The document discusses the cerebrospinal fluid (CSF) and its role in protecting the brain. CSF is produced in the ventricles of the brain by the choroid plexus, circulates through the brain and spinal cord, and is absorbed by the arachnoid villi into venous sinuses. It provides buoyancy and cushioning to the brain, maintains homeostasis, and acts as a conduit for waste removal. CSF has similar constituents as plasma but lower protein and glucose levels. It is circulated through the brain by pulsating blood vessels, respiration, and changes in posture.
A brief discussion on nervous system. central nervous system its part like a short note on brain according to b.pharma 2nd semester syllabus. short note on neurones, neurotransmitter,
A brief discussion on nervous system. central nervous system its part like a short note on brain according to b.pharma 2nd semester syllabus. short note on neurones, neurotransmitter,
BRAINSTEM
The Brainstem lies at the base of the brain and the top of the spinal cord.
The brainstem is located in the posterior cranial fossa.
The brainstem is the structure that connects the cerebrum of the brain to the spinal cord and cerebellum.
Provides a pathway for tracts running between higher and lower neural centers.
Divided into 3 major divisions:
midbrain,
pons, and
medulla oblongata.
It is responsible for many vital functions of life, such as breathing, consciousness, blood pressure, heart rate, and sleep.
It contains many critical collections of white and grey matter.
The grey matter within the brainstem consists of nerve cell bodies and form many important brainstem nuclei. Ten of the twelve cranial nerves arise from their cranial nerve nuclei in the brainstem.
The white matter tracts of the brainstem include axons of nerves traversing their course to different structures. These tracts travel both to the brain (afferent) and from the brain (efferent) such as the somatosensory pathways and the corticospinal tracts, respectively.
Mid Brain
The midbrain is continuous with the cerebral hemisphere.
The upper posterior (i.e. rear) portion of the midbrain is called the tectum, which means "roof."
The surface of the tectum is covered with four bumps representing two paired structures: the superior and inferior colliculi.
The superior colliculi are involved in eye movements and visual processing, while the inferior colliculi are involved in auditory processing.
Another important nucleus, the substantia nigra, is located here.
The substantia nigra is rich in dopamine neurons and is considered part of the basal ganglia.
Pons
An important pathway for tracts that run from the cerebrum down to the medulla and spinal cord, as well as for tracts that travel up into the brain.
It also forms important connections with the cerebellum via fibre bundles known as the cerebellar peduncles.
Posteriorly, the pons and medulla are separated from the cerebellum by the fourth ventricle.
Home to several nuclei for cranial nerves.
Medulla
The point where the brainstem connects to the spinal cord.
Contains a nucleus called the nucleus of the solitary tract that is crucial for our survival (receives information about blood flow, along with information about levels of oxygen and carbon dioxide in the blood, from the heart and major blood vessels).
When this information suggests a discordance with bodily needs (e.g. blood pressure is too low), there are reflexive actions initiated in the nucleus of the solitary tract to bring things back to within the desired range.
Blood Supply
The brain stem receives its blood supply exclusively from the posterior circulation, including the vertebrae and basilar artery.
The medulla receives its blood supply from the vertebral via medial and lateral perforating arteries.
The pons and midbrain receive their blood from the basilar via the medial and lateral perforating arteries.
understanding spinal cord, its bransches, lesions, functions and anatomy.
hope to give you better knowledge of spinal cord by the end of it.
plese review ans comment for my future updates and corrections that iw ill be needing in this.
these slides contain a brief introduction of neurons and its classification as well as details of generation of action potential, resting potential and eletrotonic potential.
BRAINSTEM
The Brainstem lies at the base of the brain and the top of the spinal cord.
The brainstem is located in the posterior cranial fossa.
The brainstem is the structure that connects the cerebrum of the brain to the spinal cord and cerebellum.
Provides a pathway for tracts running between higher and lower neural centers.
Divided into 3 major divisions:
midbrain,
pons, and
medulla oblongata.
It is responsible for many vital functions of life, such as breathing, consciousness, blood pressure, heart rate, and sleep.
