarachnoid space from prior bleeding or
meningitis.
 This causes thickening of the arachnoid leading
to blockage of the return-flow channels.

41. (B) 1- Acute :
 hydrocephalus caused by tumor
 Develops within days or few weeks
 Manifests with rapid progression of symptoms
 Requires early attention and treatment .
2- Chronic :
 Over months (or even years)
 Subtle signs of memory impairment,
walking difficulty, urinary incontinence.
 Chronic hydrocephalus can present acutely
because of changes in the pathophysiology of
the CSF absorption or flow.

42. (C) 1- Congenital :
 Present at birth or few weeks/months after
birth.
2- Acquired
 Infection (post-meningitis)
 Post – hemorrhagic (SAH,IVH)
 Tumors

43. Treatment
Diversion of CSF:
1- Ventriculoperitoneal shunt
2- Lumboperitoneal shunt