Cerebrospinal fluid

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Cerebrospinal fluid
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The cerebrospinal fluid circulates in the subarachnoid space around the brain and spinal cord, and in the ventricles of the brain.
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Image showing the location of CSF highlighting the brain's ventricular system
Details
Identifiers
Latin liquor cerebrospinalis
Acronym(s)CSF
MeSH D002555
TA98 A14.1.01.203
TA2 5388
Anatomical terminology

Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates.

Contents

CSF is produced by specialised ependymal cells in the choroid plexus of the ventricles of the brain, and absorbed in the arachnoid granulations. In humans, there is about 125 mL of CSF at any one time, and about 500 mL is generated every day. CSF acts as a shock absorber, cushion or buffer, providing basic mechanical and immunological protection to the brain inside the skull. CSF also serves a vital function in the cerebral autoregulation of cerebral blood flow.

CSF occupies the subarachnoid space (between the arachnoid mater and the pia mater) and the ventricular system around and inside the brain and spinal cord. It fills the ventricles of the brain, cisterns, and sulci, as well as the central canal of the spinal cord. There is also a connection from the subarachnoid space to the bony labyrinth of the inner ear via the perilymphatic duct where the perilymph is continuous with the cerebrospinal fluid. The ependymal cells of the choroid plexus have multiple motile cilia on their apical surfaces that beat to move the CSF through the ventricles.

A sample of CSF can be taken from around the spinal cord via lumbar puncture. This can be used to test the intracranial pressure, as well as indicate diseases including infections of the brain or the surrounding meninges.

Although noted by Hippocrates, it was forgotten for centuries, though later was described in the 18th century by Emanuel Swedenborg. In 1914, Harvey Cushing demonstrated that CSF is secreted by the choroid plexus.

Structure

Circulation

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MRI showing pulsation of CSF
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Distribution of CSF

In humans, there is about 125–150 mL of CSF at any one time. [1] This CSF circulates within the ventricular system of the brain. The ventricles are a series of cavities filled with CSF. The majority of CSF is produced from within the two lateral ventricles. From here, CSF passes through the interventricular foramina to the third ventricle, then the cerebral aqueduct to the fourth ventricle. From the fourth ventricle, the fluid passes into the subarachnoid space through four openings –the central canal of the spinal cord, the median aperture, and the two lateral apertures. [1] CSF is present within the subarachnoid space, which covers the brain and spinal cord, and stretches below the end of the spinal cord to the sacrum. [1] [2] There is a connection from the subarachnoid space to the bony labyrinth of the inner ear making the cerebrospinal fluid continuous with the perilymph in 93% of people. [3]

CSF moves in a single outward direction from the ventricles, but multidirectionally in the subarachnoid space. [3] Fluid movement is pulsatile, matching the pressure waves generated in blood vessels by the beating of the heart. [3] Some authors dispute this, posing that there is no unidirectional CSF circulation, but cardiac cycle-dependent bi-directional systolic-diastolic to-and-from cranio-spinal CSF movements. [4]

Contents

CSF is derived from blood plasma and is largely similar to it, except that CSF is nearly protein-free compared with plasma and has some different electrolyte levels. Due to the way it is produced, CSF has a lower chloride level than plasma, and a higher sodium level. [2] [5]

CSF contains approximately 0.59% plasma proteins, or approximately 15 to 40 mg/dL, depending on sampling site. [6] In general, globular proteins and albumin are in lower concentration in ventricular CSF compared to lumbar or cisternal fluid. [7] This continuous flow into the venous system dilutes the concentration of larger, lipid-insoluble molecules penetrating the brain and CSF. [8] CSF is normally free of red blood cells and at most contains fewer than 5 white blood cells per mm3 (if the white cell count is higher than this it constitutes pleocytosis and can indicate inflammation or infection). [9]

Development

At around the fifth week of development, the embryo is a three-layered disc, covered with ectoderm, mesoderm and endoderm. A tube-like formation develops in the midline, called the notochord. The notochord releases extracellular molecules that affect the transformation of the overlying ectoderm into nervous tissue. [10] The neural tube, forming from the ectoderm, contains CSF prior to the development of the choroid plexuses. [3] The open neuropores of the neural tube close after the first month of development, and CSF pressure gradually increases. [3]

As the brain develops, by the fourth week of embryological development three swellings have formed within the embryo around the canal, near to where the head will develop. These swellings represent different components of the central nervous system: the prosencephalon (forebrain), mesencephalon (midbrain), and rhombencephalon (hindbrain). [10] Subarachnoid spaces are first evident around the 32nd day of development near the rhombencephalon; circulation is visible from the 41st day. [3] At this time, the first choroid plexus can be seen, found in the fourth ventricle, although the time at which they first secrete CSF is not yet known. [3]