It contains many critical collections of white and grey matter.
The grey matter within the brainstem consists of nerve cell bodies and form many important brainstem nuclei. Ten of the twelve cranial nerves arise from their cranial nerve nuclei in the brainstem.
The white matter tracts of the brainstem include axons of nerves traversing their course to different structures. These tracts travel both to the brain (afferent) and from the brain (efferent) such as the somatosensory pathways and the corticospinal tracts, respectively.
Mid Brain
The midbrain is continuous with the cerebral hemisphere.
The upper posterior (i.e. rear) portion of the midbrain is called the tectum, which means "roof."
The surface of the tectum is covered with four bumps representing two paired structures: the superior and inferior colliculi.
The superior colliculi are involved in eye movements and visual processing, while the inferior colliculi are involved in auditory processing.
Another important nucleus, the substantia nigra, is located here.
The substantia nigra is rich in dopamine neurons and is considered part of the basal ganglia.
Pons
An important pathway for tracts that run from the cerebrum down to the medulla and spinal cord, as well as for tracts that travel up into the brain.
It also forms important connections with the cerebellum via fibre bundles known as the cerebellar peduncles.
Posteriorly, the pons and medulla are separated from the cerebellum by the fourth ventricle.
Home to several nuclei for cranial nerves.
Medulla
The point where the brainstem connects to the spinal cord.
Contains a nucleus called the nucleus of the solitary tract that is crucial for our survival (receives information about blood flow, along with information about levels of oxygen and carbon dioxide in the blood, from the heart and major blood vessels).
When this information suggests a discordance with bodily needs (e.g. blood pressure is too low), there are reflexive actions initiated in the nucleus of the solitary tract to bring things back to within the desired range.
Blood Supply
The brain stem receives its blood supply exclusively from the posterior circulation, including the vertebrae and basilar artery.
The medulla receives its blood supply from the vertebral via medial and lateral perforating arteries.
The pons and midbrain receive their blood from the basilar via the medial and lateral perforating arteries.
understanding spinal cord, its bransches, lesions, functions and anatomy.
hope to give you better knowledge of spinal cord by the end of it.
plese review ans comment for my future updates and corrections that iw ill be needing in this.
these slides contain a brief introduction of neurons and its classification as well as details of generation of action potential, resting potential and eletrotonic potential.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
5. Protective Function
The most critical role for CSF (and the meninges) is to
protect the brain. The dura is attached firmly to bone.
Normally, there is no "subdural space," with the arachnoid
being held to the dura by the surface tension of the thin
layer of fluid between the two membranes
the brain itself is supported within the arachnoid by the blood
vessels and nerve roots and by the multiple fine fibrous
arachnoid trabeculae. The brain weighs about 1400 g in air, but
in its "water bath" of CSF it has a net weight of only 50 g.
the brain itself is supported within the arachnoid by the blood
vessels and nerve roots and by the multiple fine fibrous
arachnoid trabeculae. The brain weighs about 1400 g in air, but
in its "water bath" of CSF it has a net weight of only 50 g.
6.
7. Function of CSF
• Maintenance of a constant external
environment for neurons and glia
• Mechanical cushion to protect the brain
and buoyant to the heavy brain (1400 g)
• Serve as a lymphatic system and a conduit
for neuropeptides
• pH of CSF regulates pulmonary ventilation
and CBF
8. Cerebrospinal fluid (CSF)
• Supports (buoys) mass
• Cushions CNS - like
waterbed
• Nourishes brain tissue
• Contains proper
electrolytes for CNS
8
9. Cerebrospinal fluid (CSF)
Filtered from blood
plasma in choroid
plexuses
Circulates in through
ventricles, canals, &
between meninges
Returned to blood at
superior sagittal sinus
9
10. Cerebro spinal Fluid
• The entire cerebral cavity enclosing the
brain and spinal cord has a capacity of
about 1600 to 1700 milliliters;
• about 150 milliliters of this capacity is
occupied by cerebrospinal fluid and the
remainder by the brain and cord.
