Download - Y2 s1 csf
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cerebrospinal fluid (CSF)
Prof. Vajira Weerasinghe
Dept of Physiology
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cerebral blood flow
• 750 ml/min (15% of cardiac output)
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cerebrospinal fluid
• The cavity enclosing the brain & spinal cord, and the central canal: filled with CSF
• This fluid is in– ventricles– cisterns– subarachnoid space– central canal
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cushioning function
• brain is floating in the fluid
• this provides a protective function
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contrecoup injury
• when there is a severe blow on the head
• brain is lushed so that the opposite side is struk on the skull to cause an injury
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• volume of CSF– 150 ml
• rate of production– 500 ml/day
• formed – mainly in the choroid plexuses of the ventricles– small amounts in the ventricles, arachnoid membranes & perivascular
spaces
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formation• choroid plexus projects into
– horn of lateral ventricle– posterior portion of 3rd ventricle– roof of the 4th ventricle
• Mechanism:– active transport of Na through the epithelial cells, Cl follows
passively– osmotic outflow of water– glucose moves in to CSF– K and HCO3 moved out of CSF
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absorption• arachnoid villi in the walls of venous
sinuses
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circulation• fluid secreted in the lateral ventricles into the 3rd ventricle (secretes
here)
• pass along the aqueduct of Sylvius into the 4th ventricle
• through foramina of Luschka & Magendie into the cisterna magna (behind the medulla)
• subarachnoid spaces around the brain & spinal cord
• arachnoid villi in the venous sinuses
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composition
• similar to plasma– CSF Plasma
– Na 147 (similar) 150 mmol/l
– K 2.9 (less) 4.6 mmol/l
– HCO3 25 24.8 mmol/l
– Cl 113 (more) 99 mmol/l
– Pco2 50 40 mmHg
– pH 7.33 7.4
– osmolality 289 (similar) 289 mosm
– protein 20 (less) 6000 mg/dl
– glucose 64 (less) 100 mg/dl
– urea 12 (less) 15 mg/dl
• some substances do not pass into CSF
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blood brain barrier• tight junctions between capillary endothelial cells & epithelial cells in the choroid
prevent some substances entering CSF
• small molecules & lipid soluble substances pass through easily
• blood-brain barrier exists between blood & brain tissue
• blood-CSF barrier is present in choroid
• these barriers are– highly permeable to water, CO2, O2, lipid soluble substances (such as alcohol), most anaesthetics,
– slightly permeable to electrolytes– impermeable to proteins, large organic molecules– drugs (variable)
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Blood brain barrier
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blood brain barrier
• CO2 & O2 crosses easily
• H+ & HCO3- slow penetration• glucose
– passive: slow penetration– active transport system by glucose transporter GLUT
• Na-K-Cl transporter• transporters for other substances
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blood brain barrier
– No blood brain barrier in the hypothalamus & posterior pituitary
• substances diffuses easily• these areas contain chemoreceptors for various
substances to detect changes in conc
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CSF pressure
• lumbar CSF pressure: 70-180 mmH2O
• this is regulated by absorption through arachnoid villi
• rate of CSF formation is constant
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CSF pressure rises
– if the arachnoid villi are blocked by a disease process
– brain tumour may compresses the brain and blocks the absorption
– haemorrhage into the brain tissue can block small channels in the arachnoid villi
– babies are born with high CSF (as in hydrocephalus) due to a defect before birth
• blocking the aqueduct of Sylvius
• blocking of arachnoid villi
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cerebral oedema
– because brain is enclosed in a solid cranial vault, accumulation of fluid compresses brain tissue and have serious effects
– happens due to increased capillary pressure or damage to the capillaries
– causes• compresses vasculature, decreases blood flow, brain ischaemia,
arteriolar dilatation, increased capillary pressure, oedema worsens• decreases blood flow, deceases oxygen supply, increases capillary
permeability, more fluid leakage
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Cerebral oedema• A 45-year-old man was brought to the emergency department by
his friends• because of a 1-day history of a severe headache and "bizarre
behavior.“• CT scan of his brain revealed
– acute intracranial hemorrhage– with cerebral edema– evidence of midline shift– increased intracranial pressure
• The patient was admitted to the intensive care unit (ICU)
• young patient •was found belatedly after a collapse •secondary to drug overdose•Note the extensive cerebral oedema •with loss of normal grey-white matter differentiation.•The patient never regained consciousness •eventually died with increased intracranial pressure.
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brain metabolism• brain metabolism is 15% of total metabolism of the body (although brain mass is 2% of
total body mass)
• therefore brain has an increased metabolic rate
• this is due to increased activity of neurons (AP)
• requires oxygen
• brain is not capable of anaerobic metabolism
• energy supply is by glucose
• glucose entry is not controlled by insulin
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Lumbar puncture
• This is the method of obtaining access to the subarachnoid spaceThis is done for the following purposes– To obtain CSF for examination – To estimate CSF pressure
• Patient lying on one side • LP needle is inserted between 3rd and 4th or 4th and
5th lumbar spinous processes• Fluid is withdrawn• Manometer is connected and pressure measured
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Lumbar puncture