CSF Dynamics and Disorders (2024/2025) PDF

CEREBROSPINAL FLUID (CSF) FINDINGS AND DISORDERS OF CSF DYNAMICS GENERAL PATHOLOGY. 3rd year of Medicine Academic Year 2024/2025 Ana Checa-Ros, MD, PhD Department of Medicine & Surgery [email protected] INDEX 1. Reminder of CSF Dynamics...

CEREBROSPINAL FLUID (CSF) FINDINGS AND DISORDERS OF CSF DYNAMICS GENERAL PATHOLOGY. 3rd year of Medicine Academic Year 2024/2025 Ana Checa-Ros, MD, PhD Department of Medicine & Surgery [email protected] INDEX 1. Reminder of CSF Dynamics 2. CSF Findings in Diverse Neurological Alterations 3. Disorders of CSF Dynamics: Hydrocephalus 1. REMINDER OF CSF DYNAMICS  1.1. CSF Production The CSF is produced by a specialised tissue, the choroid plexus, located in the walls of the lateral ventricles and the roofs of the third and fourth ventricles 1.2. CSF Dynamics The CSF passes from the lateral ventricles to the third ventricle through the foramen of Monro From the third ventricle, the CSF flows through the cerebral aqueduct (of Sylvius) to the fourth ventricle From the fourth ventricle, the CSF passes through the foramina of Luchska and Magendie to the subarachnoid space of the brain and spinal cord 1.3. CSF Absorption CSF absorption takes place in the dural venous sinuses through the arachnoid granulations 2. CSF FINDINGS IN DIVERSE NEUROLOGICAL ALTERATIONS 2.1. Lumbar Puncture Lumbar puncture is the technique performed to obtain a CSF sample The needle should be inserted between L3 and L4 (imaginary line between the superior part of the iliac crests) Contraindicated in increased intracranial pressure 2.2. CSF Characteristics Colour: crystal clear Haemorraghic: acute bleeding Xantochromic: subacute bleeding or high protein concentration Opening pressure: between 10-20 cmH2O (continuous flow) Stream (increased intracranial pressure) Slow flow rate (subarachnoid blockage) White blood cell count: < 5/µL Increased white blood cell count (pleocytosis): meningitis Xantochromia Normal CSF colour 2.2. CSF Characteristics Proteins: < 50mg/dL Increased: subarachnoid blockage and meningitis Albuminocytological dissociation (increased proteins but normal white blood cell count): Guillain-Barré syndrome Glucose: 50-80 mg/dL Low glucose: bacterial meningitis 3. DISORDERS OF CSF DYNAMICS: HYDROCEPHALUS 3.1. Hydrocephalus: definition It is the symptomatic accumulation of the CSF inside the cerebral ventricles 3.2. Hydrocephalus: etiology Obstructive hydrocephalus Blockage in CSF pathways (tumours) Communicating hydrocephalus Impaired CSF absorption (haemorraghe, meningitis) Hypersecretory hydrocephalus Excessive CSF production (tumour of choroid plexus) 3.3. Hydrocephalus: clinical manifestations Increased intracranial pressure: headache, vomiting and visual disturbances Macrocephaly in congenital hydrocephalus Hydrocephalus Courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453