The developing forebrain surrounds the neural cord. As the forebrain develops, the neural cord within it becomes a ventricle, ultimately forming the lateral ventricles. Along the inner surface of both ventricles, the ventricular wall remains thin, and a choroid plexus develops, producing and releasing CSF. [10] CSF quickly fills the neural canal. [10] Arachnoid villi are formed around the 35th week of development, with arachnoid granulations noted around the 39th, and continuing developing until 18 months of age. [3]

The subcommissural organ secretes SCO-spondin, which forms Reissner's fiber within CSF assisting movement through the cerebral aqueduct. It is present in early intrauterine life but disappears during early development. [3]

Physiology

Function

CSF serves several purposes:

  1. Buoyancy: The actual mass of the human brain is about 1400–1500 grams, but its net weight suspended in CSF is equivalent to a mass of 25–50 g. [11] [1] The brain therefore exists in neutral buoyancy, which allows the brain to maintain its density without being impaired by its own weight, which would cut off blood supply and kill neurons in the lower sections without CSF. [5]
  2. Protection: CSF protects the brain tissue from injury when jolted or hit, by providing a fluid buffer that acts as a shock absorber from some forms of mechanical injury. [1] [5]
  3. Prevention of brain ischemia: The prevention of brain ischemia is aided by decreasing the amount of CSF in the limited space inside the skull. This decreases total intracranial pressure and facilitates blood perfusion. [1]
  4. Regulation: CSF allows for the homeostatic regulation of the distribution of substances between cells of the brain, [3] and neuroendocrine factors, to which slight changes can cause problems or damage to the nervous system. For example, high glycine concentration disrupts temperature and blood pressure control, and high CSF pH causes dizziness and fainting. [5]
  5. Clearing waste: CSF allows for the removal of waste products from the brain, [1] and is critical in the brain's lymphatic system, called the glymphatic system. [12] Metabolic waste products diffuse rapidly into CSF and are removed into the bloodstream as CSF is absorbed. [13] When this goes awry, CSF can become toxic, such as in amyotrophic lateral sclerosis, the most common form of motor neuron disease. [14] [15]

Production

Comparison of serum and cerebrospinal fluid
SubstanceCSFSerum
Water content (% wt)9993
Protein (mg/dL)357000
Glucose (mg/dL)6090
Osmolarity (mOsm/L)295295
Sodium (mEq/L)138138
Potassium (mEq/L)2.84.5
Calcium (mEq/L)2.14.8
Magnesium (mEq/L)2.0–2.5 [16] 1.7
Chloride (mEq/L)119102
pH7.337.41

The brain produces roughly 500 mL of cerebrospinal fluid per day at a rate of about 20 mL an hour. [17] This transcellular fluid is constantly reabsorbed, so that only 125–150 mL is present at any one time. [1]

CSF volume is higher on a mL per kg body weight basis in children compared to adults. Infants have a CSF volume of 4 mL/kg, children have a CSF volume of 3 mL/kg, and adults have a CSF volume of 1.5–2 mL/kg. A high CSF volume is why a larger dose of local anesthetic, on a mL/kg basis, is needed in infants. [18] Additionally, the larger CSF volume may be one reason as to why children have lower rates of postdural puncture headache. [19]

Most (about two-thirds to 80%) of CSF is produced by the choroid plexus. [1] [2] The choroid plexus is a network of blood vessels present within sections of the four ventricles of the brain. It is present throughout the ventricular system except for the cerebral aqueduct, and the frontal and occipital horns of the lateral ventricles. [20] CSF is mostly produced by the lateral ventricles. [17] CSF is also produced by the single layer of column-shaped ependymal cells which line the ventricles; by the lining surrounding the subarachnoid space; and a small amount directly from the tiny spaces surrounding blood vessels around the brain. [2]

CSF is produced by the choroid plexus in two steps. Firstly, a filtered form of plasma moves from fenestrated capillaries in the choroid plexus into an interstitial space, [1] with movement guided by a difference in pressure between the blood in the capillaries and the interstitial fluid. [3] This fluid then needs to pass through the epithelium cells lining the choroid plexus into the ventricles, an active process requiring the transport of sodium, potassium and chloride that draws water into CSF by creating osmotic pressure. [3] Unlike blood passing from the capillaries into the choroid plexus, the epithelial cells lining the choroid plexus contain tight junctions between cells, which act to prevent most substances flowing freely into CSF. [21] Cilia on the apical surfaces of the ependymal cells beat to help transport the CSF. [22]

