1. Student: Gustavo Duarte Viana, Gomo M.S.
Group: 17
Kursk State Medical University
2012

2.  Clear liquid, derived from
the plasma and
circulates around the
brain and its cavities
(ventricles) and spinal cord.

3.  The volume of spinal fluid in an adult is approximately
2.0 ml per kg, or approximately 150ml. In infants up to
4 weeks, average 10 to 60 mL.
 500mL/day about.

4.  Cerebrospinal fluid originates
in the choroid
plexus. The choroid plexus is
composed of a mass of tiny
blood vessels that are located
in the lateral third and
fourth ventricles.
 The remaining CSF,
approximately 30%, is formed
in other places like the sub-
arachnoid
and ependymal layer of the
ventricles.

5.  The CSF is formed in the lateral ventricles, circulates through the
interventricular foramen ( foramen of Monro) into the third ventricle which
has one more choroid plexus and is going accumulating, and then via the
cerebral aqueduct into the fourth ventricle, where has one more choroid
plexus to produce more cerebrospinal fluid. Here the fluid scapes via the
lateral apertures (Luschka, opening to the brain) and the medial foramen
(Magendie, opening to the spinal cord) of the fourth ventricle into the
subarachnoid spaces, where it diffuses over the brain and spinal cord and
from the cisterns it circulates through the freely communicating
subarachnoid cisterns at the base of the brain, most of the CSF is directed
upward over the cerebral hemispheres and smaller amounts pass downward
around the spinal cord. It has been calculated that 430 to 500 ml of CSF are
produced every day, so the fluid must be changed every 6 to 7 hours.
Respiratory and circulatory changes are believed to change the pressure
within the closed system and promote the mixing and diffusion of fluid for
reabsorption into venous sinus blood via arachnoids granulations.

7.  Protecting the brain and spine trauma.
 Supplying nutrient to the nervous tissue.
 Remove degradation products of cellular metabolism.
 Serves as a pathway for pineal secretions to reach the
pituitary gland

8. Chemical level
Sodium 136.0 – 150 .0 m Eg/L
Potassium 2.3 – 2.7 m Eg/L
Chloride 1180.0 – 130.0 m Eg/L
Magnesium 2.4 – 3.0 m Eg/L
Protein 20 – 4 gm/dl (normally diffuses in
blood-brain-barrier)
Glucose 45.0 – 60.0 gm/dl
Calcium 2.1- 2.7 m Eg/L
Cholesterol Present in small amount
Creatinine 0.5 – 1.2 gm/dl
Latic acid deohydrogenase Present in small amount
Phosphorus (inorganic) 1.0 – 2.0 gm/dl
Urea 6.0 – 16.0 gm/dl
Uric acid 0.5 – 3.0 gm/dl

9. 1. Pulsation of the cerebral & spinal arteries
2. Movements of the vertebral column
3. Respiration & coughing
4. Changing of the positions

10.  CSF sample is obtained by a physician, usually
via lumbar puncture in the region L3 andL4.
 Sterile technique is often used to reduce the risk of
infection.
 Care must be taken to avoid damage to neural tissue.
 Although the sub-araquinoid can be accessed
from other levels, the lower back is
preferable, because the needle is inserted below the
end of the spinal cord.

11.  A syringe is used to collect 6 to
15 ml (babies and small
children).
 Sample is divided into 3
or 4 tubes (glass tubes should
be avoided due to cell
adhesion).
 2 to 4 ml are placed in each
tube.
 The tubes are numbered in
the order they are obtained.

13.  Tube 1: chemical and serological test
 Tube 2: Microbiological test
 Tube 3: Hematological test
 Tube 4: cytological and Miscellaneous

14.  The opening pressure is always measured (90-180 mm of
water), it is high, greater than200 mm, not more than 2 mL
of CSF should be removed.
High pressure:
Eg ICC, meningitis, cerebral edema.
Reduced pressure:
Eg dehydration, circulatory collapse, loss of CSF.

15.  colorless
 clear
 Absence of clot
 Density 1.006 to 1.008
 pH 7.3
 When the sample is received in the laboratory microscopic
examination is performed immediately.

16.  One or more are found:
•turbidity
•Clot / film
•bloody appearance
•xanthochromic

17.  Turbidity can be caused
by leukocytes, erythrocytes, fungi, bacteria, parasites, c
ontrast media, etc.
 200 WBC / microl can cause slight turbidity, the
greater number of leukocytes = higher turbidity,
 At least 400 RBC / microl are needed to
cause slight turbidity,
 May appear oily after radiological procedures

18.  Clot is always abnormal and is always due to increased
level of proteins, especially fibrinogen,
 The clot formation is common in protein levels above
1,000 mg / dL (also present at lower levels)
 Film is composed of fibrinogen and white blood cells,

19.  Specimens from patients
who suffered subarachnoid hemorrhage or cerebral
haemorrhage may have a pink-
 colored supernatant and yellow when the sample is
centrifuged within an hour after you collected.
The term that describes
 the colored supernatant is xanthochromic. The
color varies with the substance that causes the
coloration and the time interval after the incident
that the sample is examined.

