CEREBROSPINAL FLUID

and BLOOD BRAIN

BARRIER
Clinical scenario
Ventricles
CSF Flow
CSF

Colorless, isotonic alkaline, almost protein and cell free contains less glucose
and K+ than plasma
Volume 130-150 ml
Daily secretion : 0.2-0.3 ml/ min
Pressure – 130 mm of water
CSF Formation
Differences
in plasma
and CSF
CSF Functions

Weight of brain in air :1400 gm

Net weight of brain in “water bath” of CSF :50 gm
Movement of brain in CSF greatly checked by
CSF and trabeculae
Applied Aspects :CSF

Lumbar puncture studies

External /communicating hydrocephalus
Internal/non-communicating hydrocephalus
Protection from head injury
Depressed skull fractures and counter coup injuries
Blood brain barrier

History Paul Ehrlich 1885: Iv

Trypan blue stain all organ
except brain and spinal cord
1900 : M Lewandowsky
coined term blood brain
cabinet
1913 Edwin Goldman Injects
soluble dyes in Lumbar spinal
cord : Stains Bain and spinal
cord
Blood brain barrier

Tight junctions between capillary endothelial cells and between epithelial cells in
the choroid plexus effectively prevent protein from entering brain in adults and
slow penetration of molecules

Uniquely limited exchange of substances into brain is refereed as blood brain

barrier

Movement out of brain is generally more free due to bulk flow of CSF via
arachnoid villi.
Penetration of substances in brain

Water, CO2, O2, lipid soluble substances easy transport

Glucose : GLUT 1 55K and GLUT 1 45K
Na+-K+-2Cl-
P-Glycoprotein : member of ATP binding cassets: Transports back drugs and
peptides into capillary
Circumventricular organs
Posterior pituitary and median eminence of
hypothalamus : Oxytocin and Vasopressin
Area prostrema : Chemoreceptor Trigger Zone ,
Responds by vomiting to chemical
Organum vasculosum of lamina terminalis: OVLT ,
↑ water intake in response to Angiotensin II
Site for Osmoreceptors controlling vasopressin
Subfornical organ (SFO)
Structure BBB
Functions of BBB

Neurons are dependent on K+,Ca2+, Mg2+ and H+

Sensitivity of neurons to change in ionic concentrations : Defence Mechanism
Blood brain barrier
Constancy of environment of neurons
Protection of neurons from endogenous and exogenous toxins
Prevention of neurotransmitters into general circulation
Applied Aspects

Kernicterus
Severely jaundiced newborn with immature hepatic bilirubin conjugating system
free bilirubin enters brain damages basal ganglia
Amines Dopamine and serotonine penetrate brain minimally but their acid
precursors L-Dopamine and 5HT enters with ease

BBB breaks down with infecton or injury, suden high BP,I V hypertonic saline
Tumours develop new capillaries which would be fenestrated: Radioactive
iodine labelled albumin studies