• The definition of brain ventricles, their location and
function • The production, circulation and absorption of cerebrospinal fluid (CSF) • The subarachnoid cisterns and their clinical significance • The blood-CSF barrier • The contents and functions of CSF • Some clinical correlates regarding the ventricular system of the brain Objectives To describe:
• The structure and function of the ventricular system of
the brain
• The composition and function of cerebrospinal fluid
(CSF)
• The production, circulation and absorption of CSF
• The important clinical correlates regarding the
ventricular system of the brain Brain ventricles • Ventricles are cavities within the brain
• They are lined by ependymal cells that contain
choroid plexuses
• The choroid plexuses produce cerebrospinal
fluid (CSF) that bathe the surface of the brain and spinal cord Cerebral spinal fluid • Cerebral spinal fluid (CSF) is a clear colorless fluid that bathes the surface of the brain and spinal cord (CNS) • It is produced by the choroid plexuses within the ependymal lining of brain ventricles (i.e., the lateral, third and fourth ventricles) • It circulates through the ventricular system and exits via a median and two lateral apertures into the subarachnoid space, where it bathes the surfaces of the brain and spinal cord Cont/… • Some will circulate within the central canal of the spinal cord
• The fluid acts as a transport medium for
nutrients and waste products and provides a protective fluid cushion for the central nervous system. The ventricles and flow of CSF • Lateral ventricles- the cavity within each cerebral hemisphere • Third ventricle- the cavity within the diencephalon – CSF passes from the lateral ventricles to the third ventricle via the interventricular foramen of Monro • Fourth ventricle- the cavity within the hind brain – CSF passes from the third ventricle to the fourth ventricle via the cerebral/mesencephalic aqueduct – The cerebral aqueduct is the cavity of the midbrain (mesencephalon) – CSF exits the fourth ventricle to the subarachnoid space via a median aperture (foramen of Magendie) and two lateral apertures (foramina of Luschka) Production of CSF • Production is at a rate of about 0.5 ml per minute
• 50-70% of CSF is produced in the brain by
modified ependymal cells in the choroid plexuses of the lateral, third and fourth ventricles
• The remainder (30-50%) are formed around
blood vessels and along ventricular walls (i.e., originates as tissue fluid in the brain substance) Circulation of CSF • CSF circulates from the lateral ventricles to the foramen of Monro (interventricular foramen), third ventricle, aqueduct of Sylvius (cerebral aqueduct), fourth ventricle, foramen of Magendie (median aperture) and foramen of Luschka (lateral apertures), finally pouring into the subarachnoid space over brain and spinal cord.
• Movement of CSF is dependent on forces
generated by pulsations of blood vessels, respiration and posture. Absorption of CSF • The CSF is absorbed into venous sinus blood via arachnoid granulations – CSF is absorbed into the arachnoid villi that project into the dural venous sinuses, especially the superior sagittal sinus – The arachnoid villi are grouped together to form arachnoid granulations – Absorption of CSF into the venous sinuses occurs when the CSF pressure exceeds that in the sinus – However, when venous sinus pressure exceeds that of CSF, the arachnoid villi collapse, preventing the passage of blood constituents into the CSF • There is also some absorption of CSF by cells in the walls of the ventricles • Arachnoid granulations - project into sinuses of dura mater, serve as sites where cerebrospinal fluid diffuses into bloodstream Circulation and absorption of CSF CSF drains from lateral ventricle interventricular foramina third ventricle
mesencephalic aqueduct median and two lateral apertures
fourth ventricle
subarachnoid space arachnoid granulations superior sagittal sinus vein
Subarachnoid space: • Position: lies between pia and arachnoid maters containing cerebrospinal fluid • Subarachnoid cisterns: expanded parts of subarachnoid space containing relatively larger volumes of CSF - clinically significant for CSF tap • Terminal cistern: the largest part of subarachnoid space extending from termination of spinal cord to level of S2, where it is occupied by nerves of cauda equina, so it is the best site for a lumbar puncture (spinal tap) Subarachnoid cisterns: – Cerebellomedullary cistern (cisterna magna) – Interpeduncular cistern – Pontine cistern (cerebellopontine cistern) – Superior cistern – Chiasmatic cistern – Terminal cistern Lumbar spinal puncture (spinal tap) Cerebellomedullary cistern (cisterna magna) The blood-CSF barrier • The blood-CSF barrier is where selective exchange of materials between blood and CSF takes place
• It is made up of continuous tight junctions
called zona occludens Contents of CSF CSF contains: • Glucose (at about 60-70% plasma concentration) • Small amounts of proteins
• NB: The mode of passage of the above contents
into the CSF remains unknown CSF PROTEINS
CSF SERUM
PROTEIN mg/dl mg/dl RATIO
Prealbumin 1.7 23.8 14
Albumin 15.5 3600 236 Ceruloplasmin 0.1 36.6 366 Transferrin 1.4 204 142 Immunoglobulin G 1.2 987 802
Immunoglobulin A 0.13 175 1346
Functions of CSF • The CSF is a constantly circulating fluid medium that: – Bathes the CNS – Acts as a shock absorber for the CNS • provides a protective fluid cushion for the central nervous system • provides a mechanical barrier to cushion the brain and spinal cord against trauma – Acts as a transport medium for nutrients • supply nutrients to the central nervous system – Removes metabolic wastes Clinical correlates Hydrocephalus: • A condition characterized by swelling of the head as a result of accumulation or stagnation of CSF • Types? • Differences between childhood and adult hydrocephalus? • Can be caused by: – Excessive production of CSF – Poor drainage or retention of CSF as a result of partial or complete blockage of its circulatory pathway • E.g. TB meningitis may lead to blockage of cerebral aqueduct, causing hydrocephalus • Aqueductal stenosis – may be congenital or acquired MRI or CT Scan of Normal Ventricles and Hydrocephalus
(A) NORMAL VENTRICLES (B) HYDROCEPHALUS
33 Cont/… Lumber puncture/spinal tap • Collection of CSF for laboratory analysis • Sites? • Procedure? • Meaning for (1)oozing, and (2)hemorrhagic (blood-stained) CSF? Intrathecal administration of drugs • Injection of drugs into the subarachnoid space • In which situations? END