Cerebrospinal Fluid System

• Cerebrospinal fluid (CSF) system

– Meninges
– Ventricles
– CSF
• Flow of CSF
– Formed in the ventricles -> subarachnoid space ->
absorbed into the venous circulation
• Role of CSF
– Supplies water, certain amino acids, and specific ions to the
extracellular fluid
– Removes metabolites from the brain
– The meninges and the buoyancy of the fluid -> protection
to the brain
 Meninges
• Membrane covering brain & spinal cord

– Dura mater
– Arachnoid mater
– Pia mater
Meninges

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 Meninges
• Dura mater
– Touch, fibrous membrane
– Outer layer - firmly bound to the inside of the skull
– Inner layer - attached to the arachnoid
– Falx cerebri - separating the cerebral hemispheres
– Tentorium cerebelli - separating the cerebellum from the CHs

• Dural sinuses (nonfused between inner and outer layer)

– Collection of venous blood and CSF
– Non-fused between inner and outer layer
Falx cerebri & tentorium cerebelli

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 Meninges
• The arachnoid
– Soft translucent membrane
– Delicate membrane loosely attached to the dura
– Arachnoid villi - allow CSF to flow into the sinuses, arachnoid
granulations

• Pia mater
– Macroscopically thin, delicate membrane
– Tightly apposed to the surfaces of the brain and spinal cord
– Arachnoid trabeculae (collagen fibers)
– Subarachnoid space
– Denticulate ligaments - anchor the spinal cord to the dura mater
 space
• Space
– Subdural space
– Subarchnoid space
• Arteries & veins
• Cerebrospinal fluid & choroid plexus
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 Ventricular system
• Lateral ventricle – 2개
• Third ventricle
• Fourth ventricle
• Cerebrospinal fluid (CSF)
: 세포외 환경 조절
: 중추신경계 보호
: 뇌실 (특히, choroid plexuses)에서 생성되어 뇌실과 거미막밑
공간을 순환 후 정맥으로 흡수된다.
: lat. ventricle > third ventricle > cerebral aqueduct > fourth
ventricle > lat. & med. aperture > subarachoid space.
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 Ventricles
• The lateral ventricles
– Paired, one in each cerebral hemisphere
– C-shape: body, atrium, and anterior, posterior, and inferior horns
– Boundary
• Outside wall - caudate nucleus
• Below the body – thalamus
• Above the body - corpus callosum
– Connect to each other
– Interventricular foramina (foramina of Monro) -> third ventricle

• The third ventricle

– Narrow slit in the midline of the diencephalon
– Walls: thalamus and hypothalamus
– Cerebral aqueduct (aqueduct of Sylvius) -> fourth ventricles
 Ventricles
• The fourth ventricle
– Between the pons and medulla anteriorly and
cerebellum posteriorly
– Continuous with the central canal of the spinal cord
– Drains into the subarachnoid space
• Two lateral foramina (foramina of Luschka)
• Midline opening (foramen of Magendie)
 Formation and Circulation of CSF
• Formation of CSF
– Extracellular fluid leaking into the ventricles (some)
– Choroid plexuses in the ventricles (most)
• Network of capillaries embedded in connective tissue
and epithelial cells
• Formed from blood by filtration, active transport, and
facilitated transport of certain substances

• Circulation of CSF
– Lateral ventricles -> interventricular foramina ->
third ventricle -> cerebral aqueduct -> fourth
ventricle -> lateral and medial foramina ->
subarachnoid space -> spinal cord and brain ->
arachnoid villi -> dura and into the venous sinuses
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Lumbar puncture

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 Clinical Disorders of the CSF
• Epidural hematoma
– Arterial bleeding between the skull and dura mater
– A few hours of normal function -> worsening headache,
vomiting, decreasing consciousness, hemiparesis, Babinski's
sign
• Subdural hematoma
– Gradually worsen over a prolonged period (days to months)
– Slow bleeding -> venous bleeding (blood pressure < arteries)
• Hydrocephalus
 Clinical Disorders of the CSF
• Craniosacral therapy
– To evaluate and treat the CSF system
– Periodic CSF production -> fluid pressure change ->
rhythmical movement of the dura
– No evidence exists for the existence of craniosacral rhythm

• Meningitis
– Inflammation of the membranes
– Headache, fever, confusion, vomiting, neck stiffness
– Bacterial or viral infections
 Hydrocephalus
• Obstruction of flow of CSF- ventricular system or
- subarachnoid space
: rise in fluid pressure
: clinical effect – brain tumor와 비슷
- Headaches and mental impairment

• Clinical problems
– Excessive pressure in the ventricles -> compress the nervous tissue
(particularly the white matter)
– Gait and balance impairments, incontinence and headache
– Frontal lobe functions - emotions, planning, memory, and intellect
– Language, spatial awareness, and declarative memory – spared
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