CBL

Clinical Case

• A 30-year-old male presented with severe headaches, blurred and double vision, and temporary vision loss, accompanied by other symptoms such as frequent headaches, incontinence, memory loss, and difficulty walking.
• Physical examination revealed papilledema and increased intraocular pressure.
• Lumbar puncture showed high CSF protein and pressure but no signs of infection.
• MRI of the brain showed obstructive hydrocephalus with a 1.5 cm mass in the pineal region.

Ventricular System of the Brain

• The ventricles of the brain are four CSF-filled cavities located within the brain.
• The four ventricles are:
  • Two lateral ventricles
  • Third ventricle
  • Fourth ventricle
• The lateral ventricles are connected to the third ventricle by two openings called interventricular foramina.
• The third ventricle is connected to the fourth ventricle through a duct called the cerebral aqueduct.
• The fourth ventricle continues as a small central canal in the spinal cord.

Production and Absorption of CSF

• CSF is formed and secreted by ependymal cells covering the blood vessels present in the lateral, third, and fourth ventricular cavities.
• The total volume of CSF in all the spaces is about 150ml in adults.
• CSF is absorbed through arachnoid villi into dural venous sinuses.

Flow and Absorption of CSF

• CSF from the lateral ventricles flows to the third ventricle through the interventricular foramen.
• From the third ventricle, CSF flows to the fourth ventricle through the cerebral aqueduct.
• From the fourth ventricle, CSF flows to the spinal cord through the central canal.
• CSF is absorbed through the arachnoid villi into the dural venous sinuses.

Hydrocephalus

• Hydrocephalus is an abnormal increase in the volume of CSF.
• There are two main types of hydrocephalus:
  • Noncommunicating hydrocephalus: blockage of CSF flow between the choroid plexus and the foramina in the roof of the fourth ventricle.
  • Communicating hydrocephalus: no obstruction to the flow of CSF.

Causes of Hydrocephalus

• Increased CSF pressure can be due to:
  • Abnormal increase in CSF formation
  • Blockage of CSF circulation
  • Decreased absorption of CSF
• Rarely, hydrocephalus can be associated with normal CSF pressure, resulting in compensatory hypoplasia and atrophy of brain substance.

Symptoms of Hydrocephalus

• Common symptoms in infants:
  • Enlarged head
  • Vomiting
  • Irritability
  • Seizures
• Common symptoms in adults:
  • Headache
  • Vomiting
  • Dizziness
  • Reduced consciousness

Diagnosis of Hydrocephalus

• Ultrasound is often used to diagnose infants.
• MRI can determine if the ventricles have enlarged, assess CSF flow, and provide information about the brain tissue surrounding the ventricles.
• CT can show enlarged ventricles or obstruction.
• Spinal tap (lumbar puncture) can estimate CSF pressure and analyze the fluid.
• Intracranial pressure monitoring (ICP) can measure pressure.

Treatment of Hydrocephalus

• Hydrocephalus is treated with one of two surgical options:
  • Shunt (tube) inserted into the brain to drain excess fluid into the chest cavity or abdomen.
  • Other surgical options (not specified).

Clinical Case

• A 30-year-old male presented with severe headaches, blurred and double vision, and temporary vision loss, accompanied by other symptoms such as frequent headaches, incontinence, memory loss, and difficulty walking.
• Physical examination revealed papilledema and increased intraocular pressure.
• Lumbar puncture showed high CSF protein and pressure but no signs of infection.
• MRI of the brain showed obstructive hydrocephalus with a 1.5 cm mass in the pineal region.

Ventricular System of the Brain

• The ventricles of the brain are four CSF-filled cavities located within the brain.
• The four ventricles are:
  • Two lateral ventricles
  • Third ventricle
  • Fourth ventricle
• The lateral ventricles are connected to the third ventricle by two openings called interventricular foramina.
• The third ventricle is connected to the fourth ventricle through a duct called the cerebral aqueduct.
• The fourth ventricle continues as a small central canal in the spinal cord.

Production and Absorption of CSF

• CSF is formed and secreted by ependymal cells covering the blood vessels present in the lateral, third, and fourth ventricular cavities.
• The total volume of CSF in all the spaces is about 150ml in adults.
• CSF is absorbed through arachnoid villi into dural venous sinuses.

Flow and Absorption of CSF

• CSF from the lateral ventricles flows to the third ventricle through the interventricular foramen.
• From the third ventricle, CSF flows to the fourth ventricle through the cerebral aqueduct.
• From the fourth ventricle, CSF flows to the spinal cord through the central canal.
• CSF is absorbed through the arachnoid villi into the dural venous sinuses.

Hydrocephalus

• Hydrocephalus is an abnormal increase in the volume of CSF.
• There are two main types of hydrocephalus:
  • Noncommunicating hydrocephalus: blockage of CSF flow between the choroid plexus and the foramina in the roof of the fourth ventricle.
  • Communicating hydrocephalus: no obstruction to the flow of CSF.

Causes of Hydrocephalus

• Increased CSF pressure can be due to:
  • Abnormal increase in CSF formation
  • Blockage of CSF circulation
  • Decreased absorption of CSF
• Rarely, hydrocephalus can be associated with normal CSF pressure, resulting in compensatory hypoplasia and atrophy of brain substance.

Symptoms of Hydrocephalus

• Common symptoms in infants:
  • Enlarged head
  • Vomiting
  • Irritability
  • Seizures
• Common symptoms in adults:
  • Headache
  • Vomiting
  • Dizziness
  • Reduced consciousness

Diagnosis of Hydrocephalus

• Ultrasound is often used to diagnose infants.
• MRI can determine if the ventricles have enlarged, assess CSF flow, and provide information about the brain tissue surrounding the ventricles.
• CT can show enlarged ventricles or obstruction.
• Spinal tap (lumbar puncture) can estimate CSF pressure and analyze the fluid.
• Intracranial pressure monitoring (ICP) can measure pressure.

Treatment of Hydrocephalus

• Hydrocephalus is treated with one of two surgical options:
  • Shunt (tube) inserted into the brain to drain excess fluid into the chest cavity or abdomen.
  • Other surgical options (not specified).

Diagnose a 30-year-old male patient with severe headaches, vision problems, and other symptoms. Analyze the physical examination and test results to identify the underlying condition. Cases like this help medical students practice their diagnostic skills.