Water and carbon dioxide from the interstitial fluid diffuse into the epithelial cells. Within these cells, carbonic anhydrase converts the substances into bicarbonate and hydrogen ions. These are exchanged for sodium and chloride on the cell surface facing the interstitium. [3] Sodium, chloride, bicarbonate and potassium are then actively secreted into the ventricular lumen. [2] [3] This creates osmotic pressure and draws water into CSF, [2] facilitated by aquaporins. [3] CSF contains many fewer protein anions than blood plasma. Protein in the blood is primarily composed of anions where each anion has many negative charges on it. [23] As a result, to maintain electroneutrality blood plasma has a much lower concentration of chloride anions than sodium cations. CSF contains a similar concentration of sodium ions to blood plasma but fewer protein cations and therefore a smaller imbalance between sodium and chloride resulting in a higher concentration of chloride ions than plasma. This creates an osmotic pressure difference with the plasma. CSF has less potassium, calcium, glucose and protein. [5] Choroid plexuses also secrete growth factors, iodine, [24] vitamins B1, B12, C, folate, beta-2 microglobulin, arginine vasopressin and nitric oxide into CSF. [3] A Na-K-Cl cotransporter and Na/K ATPase found on the surface of the choroid endothelium, appears to play a role in regulating CSF secretion and composition. [3] [1] It has been hypothesised that CSF is not primarily produced by the choroid plexus, but is being permanently produced inside the entire CSF system, as a consequence of water filtration through the capillary walls into the interstitial fluid of the surrounding brain tissue, regulated by AQP-4. [4]

There are circadian variations in CSF secretion, with the mechanisms not fully understood, but potentially relating to differences in the activation of the autonomic nervous system over the course of the day. [3]

Choroid plexus of the lateral ventricle produces CSF from the arterial blood provided by the anterior choroidal artery. [25] In the fourth ventricle, CSF is produced from the arterial blood from the anterior inferior cerebellar artery (cerebellopontine angle and the adjacent part of the lateral recess), the posterior inferior cerebellar artery (roof and median opening), and the superior cerebellar artery. [26]

Reabsorption

CSF returns to the vascular system by entering the dural venous sinuses via arachnoid granulations. [2] These are outpouchings of the arachnoid mater into the venous sinuses around the brain, with valves to ensure one-way drainage. [2] This occurs because of a pressure difference between the arachnoid mater and venous sinuses. [3] CSF has also been seen to drain into lymphatic vessels, [27] particularly those surrounding the nose via drainage along the olfactory nerve through the cribriform plate. The pathway and extent are currently not known, [1] but may involve CSF flow along some cranial nerves and be more prominent in the neonate. [3] CSF turns over at a rate of three to four times a day. [2] CSF has also been seen to be reabsorbed through the sheathes of cranial and spinal nerve sheathes, and through the ependyma. [3]

Regulation

The composition and rate of CSF generation are influenced by hormones and the content and pressure of blood and CSF. [3] For example, when CSF pressure is higher, there is less of a pressure difference between the capillary blood in choroid plexuses and CSF, decreasing the rate at which fluids move into the choroid plexus and CSF generation. [3] The autonomic nervous system influences choroid plexus CSF secretion, with activation of the sympathetic nervous system decreasing secretion and the parasympathetic nervous system increasing it. [3] Changes in the pH of the blood can affect the activity of carbonic anhydrase, and some drugs (such as furosemide, acting on the Na-K-Cl cotransporter) have the potential to impact membrane channels. [3]

Clinical significance

Pressure

CSF pressure, as measured by lumbar puncture, is 10–18  cmH2O (8–15  mmHg or 1.1–2  kPa) with the patient lying on the side and 20–30 cmH2O (16–24 mmHg or 2.1–3.2 kPa) with the patient sitting up. [28] In newborns, CSF pressure ranges from 8 to 10 cmH2O (4.4–7.3 mmHg or 0.78–0.98 kPa). Most variations are due to coughing or internal compression of jugular veins in the neck. When lying down, the CSF pressure as estimated by lumbar puncture is similar to the intracranial pressure.

Hydrocephalus is an abnormal accumulation of CSF in the ventricles of the brain. [29] Hydrocephalus can occur because of obstruction of the passage of CSF, such as from an infection, injury, mass, or congenital abnormality. [29] [30] Hydrocephalus without obstruction associated with normal CSF pressure may also occur. [29] Symptoms can include problems with gait and coordination, urinary incontinence, nausea and vomiting, and progressively impaired cognition. [30] In infants, hydrocephalus can cause an enlarged head, as the bones of the skull have not yet fused, seizures, irritability and drowsiness. [30] A CT scan or MRI scan may reveal enlargement of one or both lateral ventricles, or causative masses or lesions, [29] [30] and lumbar puncture may be used to demonstrate and in some circumstances relieve high intracranial pressure. [31] Hydrocephalus is usually treated through the insertion of a shunt, such as a ventriculo-peritoneal shunt, which diverts fluid to another part of the body. [29] [30]

Idiopathic intracranial hypertension is a condition of unknown cause characterized by a rise in CSF pressure. It is associated with headaches, double vision, difficulties seeing, and a swollen optic disc. [29] It can occur in association with the use of vitamin A and tetracycline antibiotics, or without any identifiable cause at all, particularly in younger obese women. [29] Management may include ceasing any known causes, a carbonic anhydrase inhibitor such as acetazolamide, repeated drainage via lumbar puncture, or the insertion of a shunt such as a ventriculo-peritoneal shunt. [29]

