CEREBROSPINAL FLUID

Done by: kholoud alma’abdi

OBJECTIVES
 What is CSF?
 Characteristic of CSF
 Function of CSF
 CSF circulation
 Lumber Puncture
 Indication and contra-indication
 Method
 Abnormal findings
 References
 Cerebrospinal fluid
 is a clear bodily liquid that
surrounds, protects, and
nourishes the brain and spinal
cord.
 CSF flow in the subarachnoid
space
 About 500 mL is produced each
day.
 The rate of production 0.5 ml
per min , with total volume 150
ml ,this crossesponds to turnover
time about 5 hours
Characteristic and composition of CSF

Appearance Clear and colorless

Volume 150 mL
Rate of production 0.5\min
Pressure (spinal tap with patient in 60–150 mm of water
lateral recumbent position)
Composition
Protein
15–45 mg/100 mL
Glucose 50–85 mg/100 mL
Chloride 720–750 mg/100 mL
Number of cells 0–3 lymphocytes/column
Function of CSF
1. Cushions and protects the central nervous system from trauma
2. Provides mechanical buoyancy and support for the brain
3. Serves as a reservoir and assists in the regulation of the
contents of the skull
4. Nourishes the central nervous system
5. Removes metabolites from the central nervous system
6. Serves as a pathway for pineal secretions to reach the
pituitary gland
CSF Circulation
 CSF circulation
1. The circulation begins with its secretion from the choroid plexuses in the
ventricles (and a small amount from the brain surface).
2. The fluid passes from the lateral ventricles into the third ventricle through
the interventricular foramina
3. then passes into the fourth ventricle through the narrow cerebral aqueduct.
The circulation is aided by the arterial pulsations of the choroid plexuses
and by the cilia on the ependymal cells lining the ventricles.
4. From the fourth ventricle, the fluid passes slowly through the median
aperture and the lateral foramina of the lateral recesses of the fourth
ventricle and enters the subarachnoid space.
5. The fluid then moves through the cerebellomedullary cistern and pontine
cisterns and flows superiorly through the tentorial notch of the tentorium
cerebelli to reach the inferior surface of the cerebrum
6.
It then moves superiorly over the lateral aspect of each cerebral
hemisphere, assisted by the pulsations of the cerebral arteries. Some of
the cerebrospinal fluid moves inferiorly in the subarachnoid space around
the spinal cord and cauda equina.
Absorption

1. The main sites for the absorption of the cerebrospinal fluid are the
arachnoid villi that project into the dural venous sinuses, especially the
superior sagittal sinus The arachnoid villi tend to be grouped together to
form elevations known as arachnoid granulations.
2. Structurally, each arachnoid villus is a diverticulum of the subarachnoid
space that pierces the dura mater.
3. The absorption of cerebrospinal fluid into the venous sinuses occurs when
the cerebrospinal fluid pressure exceeds the venous pressure in the sinus.
4. Some of the cerebrospinal fluid probably is absorbed directly into the
veins in the subarachnoid space
5. Because the production of cerebrospinal fluid from the choroid plexuses is
constant, the rate of absorption of cerebrospinal fluid through the
arachnoid villi controls the cerebrospinal fluid pressure.
Lumber puncture
Lumbar puncture (spinal tap) is a simple procedure, during LP
needle inserted between two lumbar bones (vertebrae) to
remove a sample of cerebrospinal fluid
 Indication and contra-indication

Indication contra-indication
1. Collect cerebrospinal fluid for
laboratory analysis 1. A tumor in the back of the brain
that is pressing down on the brain
2. Measure the pressure of your
cerebrospinal fluid stem
3. Inject spinal anesthetics, 2. Blood clotting problems
chemotherapy drugs or other 3. Thrombocytopenia
medications
4. Inject dye (contrast material) or
radioactive substances into
cerebrospinal fluid to make
diagnostic images of the fluid's
flow — a procedure called
myelography
Method
1. The patient lies on his or her side, with knees pulled up toward the chest,
and chin tucked downward. Sometimes the test is done with the person
sitting up, but bent forward.
2. After the back is cleaned, the health care provider will inject a local
numbing medicine (anesthetic) into the lower spine.
3. A spinal needle is inserted, usually into the lower back area.
4. Once the needle is properly positioned, CSF pressure is measured and a
sample is collected.
5. The needle is removed, the area is cleaned, and a bandage is placed
over the needle site. The person is often asked to lie down for a short time
after the test.
6. Occasionally, special x-rays are used to help guide the needle into the
proper position. This is called fluoroscopy.
7. Lumbar puncture with fluid collection
Between L4and L5
 Diseases diagnosed by LP
 Multiple Sclerosis
Spinal Headaches
 Non-Hodgkins Lymphomas
Listeria
 Hydrocephalus Childhood Acute Lymphoblastic Leukemia
 Seizure (Epilepsy) Arachnoiditis
 Guillain-Barre Syndrome Headaches in Children
 Meningitis
Meningococcemia
 Brain Hemorrhage
 Brucellosis
 Valley Fever
 Polio

http://www.medicinenet.com/lumbar_puncture/article.htm
Published at 19/december/2010
Abnormal findings
of common diseases
GBS MS SAH

Albumin cytological •Elevated IgG Index EARLY :Bloody CSF

dissociation especially at time of attack LATE:
(albumin high, WBC •a protein, are usually (yellow)xanthochromic
higher than normal in the
normal) as result of hemoglobin
CSF of people with MS.
• About 90% to 95% of release or bilirubin
patients with MS have formation
OCBs.
• Myelin basic protein
(MBP).
CSF analysis for Meningitis
References
 http://thepoint.lww.com/Book/Show/3175#tab_23081
 http://www.nlm.nih.gov/medlineplus/ency/article/003428.htm
 http://www.mayoclinic.com/health/lumbar-puncture/MY00982
 http://www.medicinenet.com/lumbar_puncture/article.htm
 pjms.com.pk/.../octdec108/article/article1.html
 Netter’s concise neurology book

 http://www.4shared.com/document/_uotsv-n/293587.html
Thank you