A classroom presentation

1. Presented By-
Dr. Salma Afroz
Intern Doctor
Department of neuromedicine

2. What is CSF?
 CSF or cerebrospinal fluid is the clear,
colorless fluid that occupies the ventricles of
brain, and the subarachnoid spaces around
brain and spinal cord.

3. Properties of CSF
Appearance Clear and colorless
Volume 70- 160 ml
Rate of production .5 ml/ min
Pressure 60-150 mm of water
Protein 15-45 mg/dl
Glucose 50- 85 mg/dl
Chloride 720-750 mg/dl
No of cells 0-3 lymphocytes/ cumm

4. Functions of CSF
 Cushions and protects the central nervous
system from trauma
 Provides mechanical buoyancy and support
for the brain
 Serves as a reservoir and assists in the
regulation of the contents of the skull
 Nourishes the central nervous system
 Removes metabolites from the central
nervous system.

6. Hydrocephalous
 Hydrocephalus is a condition characterized
by excessive accumulation of CSF in the brain
 It occurs due to
(1) an abnormal increase in the formation of
the fluid (e.g. Tumor in choroid plexus)
(2) a blockage of the circulation of the fluid,
(3) a diminished absorption of the fluid.

7. Verities of hydrocephalous
 Communicating hydrocephalus occurs when
cerebrospinal fluid (CSF) can still flow among
the ventricles.
 . Noncommunicating hydrocephalus, also
called "obstructive" hydrocephalus, occurs
when the flow of CSF is blocked.

8. Presentation of
hydrocephalus
In infancy the main
symptoms are- Hydrocephalic child
 Increased head
circumference
 Vomiting
 Seizures
 Sun setting eyes

9. Presentations of
Hydrocephalus
In case of older children and
adults the main presentations
are-
CT scan shows enlarged
ventricles
 Headache
 Vomiting, nausea
 Gait disturbance
 Memory loss
 Urinary incontinence

10. Treatment of Hydrocephalus
 It is done surgically by
 Ventriculo-peritoneal
shunt

11. Raised ICP
 ICP is normally 7–15 mm Hg; at 20–25 mm
Hg, the upper limit of normal, treatment to
reduce ICP may be needed.

12. Causes of raised ICP
 mass effect: brain tumor, Cerebral edema,
subdural epidural hematoma, abscesses
 generalized brain swelling: [hypertensiveencephalopathy
,.
 increase in venous pressure:
venous sinus thrombosis,

13.  obstruction to CSF flow and/or absorption:
hydrocephalus
 increased CSF production: meningitis,
subarachnoid hemorrhage, or choroid plexus
tumor.
 Idiopathic or unknown cause: idiopathic
intracranial hypertension

14. Signs and symptoms of
raised ICP
 In general, symptoms and signs that suggest
a rise in ICP including
 headache,
 vomiting without nausea,
 ocular palsies,
 altered level of consciousness,
 papilledema

15. Cushing's Triad
 Hypertension
 Bradycardia
 Irregular respiration

16. Management of raised ICP
 Head of bed elevation
 Adequate analgesia
 Sedation
 Dieruesis with manitol
 Treatment of the cause

17. CSF abnormalities in
meningitis
Trait Bacterial Viral Tubercular
Pressure Normal/ increased Normal Normal/ increased
color Cloudy Clear Straw, Cob web in
settlement
Protein >250 mg/dl <100 mg/dl 50-500 mg/dl
WBC count 1000-5000
polymorph
0-50 lymphocyte 50-5000
lymphocytes
Glucose <40 mg/dl >40 mg/dl <40 mg/dl
Microbiology Organism on gm
stain/culture
Sterile AFB or TB culture
(+) ve

20. CSF changes in other
diseases
 Guillian Barre syndrome
 The CSF hallmark is albuminocytological
dissociation.
 The white cell count : 5-50 range.
 The protein: can be normal early, but after 7
days it becomes 50-1,000 mg/dl .

21.  Multiple Sclerosis
 Quantitive increase of CSF IgG-
 IgG index
 IgG synthesis rate
 Qualitative change in CSF IgG-
 Oligoclonal bands

22.  Subarachnoid Hemorrhage:
 CSF pressure: Increased
 Color: Blood stained/ xanthochromia
 RBC count: Increased
 Protein: Increased

23. Sites of CSF collection
Adults: Between L3 & L4 Child: Between L4 & L5