CSF leak

CSF can leak from the dura as a result of different causes such as physical trauma or a lumbar puncture, or from no known cause when it is termed a spontaneous cerebrospinal fluid leak. [32] It is usually associated with intracranial hypotension: low CSF pressure. [31] It can cause headaches, made worse by standing, moving and coughing, [31] as the low CSF pressure causes the brain to "sag" downwards and put pressure on its lower structures. [31] If a leak is identified, a beta-2 transferrin test of the leaking fluid, when positive, is highly specific and sensitive for the detection for CSF leakage. [32] Medical imaging such as CT scans and MRI scans can be used to investigate for a presumed CSF leak when no obvious leak is found but low CSF pressure is identified. [33] Caffeine, given either orally or intravenously, often offers symptomatic relief. [33] Treatment of an identified leak may include injection of a person's blood into the epidural space (an epidural blood patch), spinal surgery, or fibrin glue. [33]

Lumbar puncture

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Vials containing human cerebrospinal fluid

CSF can be tested for the diagnosis of a variety of neurological diseases, usually obtained by a procedure called lumbar puncture. [34] Lumbar puncture is carried out under sterile conditions by inserting a needle into the subarachnoid space, usually between the third and fourth lumbar vertebrae. CSF is extracted through the needle, and tested. [32] About one third of people experience a headache after lumbar puncture, [32] and pain or discomfort at the needle entry site is common. Rarer complications may include bruising, meningitis or ongoing post lumbar-puncture leakage of CSF. [1]

Testing often includes observing the colour of the fluid, measuring CSF pressure, and counting and identifying white and red blood cells within the fluid; measuring protein and glucose levels; and culturing the fluid. [32] [34] The presence of red blood cells and xanthochromia may indicate subarachnoid hemorrhage; whereas central nervous system infections such as meningitis, may be indicated by elevated white blood cell levels. [34] A CSF culture may yield the microorganism that has caused the infection, [32] or PCR may be used to identify a viral cause. [34] Investigations to the total type and nature of proteins reveal point to specific diseases, including multiple sclerosis, paraneoplastic syndromes, systemic lupus erythematosus, neurosarcoidosis, cerebral angiitis; [1] and specific antibodies such as aquaporin-4 may be tested for to assist in the diagnosis of autoimmune conditions. [1] A lumbar puncture that drains CSF may also be used as part of treatment for some conditions, including idiopathic intracranial hypertension and normal pressure hydrocephalus. [1]

Lumbar puncture can also be performed to measure the intracranial pressure, which might be increased in certain types of hydrocephalus. However, a lumbar puncture should never be performed if increased intracranial pressure is suspected due to certain situations such as a tumour, because it can lead to fatal brain herniation. [32]

Anaesthesia and chemotherapy

Some anaesthetics and chemotherapy are injected intrathecally into the subarachnoid space, where they spread around CSF, meaning substances that cannot cross the blood–brain barrier can still be active throughout the central nervous system. [35] [36] Baricity refers to the density of a substance compared to the density of human cerebrospinal fluid and is used in regional anesthesia to determine the manner in which a particular drug will spread in the intrathecal space. [35]

Liquorpheresis

Liquorpheresis is the process of filtering the CSF in order to clear it from endogen or exogen pathogens. It can be achieved by means of fully implantable or extracorporeal devices, though the technique remains experimental today.[ citation needed ]

History

Various comments by ancient physicians have been read as referring to CSF. Hippocrates discussed "water" surrounding the brain when describing congenital hydrocephalus, and Galen referred to "excremental liquid" in the ventricles of the brain, which he believed was purged into the nose. But for some 16 intervening centuries of ongoing anatomical study, CSF remained unmentioned in the literature. This is perhaps because of the prevailing autopsy technique, which involved cutting off the head, thereby removing evidence of CSF before the brain was examined. [37]

The modern rediscovery of CSF is credited to Emanuel Swedenborg. In a manuscript written between 1741 and 1744, unpublished in his lifetime, Swedenborg referred to CSF as "spirituous lymph" secreted from the roof of the fourth ventricle down to the medulla oblongata and spinal cord. This manuscript was eventually published in translation in 1887. [37]

Albrecht von Haller, a Swiss physician and physiologist, made note in his 1747 book on physiology that the "water" in the brain was secreted into the ventricles and absorbed in the veins, and when secreted in excess, could lead to hydrocephalus. [37] François Magendie studied the properties of CSF by vivisection. He discovered the foramen Magendie, the opening in the roof of the fourth ventricle, but mistakenly believed that CSF was secreted by the pia mater. [37]

Thomas Willis (noted as the discoverer of the circle of Willis) made note of the fact that the consistency of CSF is altered in meningitis. [37] In 1869 Gustav Schwalbe proposed that CSF drainage could occur via lymphatic vessels. [1]

In 1891, W. Essex Wynter began treating tubercular meningitis by removing CSF from the subarachnoid space, and Heinrich Quincke began to popularize lumbar puncture, which he advocated for both diagnostic and therapeutic purposes. [37] In 1912, a neurologist William Mestrezat gave the first accurate description of the chemical composition of CSF. [37] In 1914, Harvey W. Cushing published conclusive evidence that CSF is secreted by the choroid plexus. [37]