11. • This fluid, is present in the ventricles
• of the brain, in the cisterns around the
outside of the brain, and in the subarachnoid
space around both the brain and the spinal
cord.
• All these chambers are connected with one
another, and the pressure of the fluid
• is maintained at a surprisingly constant level.
12. 12
From: Laterra J et al., in Basic Neurochemistry
Cerebrospinal fluid (CSF)
13. Cerebro spinal fluid production & Circulation
Clear, colourless, alkaline fluid is found in
Ventricles of brain
Cisterns around brain
Subarachnoid space around
brain and spinal cord
14. Ventricular System
• Within the brain is a communicating system of
cavities that are lined with ependyma cells and
filled with cerebrospinal fluid (CSF)
• There are:
– two lateral ventricles,
– the third ventricle,
– the cerebral aqueduct,
– and the fourth ventricle within the brain stem.
15. Ventricles of the Brain
2 Lateral ventricles (1, 2) in cerebral hemispheres
Third ventricle (3) between hemispheres
Fourth ventricle (4) in midbrain and medulla
15
17. Choroid Plexus :
Temporal horn of each lateral ventricle
Choroid plexus
present in Posterior portion of III ventricle
Roof of IV ventricle
Vascular fringes of piamater break up into complex
capillary network covered by cuboidal epithelial
cells,
Cells contain mitochondria, granules, vesicles indicating
involvement in active metabolic process (secretory)
19. Arachnoid villi
Microscopic finger like projections of arachnoid
membrane into walls of venous sinuses.
Lined by endothelial cells
Large conglomerates of villi called arachnoid
granulations / pachionian bodies
Electron microscopic study shows transcellular
channels / pores in lining endothelium which allows
free absorption of CSF, proteins.
Arachnoid villi
Microscopic finger like projections of arachnoid
membrane into walls of venous sinuses.
Lined by endothelial cells
Large conglomerates of villi called arachnoid
granulations / pachionian bodies
Electron microscopic study shows transcellular
channels / pores in lining endothelium which allows
free absorption of CSF, proteins.
21. Perivascular space :
Blood vessel entering brain substance will carry
with it sleeve of arachnoid immediately surrounding the
vessel and sleeve of pia more externally. Extension of
SAS around the vessel known as PV space / virchow robin
space.
Products of metabolism, inflammatory exudates
pass from brain substance into perivascular space, to enter
CSF in subarachnoid space.
22.
23. Formation of CSF
Active secretion by choroid plexus
Trans ependymal diffusion of brains
interstitial fluid into ventricles (minimal)
24. Secretion :
Na+
K+
ATPase, carbonic anhydrase takes part in
Active transport of Na+ occurs through epithelial cells
lining choroid plexus
Na+
will carry Cl
-
with it.
Na+
& Cl-
increase the quantitiy of osmoticaly active
substances in CSF, which cause immediate osmosis of
water through the membrane.
Less important transport process move small amount of
glucose into CSF, K+
& HCO3- out of CSF
25. 25
Net transport of Na+
and Cl-
across
the epithelium results in the
secretion of CSF.
Cl-
efflux from the epithelium to
CSF is mediated by a cotransporter.
The generation of H+
and HCO3 by
carbonic anhydrase is important in
the secretion of CSF.
From: Laterra J et al., in Basic Neurochemistry
Production of CSF
26.
27. Resulting characteristics of CSF :
Osmotic pressure & Na+
equal to plasma
Cl-
15% greater than plasma
K+
40% less than plasma
Glucose 30% less than plasma
Resulting characteristics of CSF :
Osmotic pressure & Na+
equal to plasma
Cl-
15% greater than plasma
K+
40% less than plasma
Glucose 30% less than plasma
28. CSF formationCSF formation
• 50% by choroid plexuses in the ventricles
• 40% by meningeal blood vessels and
ependymal lining of ventricles
• 10% by brain and spinal cord blood vessels
• Absorption
• 80% by arachinoid villi into venous sinuses
and spinal veins
• 20% by cervical lymphatics and perivascular
spaces
• 50% by choroid plexuses in the ventricles
• 40% by meningeal blood vessels and
ependymal lining of ventricles
• 10% by brain and spinal cord blood vessels
• Absorption
• 80% by arachinoid villi into venous sinuses
and spinal veins
• 20% by cervical lymphatics and perivascular
spaces
29. CSFCSF
• CSF is a clear colorless, isotonic alkaline
fluid, almost protein and cell free and contains
less glucose and k+ than plasma.
