CERBRAL EDEMA

HYDROCEPHALUS
 Cerebrospinal fluid (CSF)
• is an ultrafiltrate of plasma contained within the
ventricles of the brain and the subarachnoid
spaces of the cranium and spine.
• CSF production is via a network of modified
ependymal cells known as the choroid plexus (CP).
• Absorptions into the venous outflow system via
arachnoid villi.
• CSF also enters into the lymphatic system via the
nasal cribriform plate or spinal nerve roots.
 FUNCTIONS OF CSF
• providing nourishment
• waste removal
• protection to the brain
– shock absorber, cushioning the brain against the skull
– allows the brain and spinal cord to become buoyant

• Adult CSF volume is estimated to be 150 ml

– 125 ml within the subarachnoid spaces and
– 25 ml within the ventricles.
COMPOSITION OF CSF
CSF ANALYSIS
 INTRACRANIAL PRESSURE(ICP)
• The normal intracranial pressure (ICP) ranges
from 7 to 15 mm Hg, while in the vertical
position, it does not exceed -15 mm Hg.
• Overnight sleep monitoring is considered the
“gold standard” in conscious patients.
• ICP lowering therapy initiates when ICP is
greater than 20 to 25 mm Hg.
 INCREASED ICP
Signs and symptoms:
• Morning headache
• Vomiting without naused
• Ocular palsies
• Altered level of consciousness
• Back pain
• papilledema
 Causes of abnormal intracranial pressure

• Mass effect
• Generalized brain swelling
• Increase in venous pressure
• Obstruction to CSF flow and/or absorption
• Increased CSF production
• Idiopathic or unknown cause
 Low ICP
• result of an occult leak of CSF into another
body cavity
• lumbar puncture or other medical procedures
 CEREBRAL EDEMA
• -brain parenchyamal edema resulting from
increased fluid leakage from blood vessels and
injury to various cells of the CNS.
 CEREBRAL EDEMA
2 pathways of edema formation in brain:
• Vasogenic edema
– Blood brain barrier disruption
• Cytotoxic edema
• -increase in intercellular fluid secondary to
neuronal, glial or endothelial cell membrane
injury-hypoxic/ischemic insults
 HYDROCEPHALUS
• Term derived from greek word
“Hydro” means water
“cephalus” means head

• Hydrocephalus is term used for increased

volume of CSF within the skull, accompanied
by dilatation of the ventricles
 CSF
• CSF formed by choroid plexus
• Normal amount of CSF is 120-
150ml
• Absorbed by arachnoids villi
• Normally about 500ml is formed
everyday and an equal amount
is absorbed
 Types and etiopathogensis
1. Primary Hydrocephalus
- more common
- actual increase in volume of CSF within skull along with
increased intracranial pressure

2. Secondary Hydrocepalus
- less common
- compensatory increase of CSF due to loss of neural tissue
- CSF pressure is normal
- eg: from cerebral atrophy and infarction
 Primary Hydrocephalus
Mechanism:
• Obstruction to the flow of CSF
• Overproduction of CSF
• Deficient reabsorption of CSF

• However obstruction to the flow of CSF is by far most

common and is termed as Obstructive hydrocephalus
– Communicating hydrocephalus
– Non- communicating hydrocephalus
 Communicating hydrocephalus
• The ventricular system remains in continuity
with the subarchnoid space with enlargement
of the entire ventricular system
• Causes:
–Overproduction of CSF e.g. Choroid plexus
papilloma
–Deficient reabsorption of CSF e.g. arachnoid fibrosis
following meningitis, subarachnoid haemorrhage
 Non- communicating hydrocephalus
• Ventricular system focal
obstruction due to mass in 3rd
ventricle or to aqueductal stenosis.
• Causes:
–Congenital:
•stenosis of aqueduct,
•Arnold- Chiari malformation
–Acquired:
•Tumor like Ependymoma,
medulloblastoma
 Morphological features
Gross:
- Dilatation of ventricle depending
upon site of obstruction
- Thinning and stretching of brain
- Scalp veins engorged and
fontanelle remain open

Microscopic:
- Severe hydrocephalus causes
damage to ependymal lining of
ventricle
- periventricular interstitial edema.
THE END