Other animals

During phylogenesis, CSF is present within the neuraxis before it circulates. [3] The CSF of Teleostei fish, which do not have a subarachnoid space, is contained within the ventricles of their brains. [3] In mammals, where a subarachnoid space is present, CSF is present in it. [3] Absorption of CSF is seen in amniotes and more complex species, and as species become progressively more complex, the system of absorption becomes progressively more enhanced, and the role of spinal epidural veins in absorption plays a progressively smaller and smaller role. [3]

The amount of cerebrospinal fluid varies by size and species. [38] In humans and other mammals, cerebrospinal fluid turns over at a rate of 3–5 times a day. [38] Problems with CSF circulation, leading to hydrocephalus, can occur in other animals as well as humans. [38]

See also

Related Research Articles

<span class="mw-page-title-main">Hydrocephalus</span> Abnormal increase in cerebrospinal fluid in the ventricles of the brain

Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. This typically causes increased pressure inside the skull. Older people may have headaches, double vision, poor balance, urinary incontinence, personality changes, or mental impairment. In babies, it may be seen as a rapid increase in head size. Other symptoms may include vomiting, sleepiness, seizures, and downward pointing of the eyes.

<span class="mw-page-title-main">Ventricular system</span> Set of structures containing cerebrospinal fluid in the brain

In neuroanatomy, the ventricular system is a set of four interconnected cavities known as cerebral ventricles in the brain. Within each ventricle is a region of choroid plexus which produces the circulating cerebrospinal fluid (CSF). The ventricular system is continuous with the central canal of the spinal cord from the fourth ventricle, allowing for the flow of CSF to circulate.

<span class="mw-page-title-main">Lumbar puncture</span> Procedure to collect cerebrospinal fluid

Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. Examples of these conditions include meningitis and subarachnoid hemorrhage. It may also be used therapeutically in some conditions. Increased intracranial pressure is a contraindication, due to risk of brain matter being compressed and pushed toward the spine. Sometimes, lumbar puncture cannot be performed safely. It is regarded as a safe procedure, but post-dural-puncture headache is a common side effect if a small atraumatic needle is not used.

<span class="mw-page-title-main">Pia mater</span> Delicate innermost layer of the meninges, the membranes surrounding the brain and spinal cord

Pia mater, often referred to as simply the pia, is the delicate innermost layer of the meninges, the membranes surrounding the brain and spinal cord. Pia mater is medieval Latin meaning "tender mother". The other two meningeal membranes are the dura mater and the arachnoid mater. Both the pia and arachnoid mater are derivatives of the neural crest while the dura is derived from embryonic mesoderm. The pia mater is a thin fibrous tissue that is permeable to water and small solutes. The pia mater allows blood vessels to pass through and nourish the brain. The perivascular space between blood vessels and pia mater is proposed to be part of a pseudolymphatic system for the brain. When the pia mater becomes irritated and inflamed the result is meningitis.

<span class="mw-page-title-main">Intracranial pressure</span> Pressure exerted by fluids inside the skull and on the brain

Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury (mmHg) and at rest, is normally 7–15 mmHg for a supine adult. The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF.

<span class="mw-page-title-main">Choroid plexus</span> Structure in the ventricles of the brain

The choroid plexus, or plica choroidea, is a plexus of cells that arises from the tela choroidea in each of the ventricles of the brain. Regions of the choroid plexus produce and secrete most of the cerebrospinal fluid (CSF) of the central nervous system. The choroid plexus consists of modified ependymal cells surrounding a core of capillaries and loose connective tissue. Multiple cilia on the ependymal cells move to circulate the cerebrospinal fluid.

<span class="mw-page-title-main">Fourth ventricle</span> Ventricle in front of the cerebellum

The fourth ventricle is one of the four connected fluid-filled cavities within the human brain. These cavities, known collectively as the ventricular system, consist of the left and right lateral ventricles, the third ventricle, and the fourth ventricle. The fourth ventricle extends from the cerebral aqueduct to the obex, and is filled with cerebrospinal fluid (CSF).

<span class="mw-page-title-main">Neuromere</span>

Neuromeres are distinct groups of neural crest cells, forming segments in the neural tube of the early embryonic development of the brain. There are three classes of neuromeres in the central nervous system – prosomeres, mesomeres and rhombomeres that will develop the forebrain, midbrain, and hindbrain respectively.

<span class="mw-page-title-main">Ependyma</span> Lining of the ventricular system of the brain

The ependyma is the thin neuroepithelial lining of the ventricular system of the brain and the central canal of the spinal cord. The ependyma is one of the four types of neuroglia in the central nervous system (CNS). It is involved in the production of cerebrospinal fluid (CSF), and is shown to serve as a reservoir for neuroregeneration.