• Volume- 130-150ml
• Daily secretion-500-550ml
• Rate of formation-0.2-0.3ml/min
• Pressure-130mm of water
• CSF is a clear colorless, isotonic alkaline
fluid, almost protein and cell free and contains
less glucose and k+ than plasma.
• Volume- 130-150ml
• Daily secretion-500-550ml
• Rate of formation-0.2-0.3ml/min
• Pressure-130mm of water
30.
31. Circulation :
From lateral ventricles through foramen of monro / inter
ventricular foramen to III ventricle
From III ventricle through cerebral aqueduct of sylvius
to IV ventricle
From IV ventricle leaves via median and lateral foramen
of magendie and luschka to reach SAS covering cerebrum
and spinal cord
After bathing surface of spinal cord and base of brain
CSF passes upward over convexity of hemispheres to be
absorbed in intracranial venous sinuses.
32.
33. Circulation of cerebrospinal fluid
CSF drains from lateral ventricle interventricular foramina third ventricle
mesencephalic aqueduct
fourth ventricle median and two lateral apertures
subarachnoid space arachnoid granulations superior sagittal sinus vein
37. Absorption :
4/5th
of CSF absorbed via cerebral arachnoid villi
1/5th
spinal arachnoid villi
Hydrostatic pressure in sub arachnoid space is higher than
in dural sinuses facilitates fluid movement
Small amount pass into perivascular space, sheath of cranial
nerves
Characteristics of CSF
pH 7.31 – 7.34
Specific gravity - 1005
Osmolarity 290 – 295 mosm /l
Volume 70-120 ml (25ml ventricles 25 ml spinal theca)
38. Force of circulationForce of circulation
• Movement of the CSF is by pulsating blood
vessels, respiration and changes of posture
• CSF is secreted continuously at a rate of
about 0.5ml per minute i.e. 720 ml per day
• Total CSF in the brain 120 ml
• CSF pressure can be measured by attaching
a vertical tube to the lumbar puncture
needle – 10 cm water
• Movement of the CSF is by pulsating blood
vessels, respiration and changes of posture
• CSF is secreted continuously at a rate of
about 0.5ml per minute i.e. 720 ml per day
• Total CSF in the brain 120 ml
• CSF pressure can be measured by attaching
a vertical tube to the lumbar puncture
needle – 10 cm water
38
39.
40. Rate of formation : 0.35 ml / min
500 ml / day
Rate of formation : 0.35 ml / min
500 ml / day
ConstituentsConstituents mg / dlmg / dl PlasmaPlasma CSFCSF
ProteinProtein 7000-80007000-8000 20-4020-40
GlucoseGlucose 70-11070-110 40-7040-70
NaclNacl 560-630560-630 720-750720-750
CholestrolCholestrol 130-230130-230 NilNil
UreaUrea 20-4020-40 10-3010-30
CreatinineCreatinine 0.6 – 1.50.6 – 1.5 0.5 – 1.90.5 – 1.9
Uric acidUric acid 2 – 82 – 8 0.5 – 2.50.5 – 2.5
PhosphatesPhosphates 2- 42- 4 1.2 – 2.01.2 – 2.0
45. Optic Disc Edema
• Papilledema/Choked Disk
– non-inflammatory congestion of optic disk
associated with increased ICP (due to cerebral
tumors, abscesses, subdural hematoma,
hydrocephalous, malignant hypertension)
– Mechanism: obstruction of venous flow caused
by pressure on the Central Retinal Vein where
it leaves the optic nerve
• Papilledema/Choked Disk
– non-inflammatory congestion of optic disk
associated with increased ICP (due to cerebral
tumors, abscesses, subdural hematoma,
hydrocephalous, malignant hypertension)
– Mechanism: obstruction of venous flow caused
by pressure on the Central Retinal Vein where
it leaves the optic nerve
46. Clinical Findings
• enlarged blind spot
• normal VA and normal
VF
• Fundus Findings:
hyperemia of the disk,
blurring of the margins,
distention of retinal
veins, absence of
pulsation of CRV, disk
swelling to 6-10 D,
hemorrhages
• enlarged blind spot
• normal VA and normal
VF
• Fundus Findings:
hyperemia of the disk,
blurring of the margins,
distention of retinal
veins, absence of
pulsation of CRV, disk
swelling to 6-10 D,
hemorrhages
48. “Hydrocephalus” means excess water in the cranial
vault.
