Definition of terms: CSF-cerebrospinal fluid the fluid within the subarachnoid space, the central canal of the spinal

cord, and the four ventricles of the brain. The fluid is formed continuously by the choroid plexus in the ventricles, and, so that there will not be an abnormal increase in amount and pressure, it is reabsorbed into the blood by the arachnoid villi at approximately the same rate at which it is produced. The normal cerebrospinal fluid pressure is 5 mm Hg (100 mm H2O) when the individual is lying in a horizontal position on his side. Fluid pressure may be increased by a brain tumor or by hemorrhage or infection in the cranium Choroid plexus-A vascular proliferation of the cerebral ventricles that serves to regulate intraventricular pressure by secretion or absorption of cerebrospinal fluid. Pia mater-The fine vascular membrane that closely envelops the brain and spinal cord under the arachnoid and the dura mater. Arachnoid-Resembling a cobweb. Used of the arachnoid membrane covering the brain and spinal cord. Subarachnoid-Referring to the space underneath the arachnoid mater. Right and Left lateral ventricle- right and left lateral ventricles are structures within the brain that contain cerebrospinal fluid.The lateral and third ventricles connect through the right and left interventricular foramina, while the third and fourth ventricles connect through a foramen known as the cerebral aqueduct Third ventricle-the third ventricle and the fourth ventricle, they are part of the body's ventricular system Fourth venricleCerebral aqueduct-he cerebral aqueduct is the narrow conduit, between the third and the fourth ventricles in the midbrain, that conveys the cerebrospinal fluid and thereby prevents its potentially deadly buildup in the brain. Also called the aqueduct of Sylvius. Central canal-) a relatively narrow tubular passage or channel Central part of left lateral ventricle-The lateral ventricles are part of the ventricular system of the brain. Classified as part of the telencephalon, they are the largest of the ventricles.

ANATOMY AND PHYSIOLOGY

The anterior cranial fossa is a depression in the floor of the cranial vault which houses the projecting frontal lobes of the brain. It is formed by the orbital plates of the frontal, the cribriform plate of the ethmoid, and the small wings and front part of the body of the sphenoid; it is limited behind by the posterior borders of the small wings of the sphenoid and by the anterior margin of the chiasmatic groove. The lesser wings of the sphenoid separate the anterior and middle fossae. The posterior cranial fossa is part of the intracranial cavity, located between the foramen magnum and tentorium cerebelli. It contains the brainstem and cerebellum. This is the most inferior of the fossae. It houses the cerebellum, medulla and pons. Anteriorly it extends to the apex of the petrous temporal. Posteriorly it is enclosed by the occipital bone. Laterally portions of the squamous temporal and mastoid part of the temporal bone form its walls.

The system comprises four ventricles: lateral ventricles right and left third ventricle fourth ventricle There are several foramina , openings acting as channels, that connect the ventricles. The interventricular foramina (also called the foramina of Monro) connect the lateral ventricles to the third ventricle through which the cerebrospinal fluid can flow. Ventricles The cavities of the hollow human brain are called ventricles.[1] There are four ventricles in human brain: two in cerebrum called lateral ventricles or paracoels, one in diencephalon of forebrain called as diacoel, and one in medulla of hind brain called metacoel. Flow of cerebrospinal fluid The ventricles are filled with cerebrospinal fluid (CSF) which bathes and cushions the brain and spinal cord within their bony confines. CSF is produced by modified ependymal cells of the choroid plexus found in all components of the ventricular system except for the cerebral aqueduct and the posterior and anterior horns of the lateral ventricles. CSF flows from the lateral ventricles via the foramina of Monro into the third ventricle, and then the fourth ventricle via the cerebral aqueduct in the brainstem. From there it can pass into the central canal of the spinal cord or into the cisterns of the subarachnoid space via three small foramina: the central foramen of Magendie and the two lateral foramina of Luschka.

The fluid then flows around the superior sagittal sinus to be reabsorbed via the arachnoid villi into the venous system. CSF within the spinal cord can flow all the way down to the lumbar cistern at the end of the cord around the cauda equina where lumbar punctures are performed. The cerebral aqueduct between the third and fourth ventricles is very small, as are the foramina, which means that they can be easily blocked, causing high pressure in the lateral ventricles. This is a common cause of hydrocephalus (known colloquially as "water on the brain"), which is an extremely serious condition due to both the damage caused by the pressure as well as nature of whatever caused the block (e.g. a tumour or inflammatory swelling).

The brain and spinal cord are covered by the meninges, (three tough membranes) which protect these organs from rubbing against the bones of the skull and spine. The cerebrospinal fluid (CSF) within the skull and spine is found between the pia mater and the arachnoid mater and provides further cushioning. The CSF that is produced in the ventricular system has four main purposes: buoyancy, protection, chemical stability, and the provision of nutrients necessary to the brain. The protection purpose comes into play with the meninges: pia mater, and the arachnoid mater. The CSF is there to protect the brain from striking the cranium when the head is jolted. CSF provides buoyancy and support to the brain against gravity. The buoyancy protects the brain since the brain and CSF are similar in density; this makes the brain float in neutral buoyancy, suspended in the CSF. This allows the brain to attain a decent size and weight without resting on the floor of the cranium, which would kill nervous tissue.[2][3]

Sign and symptoms: Severe headache Back pain weakness sensory loss fever stiff neck, nausea and vomiting, tiredness or disorientation

Nursing Management: Assess neurologic and respiratory status Assess pain Assess for increased ICP

Monitor vital signs, I/O Turn and reposition client every 2 hours to maintain skin integrity Maintain the clients diet to promote healing Encourage the client to drink fluids to maintain hydration Administer IVF to maintain hydration if client cant drink adequate amount Administer oxygen to prevent ischemia Implement increased ICP precautions Encourage the patient to verbalization of feelings Maintain seizure precautions.

Medical Management: Medications: Anticonvulsant Antineoplastic Diuretics Decreased ICP Glucocorticoid dexamethasone to relieve inflammation

Surgical Management: a. Craniotomyb. Radiation therapy-