<span class="mw-page-title-main">Median aperture</span>

The median aperture is an opening of the fourth ventricle at the caudal portion of the roof of the fourth ventricle. It allows flow of cerebrospinal fluid (CSF) from the fourth ventricle into the cisterna magna. The other two openings of the fourth ventricle are the lateral apertures - one on either side. Nonetheless, the median aperture accounts for most of the outflow of CSF out of the fourth ventricle. The median aperture varies in size.

<span class="mw-page-title-main">Arachnoid mater</span> Web-like middle layer of the three meninges

The arachnoid mater is one of the three meninges, the protective membranes that cover the brain and spinal cord. It is so named because of its resemblance to a spider web. The arachnoid mater is a derivative of the neural crest mesoectoderm in the embryo.

Cisternography is a medical imaging technique to examine the flow of cerebrospinal fluid (CSF) in the brain, and spinal cord. The gold standard for diagnosis of a cranial cerebrospinal fluid leak is CT cisternography. For the diagnosis of a spinal CSF leak radionuclide cisternography also known as radioisotope cisternography is used. The third type of cisternography is MR cisternography.

<span class="mw-page-title-main">Choroid plexus papilloma</span> Medical condition

Choroid plexus papilloma, also known as papilloma of the choroid plexus, is a rare benign neuroepithelial intraventricular WHO grade I lesion found in the choroid plexus. It leads to increased cerebrospinal fluid production, thus causing increased intracranial pressure and hydrocephalus.

<span class="mw-page-title-main">Intraventricular hemorrhage</span> Medical condition

Intraventricular hemorrhage (IVH), also known as intraventricular bleeding, is a bleeding into the brain's ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. It can result from physical trauma or from hemorrhagic stroke.

<span class="mw-page-title-main">Leptomeningeal cancer</span> Medical condition

Leptomeningeal cancer is a rare complication of cancer in which the disease spreads from the original tumor site to the meninges surrounding the brain and spinal cord. This leads to an inflammatory response, hence the alternative names neoplastic meningitis (NM), malignant meningitis, or carcinomatous meningitis. The term leptomeningeal describes the thin meninges, the arachnoid and the pia mater, between which the cerebrospinal fluid is located. The disorder was originally reported by Eberth in 1870. It is also known as leptomeningeal carcinomatosis, leptomeningeal disease (LMD), leptomeningeal metastasis, meningeal metastasis and meningeal carcinomatosis.

<span class="mw-page-title-main">External ventricular drain</span> Medical device

An external ventricular drain (EVD), also known as a ventriculostomy or extraventricular drain, is a device used in neurosurgery to treat hydrocephalus and relieve elevated intracranial pressure when the normal flow of cerebrospinal fluid (CSF) inside the brain is obstructed. An EVD is a flexible plastic catheter placed by a neurosurgeon or neurointensivist and managed by intensive care unit (ICU) physicians and nurses. The purpose of external ventricular drainage is to divert fluid from the ventricles of the brain and allow for monitoring of intracranial pressure. An EVD must be placed in a center with full neurosurgical capabilities, because immediate neurosurgical intervention can be needed if a complication of EVD placement, such as bleeding, is encountered.

<span class="mw-page-title-main">Spinal cord</span> Long, tubular central nervous system structure in the vertebral column

The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal cord is hollow and contains a structure called the central canal, which contains cerebrospinal fluid. The spinal cord is also covered by meninges and enclosed by the neural arches. Together, the brain and spinal cord make up the central nervous system.

<span class="mw-page-title-main">Cerebrospinal fluid leak</span> Medical condition

A cerebrospinal fluid leak is a medical condition where the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks out of one or more holes or tears in the dura mater. A CSF leak is classed as either nonspontaneous (primary), having a known cause, or spontaneous (secondary) where the cause is not readily evident. Causes of a primary CSF leak are those of trauma including from an accident or intentional injury, or arising from a medical intervention known as iatrogenic. A basilar skull fracture as a cause can give the sign of CSF leakage from the ear nose or mouth. A lumbar puncture can give the symptom of a post-dural-puncture headache.

Bobble-head doll syndrome is a rare neurological movement disorder in which patients, usually children around age 3, begin to bob their head and shoulders forward and back, or sometimes side-to-side, involuntarily, in a manner reminiscent of a bobblehead doll. The syndrome is related to cystic lesions and swelling of the third ventricle in the brain.

