It’s a small presentation on CSF as this comes as short note in theory examination for MD anaesthesia students. This ppt will help students to understand and revise the topic few days before anaesthesia exam. This ppt is all about what is CSF, how it forms , where it forms , how it circulates , where absorption occurs, composition of this fluids, functions of CSF, and some pathological conditions where this fluid used to diagnose some diseases.

1. CEREBROSPINAL FLUID
CSF DR MEENA SINGH
PROFESSOR
NEUROANAESTHESIA
NSCB MEDICAL
COLLEGE, JABALPUR(MP)

2. INTRODUCTION
• It Is clear, colorless, odourless fluid, found in intracranial cavity, central canal, and
in subarachnoid space in the CNS. It is formed in lateral ventricles, third ventricle
and in forth ventricle by choroid plexus.
• Choroid plexus: are secretory unit, which consist of telachoroidae and ependymal
cells. Ependymal cells form CSF by filtration process from blood plasma.

3. There Are 4 CSF Filled Cavities/Ventricles In Brain:
 Lateral Ventricle (One In Each Cerebral Hemisphere).
Lateral Ventricles Are Separated By Septum Pellucidum.
 Third Ventricle
 Forth Ventricle

4. CSF PRODUCTION
• Depends on function of Na+K+ATPase pump. The movement of Na+ from
ependymal cells to the cavity is accompanied by Cl- and HCO3- ions and water
because of osmotic gradient. The water transport is distributed from blood
system to ventricular system through aquaporin-1(aqp1) water channels.
• CSF examination : sample of CSF can be taken by lumbar puncture below L2
by spinal tap.

5. CSF CIRCULATION

6. ON CSF EXAMINATION DURING SPINAL TAPPING
• BLOOD IN CSF MAY BE DUE TO:
 Internal haemorrhage in the central nervous system
 Trauma during the collection of the specimen
• XANTHOCHROMIA (YELLOW-ORANGE TINGE) OF CSF IS DUE TO:
 Subarachnoid Haemorrhage
 Jaundice
• .

7. CONTINUE…
• TURBIDITY/ IN THE CSF(CLOUDY):
 Increased num of WBC.
 Presence of bacteria/pus cell.
 Increase Protein Content(precipitate: cob web appearance).
• Cultural to be sent and also Molecular analysis can help to look for protein
abnormalities

8. ADULT CHILDREN
CSF Volume 130-150ml
-Approx 35 ml In
Ventricular System
-100-110 ml In
Subarachnoid space
Infant: 40-60ml
Young child: 60-80ml
Older child: 80-100ml
CSF Pressure 10mmhg 3-7.5mmhg
Rate Of Production 0.5ml/min
21ML/hour
0.3-0.4ml/min

9. CSF COMPOSITION
WATER =99%
Organic substances: Protein: 15-45mg/dl, Glucose: 40-80mg/dl, Amino Acids
Cholesterol
Urea, Uric Acids, Creatinine, Lactic Acid
Inorganic substances: Sodium 150 Me/L, Potassium 2.8 Me/L, Chloride 116-
122mE/L, Calcium 2.1mE/L, Magnisium 2.5 mE/L, Phosphate, Bicarbonates,
Sulphates, Lymphocytes(4-5 normal), Neutrophills- Absent
pH 7.33 And Specific Gravity 1.003-1.007
Osmolarity-295 mOs/L

10. PATHOLOGICAL FINDINGS OF CSF:
• GLUCOSE: 2/3rd
Of Value Of Blood Glucose(60mg%)
NORMAL GLUCOSE: Viral Meningitis
LOW GLUCOSE
• -Bacterial Meningitis (Nearly 0)
• -Tb Meningitis
• -Fungal Infection
• -Dissemination Of Tumours
HIGH GLUCOSE: Not a specific diagnostic indicator.
• LACTATE : Higher: In Birth Asphyxia, Hypoxic Brain Injury.

11. PATHOLOGICAL CSF FINDING CONTINUES…..
• PROTEINS: 20-40 mg/dl
• Moderate Increase: Inflammatory Disease Of Meninges (Bacterial/Viral,
Encephalitis), Subarachnoid Hemorrahge, Cerebral Infarction
• Severe Increase; Guillain Barre Syndrome
• CSF ADA: Normal Upto 5 IU/L
• Higher In TB Meningitis
• LDH:1/5th
Of Serum Or 20-80 IU/L

12. CONTINUES….
• WBC: Normal 4-5 Cells, Increased in Infection, Inflammation
• Lymphocyte =Viral Infections, Encephalitis, Syphilis, TB Meningitis.
• Neutrophil =Bacterial Infection, Acute Suppurative Meningitis.
• RBC: Normal: 4-5 Cells
• Increase=Haemorrhage-Stroke, Malignancy, Traumatic, Trauma During LP.

13. NOTE:
• Beta 2-transferrin is only found in CSF, ocular fluids and
perilymph.
• Presence of beta 2 transferrin in a fluid sample can be used
to confirm clinical suspicion of CSF-leak

14. CSF FUNCTION:
• Homeostasis: Provides Suitable Chemical Envionment For Neuronal Signalling.
• Physical Protection, Shock Absorbing Medium-Prevents Brain And Spinal Cord Bouncing Of
Bony Surfaces (Cranial Cavity/Vertebral Canal).
• Nutrient transport: Exchange Of Nutrients Between Blood And Nerve Tissue
• Immune function: it participates in the immune response within the CNS carrying immune
cells and antibodies.
• Waste removal: it clears metabolic waste products and toxins from the CNS.
• Pressure regulation: CSF pressure is regulated which is crucial for cerebral blood flow and
neurological function

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