This condition is frequently divided into communicating
hydrocephalus and noncommunicating hydrocephalus.
In communicating hydrocephalus fluid flows
readily from the ventricular system into the subarachnoid
space, whereas in noncommunicating hydrocephalus
fluid flow out of one or more of the ventricles
is blocked.
“Hydrocephalus” means excess water in the cranial
vault.
This condition is frequently divided into communicating
hydrocephalus and noncommunicating hydrocephalus.
In communicating hydrocephalus fluid flows
readily from the ventricular system into the subarachnoid
space, whereas in noncommunicating hydrocephalus
fluid flow out of one or more of the ventricles
is blocked.
49. Hydrocephalus
• Large amounts of fluid accumulate
when the capacity for CSF
reabsorption is decreased
• (external hydrocephalus,
communicating hydrocephalus).
50. Hydrocephalus
• Fluid accumulates proximal to the
block and distends the ventricles when
the foramens of Luschka and Magendie
are blocked or there is obstruction
within the ventricular system (internal
hydrocephalus, noncommunicating
hydrocephalus).
51. HydrocephalusHydrocephalus
• Obstructive hydrocephalus/internal/
• noncomunicating
– Congenital malformations
– After inflammation or hemorrhage
– Mass lesions
• Communicating hydrocephalus(external)
– Overproduction of CSF
– Defective absorption of CSF
– Venous drainage insufficiency
• Obstructive hydrocephalus/internal/
• noncomunicating
– Congenital malformations
– After inflammation or hemorrhage
– Mass lesions
• Communicating hydrocephalus(external)
– Overproduction of CSF
– Defective absorption of CSF
– Venous drainage insufficiency
52. Usually the noncommunicating type of hydrocephalus
is caused by a block in the aqueduct of Sylvius,
resulting from atresia (closure) before birth in many
babies or from blockage by a brain tumor at any age.
As fluid is formed by the choroid plexuses in the two
lateral and the third ventricles, the volumes of these
three ventricles increase greatly.
This flattens the brain into a thin shell against the
skull.
53. In neonates, the increased pressure also causes the whole
head to swell because the skull bones have not yet fused.
54.
55. The communicating type of hydrocephalus is usually
caused by blockage of fluid flow in the subarachnoid
spaces around the basal regions of the brain or by blockage
of the arachnoidal villi where the fluid is normally
absorbed into the venous sinuses. Fluid therefore collects
both on the outside of the brain and to a lesser
extent inside the ventricles.This will also cause the head
to swell tremendously if it occurs in infancy when the
skull is still pliable and can be stretched, and it can
damage the brain at any age.
56. Treatment
• A therapy for many types of hydrocephalus
is surgical placement of a silicone tube
shunt all the way from one of the brain
ventricles to the peritoneal cavity where the
excess fluid can be absorbed into the blood.
64. Cerebral EdemaCerebral Edema
• Vasogenic edema: A state of increased
extracellular fluid volume; Brain tumor, abscess, infarct,
hemorrhage; glucocorticoids, hypertonic solutions
• Cytotoxic edema: The swelling of cellular
elements; Hypoxia/asphyxia, water intoxication, meningitis,
encephalitis, Reye’s syndrome
• Interstitial edema: Attributed to increased
water and sodium in periventricular white
matter; Obstructive hydrocephalus; Surgical shunting, acetazolamide
67. CSF samplingCSF sampling
• Contraindication or precaution in ↑ICP
• Pressure from lumbar puncture: 65-195 mm CSF (H2O), or
5 – 15 mmHg
• Cells: 0; ↑ by inflammation, tumor, or other cerebral
damage
• Protein: < 35 mg/dl; ↑ in blockage or increased BBB
permeability.