<span class="mw-page-title-main">Glymphatic system</span> System for waste clearance in the central nervous system of vertebrates

The glymphatic system is a system for waste clearance in the central nervous system (CNS) of vertebrates. According to this model, cerebrospinal fluid (CSF) flows into the paravascular space around cerebral arteries, combining with interstitial fluid (ISF) and parenchymal solutes, and exiting down venous paravascular spaces. The pathway consists of a para-arterial influx route for CSF to enter the brain parenchyma, coupled to a clearance mechanism for the removal of interstitial fluid (ISF) and extracellular solutes from the interstitial compartments of the brain and spinal cord. Exchange of solutes between CSF and ISF is driven primarily by arterial pulsation and regulated during sleep by the expansion and contraction of brain extracellular space. Clearance of soluble proteins, waste products, and excess extracellular fluid is accomplished through convective bulk flow of ISF, facilitated by astrocytic aquaporin 4 (AQP4) water channels.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Wright BL, Lai JT, Sinclair AJ (August 2012). "Cerebrospinal fluid and lumbar puncture: a practical review". Journal of Neurology. 259 (8): 1530–45. doi:10.1007/s00415-012-6413-x. PMID   22278331. S2CID   2563483.
  2. 1 2 3 4 5 6 7 8 9 Guyton AC, Hall JE (2005). Textbook of medical physiology (11th ed.). Philadelphia: W.B. Saunders. pp. 764–7. ISBN   978-0-7216-0240-0.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Sakka L, Coll G, Chazal J (December 2011). "Anatomy and physiology of cerebrospinal fluid". European Annals of Otorhinolaryngology, Head and Neck Diseases. 128 (6): 309–16. doi: 10.1016/j.anorl.2011.03.002 . PMID   22100360.
  4. 1 2 Orešković D, Klarica M (2014). "A new look at cerebrospinal fluid movement". Fluids and Barriers of the CNS. 11: 16. doi: 10.1186/2045-8118-11-16 . PMC   4118619 . PMID   25089184.
  5. 1 2 3 4 5 Saladin K (2012). Anatomy and Physiology (6th ed.). McGraw Hill. pp. 519–20.
  6. ↑ Felgenhauer K (December 1974). "Protein size and cerebrospinal fluid composition". Klinische Wochenschrift. 52 (24): 1158–64. doi:10.1007/BF01466734. PMID   4456012. S2CID   19776406.
  7. ↑ Merril CR, Goldman D, Sedman SA, Ebert MH (March 1981). "Ultrasensitive stain for proteins in polyacrylamide gels shows regional variation in cerebrospinal fluid proteins". Science. 211 (4489): 1437–8. Bibcode:1981Sci...211.1437M. doi:10.1126/science.6162199. PMID   6162199.
  8. ↑ Saunders NR, Habgood MD, Dziegielewska KM (January 1999). "Barrier mechanisms in the brain, I. Adult brain". Clinical and Experimental Pharmacology & Physiology. 26 (1): 11–9. doi:10.1046/j.1440-1681.1999.02986.x. PMID   10027064. S2CID   34773752.
  9. ↑ Jurado R, Walker HK (1990). "Cerebrospinal Fluid". Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.). Butterworths. ISBN   978-0409900774. PMID   21250239.
  10. 1 2 3 4 Schoenwolf GC, Larsen WJ (2009). "Development of the Brain and Cranial Nerves". Larsen's human embryology (4th ed.). Philadelphia: Churchill Livingstone/Elsevier. ISBN   978-0-443-06811-9.[ page needed ]
  11. ↑ Noback C, Strominger NL, Demarest RJ, Ruggiero DA (2005). The Human Nervous System. Humana Press. p. 93. ISBN   978-1-58829-040-3.
  12. ↑ Iliff JJ, Wang M, Liao Y, Plogg BA, Peng W, Gundersen GA, et al. (August 2012). "A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β". Science Translational Medicine. 4 (147): 147ra111. doi:10.1126/scitranslmed.3003748. PMC   3551275 . PMID   22896675.
  13. ↑ Ropper, Allan H.; Brown, Robert H. (March 29, 2005). "Chapter 30". Adams and Victor's Principles of Neurology (8th ed.). McGraw-Hill Professional. p. 530.
  14. ↑ Kwong KC, Gregory JM, Pal S, Chandran S, Mehta AR (2020). "Cerebrospinal fluid cytotoxicity in amyotrophic lateral sclerosis: a systematic review of in vitro studies". Brain Communications. 2 (2): fcaa121. doi: 10.1093/braincomms/fcaa121 . PMC   7566327 . PMID   33094283.
  15. ↑ Ng Kee Kwong KC, Mehta AR, Nedergaard M, Chandran S (August 2020). "Defining novel functions for cerebrospinal fluid in ALS pathophysiology". Acta Neuropathologica Communications. 8 (1): 140. doi: 10.1186/s40478-020-01018-0 . PMC   7439665 . PMID   32819425.
  16. ↑ Irani DN (14 April 2018). Cerebrospinal Fluid in Clinical Practice. Elsevier Health Sciences. ISBN   9781416029083 . Retrieved 14 April 2018– via Google Books.