21.  Meningis are menbrane covering the brain and spinal
cord.
 Meningis consists of three menbranes.
1- Dura mater 2- arachinoid mater 3- Pia mater
strong “tough mater” spidery, holds blood vessesl “delicate mother”
A- Falx cerebri
B- Falx cerebelli
C- Tentorium cerebelli
D- Diaphragma sella

23.  Thick dense inelastic membrane and the outermost layer of
the meninges.(pachymeninx)
 Bilaminar:
• Endosteal layer:
◦Peristoneum, inner surface of the skull bone.
◦Not contineous with dura mater of the spinal cord.
• Meningeal layer:
◦Dura mater proper covering the brain and contineous
with dura mater of the spinal cord.
◦Folded inwards as 4 septa between part of the brain.
◦The function of this septa is restrict the rotatory
displacement of the brain.
They are closely united except along certain lines, where
they separate to form venous sinuses.

24.  1. Falx cerebri- lies between the cerebral hemisphere in the
longitudinal cerebral fissure.
◦contains the superior and inferior sagittal sinuses between its
two layers.
 2. Falx cerebelli- it is a small sickle-shaped fold, attached to the
internal occipital crest and projects forward between the two
hemispheres of the cerebellum.
 3. Temtorium sellae- separates posterior cranial fossa from the
middle cranial fossa.
◦ separates the occipital and temporal lobes from the
cerebellum and intentorial brainstem.
 4. Diaphragma sellae – forms the roof of the hypophyseal fossa.
◦ contains an aperture through which the hypophyseal stalk
(infundibulum) passes.

25. Falx cerebri
Diaphragma Tentorium
Sellae cerebeli
Falx cerebeli

26. Falx cerebi
Tentorium
cerebeli

27.  Delicate, impermeable and avascular membrane
covering the brain.
 Lying between dura and pia mater.
 Separete from dura mater by a potential space, the
subdural space.
 Separed from pia mater by the arachinoid space.
 The outer and inner surface are covered with flattened
mosothelial cells.

28.  1- epidural space- is located between the peristoneum
and the outer layer of the Dura mater, contains venous
tissue, loose connective tissue and lymphatics.
 2-subdural space – is a potential space between the
Dura and Arachinoid mater, intracranially transmits the
superior cerebral veins venous lacunae of the superior
sagittal sinus.
 3- arachnoids space- located between the Arachinoid
and Pia mater, contains the CFS, surrounds the entire
brain and spinal cord.

29.  Pia mater (leptomeninx) is a delicate and highly
vascular membrane, closely covers the surface of the
brain and spinal cord.
Filum terminale – extends from the conus medulares
to the end of the dural sac and fuses with it.

30. Pia mater close to the brain

32.  Meningitis is inflammation of the meninges. The infection occurs most often
in children, teens, and young adults. Also at risk are older adults and people
who have long-term health problems, such as a weakened immune system.
 There are two main kinds of meningitis:
◦Viral meningitis is fairly common. It usually does not cause serious illness.
In severe cases, it can cause prolonged fever and seizures.
◦Bacterial meningitis is not as common but is very serious. It needs to be
treated right away to prevent brain damage and death.
 The two kinds of meningitis share the same symptoms. It’s very important to
see a doctor if you have symptoms, so that he or she can find out which type
you have.
 Meningitis can also be caused by other organisms and some medicines, but
this is rare.
 Meningitis is contagious. The germs that cause it can be passed from one
person to another through coughing and sneezing and through close contact.

33.  Dandy-Walker Syndrome: A congenital brain malformation of
the openings called foramina Luschka and Magendie, it is
characterized by increased fluid in the brain.
 Symptoms of Dandy-walker Syndrome:
◦Hydrocephalus
◦Increased intracranial pressure
◦Sow motor development
◦Progressive macrocrania (abnormally enlarged of skull)
◦Irritability
◦Vomiting
◦Convulsions
◦Ataxia
◦Nystagmus (Jerky eyes)

34. The term hydrocephalus is derived from the Greek
words "hydro" meaning water and "cephalus"
meaning head.
It is excessive accumulation of fluid in the brain.

35. Nystagmus is a condition of involuntary eye movement, acquired in infancy or
later in life, that may result in reduced or limited vision, it is cause by the high
cranial pressure due the big amount of CSF.