• Glucose: > 40 mg/dl; ↓ in meningeal tumor, fungal or TB
infection, sarcoidosis
• Appearance: not cloudy or xanthochromic
• Contraindication or precaution in ↑ICP
• Pressure from lumbar puncture: 65-195 mm CSF (H2O), or
5 – 15 mmHg
• Cells: 0; ↑ by inflammation, tumor, or other cerebral
damage
• Protein: < 35 mg/dl; ↑ in blockage or increased BBB
permeability.
• Glucose: > 40 mg/dl; ↓ in meningeal tumor, fungal or TB
infection, sarcoidosis
• Appearance: not cloudy or xanthochromic
68.
69. barriers, called the blood cerebrospinal
fluid barrier and the blood-brain barrier,
exist between the blood and the
cerebrospinal fluid and brain fluid,
respectively.
70. Barriers exist both at the choroid plexus and at
the tissue capillary membranes in essentially all
areas of the brain parenchyma except in some
areas of the hypothalamus, pineal gland, and
area postrema, where substances diffuse with
greater ease into the tissue spaces.
71.
72.
73. In general, the blood–cerebrospinal fluid and blood
brain barriers are highly permeable to water, carbon
dioxide, oxygen, and most lipid-soluble substances
such as alcohol and anesthetics;
slightly permeable to electrolytes such as sodium,
chloride, and potassium;
almost totally impermeable to plasma proteins and
most non–lipid-soluble large organic molecules.
74. The cause of the low permeability of the blood–
cerebrospinal fluid and blood-brain barriers is the
manner in which the endothelial cells of the brain
tissue capillaries are joined to one another.They are
joined by so-called tight junctions. That is, the
membranes of the adjacent endothelial cells are tightly
fused rather than having large slit-pores between
them, as is the case for most other capillaries of the
body.
75.
76. Function of CSF
• Maintenance of a constant external
environment for neurons and glia
• Mechanical cushion to protect the brain and
provide buoyancy to the heavy brain (1400
g)
• Serves as a lymphatic system and a conduit
for neuropeptides
• pH of CSF regulates pulmonary ventilation
and CBF
77. Function of CSF
• Maintenance of a constant external
environment for neurons and glia
• Mechanical cushion to protect the brain and
provide buoyancy to the heavy brain (1400
g)
• Serves as a lymphatic system and a conduit
for neuropeptides
• pH of CSF regulates pulmonary ventilation
and CBF
78. Functions and Properties of the BBBFunctions and Properties of the BBB
• General Properties of the BBB
1. Large molecules do not pass through the BBB easily.
2. Low lipid (fat) soluble molecules do not penetrate into the brain.
However, lipid soluble molecules rapidly cross the BBB into the
brain.
3. Molecules that have a high electrical charge to them are slowed.
• Therefore:
– The BBB is selectively permeable to :Oxygen, Carbon dioxide and
glucose
– The BBB is not permeable to
hydrogen ions
• General Properties of the BBB
1. Large molecules do not pass through the BBB easily.
2. Low lipid (fat) soluble molecules do not penetrate into the brain.
However, lipid soluble molecules rapidly cross the BBB into the
brain.
3. Molecules that have a high electrical charge to them are slowed.
• Therefore:
– The BBB is selectively permeable to :Oxygen, Carbon dioxide and
glucose
– The BBB is not permeable to
hydrogen ions
79.
80. Function of CSF
• Maintenance of a constant external
environment for neurons and glia
• Mechanical cushion to protect the brain and
provide buoyancy to the heavy brain (1400
g)
• Serves as a lymphatic system and a conduit
for neuropeptides
• pH of CSF regulates pulmonary ventilation
and CBF