  17. 1 2 Czarniak N, Kamińska J, Matowicka-Karna J, Koper-Lenkiewicz OM (May 2023). "Cerebrospinal Fluid-Basic Concepts Review". Biomedicines. 11 (5): 1461. doi: 10.3390/biomedicines11051461 . PMC   10216641 . PMID   37239132.
  18. ↑ Thiele, Eryn L.; Nemergut, Edward C. (June 2020). "Miller's Anesthesia, 9th ed". Anesthesia & Analgesia. 130 (6): e175–e176. doi:10.1213/ane.0000000000004780. ISSN   0003-2999.
  19. ↑ Janssens E, Aerssens P, Alliët P, Gillis P, Raes M (March 2003). "Post-dural puncture headaches in children. A literature review". European Journal of Pediatrics. 162 (3): 117–121. doi:10.1007/s00431-002-1122-6. PMID   12655411. S2CID   20716137.
  20. ↑ Young PA (2007). Basic clinical neuroscience (2nd ed.). Philadelphia, Pa.: Lippincott Williams & Wilkins. p. 292. ISBN   978-0-7817-5319-7.
  21. ↑ Hall J (2011). Guyton and Hall textbook of medical physiology (12th ed.). Philadelphia, Pa.: Saunders/Elsevier. p. 749. ISBN   978-1-4160-4574-8.
  22. ↑ Kishimoto N, Sawamoto K (February 2012). "Planar polarity of ependymal cilia". Differentiation; Research in Biological Diversity. 83 (2): S86-90. doi:10.1016/j.diff.2011.10.007. PMID   22101065.
  23. ↑ Staempfli, Henry R.; Constable, Peter D. (1 August 2023). "Experimental determination of net protein charge and Atot and Ka of nonvolatile buffers in human plasma". Journal of Applied Physiology. 95 (2): 620–630. doi:10.1152/japplphysiol.00100.2003. PMID   12665532 . Retrieved 18 August 2023.
  24. ↑ Venturi S, Venturi M (2014). "Iodine, PUFAs and Iodolipids in Health and Disease: An Evolutionary Perspective". Human Evolution. 29 (1–3): 185–205.
  25. ↑ Zagórska-Swiezy K, Litwin JA, Gorczyca J, Pityński K, Miodoński AJ (August 2008). "Arterial supply and venous drainage of the choroid plexus of the human lateral ventricle in the prenatal period as revealed by vascular corrosion casts and SEM". Folia Morphologica. 67 (3): 209–13. PMID   18828104.
  26. ↑ Sharifi M, Ciołkowski M, Krajewski P, Ciszek B (August 2005). "The choroid plexus of the fourth ventricle and its arteries". Folia Morphologica. 64 (3): 194–8. PMID   16228955.
  27. ↑ Johnston M (2003). "The importance of lymphatics in cerebrospinal fluid transport". Lymphatic Research and Biology. 1 (1): 41–4, discussion 45. doi:10.1089/15396850360495682. PMID   15624320.
  28. ↑ Agamanolis D (May 2011). "Chapter 14 – Cerebrospinal Fluid :THE NORMAL CSF". Neuropathology. Northeast Ohio Medical University. Retrieved 2014-12-25.
  29. 1 2 3 4 5 6 7 8 Colledge NR, Walker BR, Ralston SH, eds. (2010). Davidson's principles and practice of medicine (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 1220–1. ISBN   978-0-7020-3084-0.
  30. 1 2 3 4 5 "Hydrocephalus Fact Sheet". www.ninds.nih.gov. National Institute of Neurological Disorders and Stroke. Retrieved 19 May 2017.
  31. 1 2 3 4 Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J (2015). Harrison's Principles of Internal Medicine (19 ed.). McGraw-Hill Professional. pp. 2606–7. ISBN   978-0-07-180215-4.
  32. 1 2 3 4 5 6 7 Colledge NR, Walker BR, Ralston SH, eds. (2010). Davidson's principles and practice of medicine (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 1147–8. ISBN   978-0-7020-3084-0.
  33. 1 2 3 Rosen CL (October 2003). "Meningiomas: the role of preoperative angiography and embolization". Neurosurgical Focus. 15 (4): 1 p following ECP4. doi: 10.3171/foc.2003.15.6.8 . PMID   15376362.
  34. 1 2 3 4 Seehusen DA, Reeves MM, Fomin DA (September 2003). "Cerebrospinal fluid analysis". American Family Physician. 68 (6): 1103–8. PMID   14524396. Archived from the original on 2008-05-15. Retrieved 2009-03-05.
  35. 1 2 Hocking G, Wildsmith JA (October 2004). "Intrathecal drug spread". British Journal of Anaesthesia. 93 (4): 568–78. doi: 10.1093/bja/aeh204 . PMID   15220175.
  36. ↑ "Intrathecal Chemotherapy for Cancer Treatment | CTCA". CancerCenter.com. Archived from the original on 1 January 2018. Retrieved 22 May 2017.
  37. 1 2 3 4 5 6 7 8 Hajdu SI (2003). "A note from history: discovery of the cerebrospinal fluid". Annals of Clinical and Laboratory Science. 33 (3): 334–6. PMID   12956452.
  38. 1 2 3 Reece WO (2013). Functional Anatomy and Physiology of Domestic Animals. John Wiley & Sons. p. 118. ISBN   978-1-118-68589-1.
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