WRITE SHORT NOTES ON CSF

Definition:

The ventricular system, together with the cranial and spinal subarachnoid spaces, contains CSF. CSF is a
clear fluid produced by dialysis of blood in the choroid plexus.

Constituents:

CSF has a very low protein constituent, with only albumin being present together with a very low level of
cellularity. The biochemistry of CSF includes high concentrations of sodium and chloride and very high
concentrations of magnesium. Concentrations of potassium, calcium and glucose are low.

Functions:

CSF helps cushion the central nervous system (shock absorber). It also acts as a chemical buffer
providing immunological protection and a transport system for waste products and nutrients. The CSF
also provides buoyancy to the soft neural tissues which effectively allows the neural tissue to "float" in
the CSF. This prevents the brain tissue from becoming deformed under its own weight. It also acts as a
diffusion medium for the transport of neurotransmitters and neuroendocrine substances.

CSF production:

CSF is produced by the choroid plexus, which is located in the lateral, third and fourth ventricles. The
choroid plexus is formed by invagination of the vascular pia mater into the ventricular lumen, where it
becomes highly convoluted, producing a sponge-like appearance. The choroid plexus enters the third
and fourth ventricles through their roofs and the lateral ventricle through the choroid fissure, along the
line of the fimbria/fornix.

CSF is produced partly by an active secretory process and partly by passive diffusion. The volume of CSF
in the combined ventricular and subarachnoid spaces is of the order of 150 ml. CSF is produced
continuously; at rate sufficient to fill these spaces several times each day (rate of CSF formation in
humans is 0.3 – 0.4 ml min-1). This means that and efficient mechanism is required for the circulation of
CSF and its reabsorption.
Circulation of CSF:

Choroid plexus of the lateral

ventricle

Interventricular foramen

3rd ventricle

Cerebral aqueduct

4th ventricle

Median 2 lateral
aperture aperture

Cisterna Subarachnoid space (in

magna cerebellopontine angle)

From these sites, the majority of CSF flows superiorly, round the cerebral hemispheres, to the sites of
reabsorption. Within the subarachnoid space, CSF serves partially to cushion the brain from sudden
movement of the head.

Reabsorption of CSF:

CSF is reabsorbed into the venous system by passing into the dural venous sinuses, principally the
superior sagittal sinus. Along the sinuses are located numerous arachnoid villi, which consist of
invaginations of arachnoid mater through the dural wall and into the lumen of the sinus. Reabsorption
occurs at these sites because the hydrostatic pressure in the subarachnoid space is higher than that in
the sinus lumen and because of the greater colloid osmotic pressure of venous blood compared with
CSF. With age, the arachnoid villi become hypertrophic to form arachnoid granulations.

Clinical implication:

Obstruction of the the flow of CSF within the ventricular system or the subarachnoid space leads to a
rise in fluid pressure causing swelling of the ventricles (hydrocephalus). Clinical effects – headache,
unsteadiness, mental impairment, papilloedema.