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49 Cards in this Set

  • Front
  • Back
Generally describe the flow of CSF.
Secreted in ventricles,

Flows into subarachnoid space surrounding brain and spinal cord.

Returns to blood via venous sinuses
Describe the functions of CSF.
1. Physical support of brain

2. Transfer of Neuromodulators

3. Lymphatic system for drainage of fluid in CNS
What connects the lateral ventricles to the third ventricle?
Interventricular Foramen
What connects the third ventricle to the fourth ventricle?
Cerebral Aqueduct.
How many apertures are there?
2 lateral and 1 median aperture

(Total = 3)
New evidence shows that neural stem cells are present where?
Subependymal region in adult brain
Ventricles are lined with a simple cuboidal layer of what cells?
Ependymal cells.
Where would you find the choroid plexus?
Along the roof of the third ventricle.

Inside the interventricular foramen.

Along the inferior part of the lateral ventricles down to the superior part of the inferior horn.

Also along the interior part of the fourth ventricle
What are glomus?
Extended portion of the choroid plexus in the trigone region.

Often calcified in adults
What are the blood supplies of the choroid plexus? x3
1. Anterior Choroidal artery
2. Posterior Choroidal artery
3. Anterior & Posterior Inferior Cerebellar Arteries.
Specifically describe how CSF flows.
Blood fills the Choroid plexus.

CSF flows from the lateral ventricles, to the interventricular foramina of Monro, to the third ventricle, to the cerebral aqueduct, to the fourth ventricle.

Comes out the median and lateral aperture.

Goes down and around the spinal cord, then back up to surround the brain.
Where does the CSF drainage begin?
At the arachnoid villi (granulations) and then into dural sinuses
Describe how CSF ends up at the ventricular space.
Flows from the choroid capillary, through the choroid epithelium, then into ventricular space.
Name all the ventricular recesses.
1. Lateral recess
2. Infundibular recess
3. Pineal recess
4. Optic recess
Name all the cisterns
1. Cisterna Magna
2. Cisterna Ambiens
3. Cistern of Lamina Terminalis
4. Prepontine
5. Interpeduncular
6. Chiasmatic
7. Superior
Describe the level of the lumbar cistern.
L2 to S2
What is hydrocephalus?
Enlargement of lateral ventricles with increased intercranial pressure
What is obstructive (non-communicating) hydrocephalus?
Hydrocephalus due to an obstruction in the ventricular system (not in the subarachnoid space)
How would you treat a child with obstructive hydrocephalus?
Place a shunt in the trigone region and drain into abdomen.
What is communicating hydrocephalus?
Hydrocephalus due to a subarachnoid obstruction.
Communicating hydrocephalus usually occurs following what? Give three examples?
1. Bacterial Meningitis
2. Subarachnoid hemorrhage (forming blood clots)
3. Protein in CSF forms a blood clot (Guillain-Barre Syndrome)
What is Normal Pressure hydrocephalus?
Increased pressure enlarges ventricles, then normal pressure returns.
Normal Pressure Hydrocephalus affects whom, and mimics what?
Affects elderly, and mimics dementia and Parkinson's.
Etiology of Normal Pressure Hydrocephalus.
What is psuedotumor cerebri?
Increased CSF pressure with resultant HA.
What is the predilection for Psuedotumor Cerebri? What is it associated with?
Young obese females.

Adrenal/PTH abnormalities and Drugs (e.g. - tetracycline)
Cortisone Tx
What is the usual outcome of psuedotumor cerebri?
Self resolve
What type of tumor is involved in psuedotumor cerebri?
Not a tumor
What is a good way to palpate for lumbar puncture at L3-L4?
Level of illiac crest
What is the turnover for CSF?
Four times in 24 hours
What is the body volume of CSF?
120 ml
What is the CSF composition in bacterial meningitis?
Glucose decrease
Protein increase
Neutrophils: 1,000 to 10,000/ml
What is the CSF composition in viral (aseptic) meningitis?
Lymphocytes: 200+/ml
What is the CSF composition in multiple sclerosis?
IgG increase
Lymphocytes: 50/mL
Oligoclonal bands
Myelin Basic Protein
What are the three structural components of the choroid plexus?
1. Choroid Epithelium
2. Blood vessels
3. Pia connective tissue
Do the blood vessels in the brain have tight junctions?
No tight junctions in the villus of choroid plexus.

Outside of the villus, tight junctions do exist on them
Do Ependymal cells have tight junctions?
No tight junctions
Do Choroid epithelium have tight junctions?
Yes, it does have tight junctions.
What is the barrier between the brain and the CSF?
No barrier
Describe the the blood capillary endothelium in brain.
Non-fenestrated with tight junctions and selective, specialized transporters.
In the brain, what usually surrounds the capillary endothelium?
What type of passage is allowed in the CNS capillary?
Lipid soluble


Carrier-mediated transcellular passage.
T/F - Astrocytes form a barrier to the transport of molecules.
What do astrocytes do?
Induce the endothelium to form tight junctions.

May prevent cellular invasion into the CNS.
T/F - The choroid plexus has a blood brain barrier?
What character is seen in areas with no blood brain barrier?
Responsive to levels of metabolites in blood.
Which areas have no blood brain barrier?
1. Neurohypophysis
2. Area Postrema
3. Pineal gland.
4. Choroid Plexus
Where is the emetic center and what is its function.
Responds to toxic substances in blood and triggers vomiting.
What structures are identical in blood brain barrier and Blood CSF barrier?
Receptor mediated transporter system (Glycoprotein receptors)