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TAS Neurology > Cerebrospinal Fluid > Flashcards

Cerebrospinal Fluid Flashcards

(73 cards)

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1
Q

Is the CSF-brain barrier and BBB the same thing?

A

No

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2
Q

What does the CSF-brain barrier relate to>?

A

The extracerebral fluid that is found within the ventricles and around the brain

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3
Q

What are the two main categories of function of the CSF-brain barrier?

A
  • Physical

- Biochemical

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4
Q

What are the physical functions of the CSF-brain barrier?

A
  • Cushions and protects the brain from shear forces and impact
  • Plays a role in regulating intracerebral blood pressure, thus prevents ischaemia
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5
Q

What are the biochemical functions of the CSF-brain barrier?

A
  • Removes waste and toxins from the CNS

- Helps regulate levels of hormones and neurologically active substances

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6
Q

What is CSF produced by?

A

A type of glial cell called an ependymal cell

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7
Q

Where is CSF produced?

A

Mainly in the choroid plexi in the lateral ventricles of the brain

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8
Q

Where does CSF exit after it’s produced in the choroid plexus?

A

Through the intraventricular foramen of Munro, into the third ventricle

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9
Q

Where does CSF go after the third ventricle?

A

Through the aqueduct of Sylvius, into the fourth ventricle

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10
Q

Where does CSF go after the fourth ventricle?

A

Down the spinal cord and over the cerebral hemispheres

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11
Q

How is CSF reabsorbed into the circulation?

A

Via the arachnoid villi

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12
Q

At what rate is CSF produced?

A

Around 30ml/hour

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13
Q

What is the volume of CSF after age of 2 years?

A

150ml

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14
Q

What volume of CSF is found in the ventricular system after the age of 2?

A

35ml

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15
Q

What might abnormalities of CSF circulation result in?

A

Hydrocephalus

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16
Q

What are the types of hydrocephalus?

A
  • Communicating

- Non-communicating

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17
Q

What is the difference between communicating and non-communicating hydrocephalus?

A

In communicating, there is no obstruction between the ventricles and the subarachnoid space.
In non-communicating, there is a physical obstruction between the ventricles and subarachnoid space

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18
Q

What can communicating hydrocephalus be caused by?

A
  • Excessive CSF production

- Impaired CSF reabsorption

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19
Q

Is excessive CSF production common?

A

No, it is rare

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20
Q

What can cause excessive CSF production?

A

Choroid plexus tumour

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21
Q

What can cause impaired CSF reabsorption?

A

Blockage of arachnoid granulations by debris after meningitis or haemorrhage

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22
Q

What can non-communicating hydrocephalus be caused by?

A
  • Congenital malformations

- Acquired obstruction

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23
Q

Give 2 examples of congenital malformations causing non-communicating hydrocephalus?

A
  • Aqueduct stenosis

- Arnold-Chiari malformations

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24
Q

Give an example of an acquired obstruction causing non-communicating hydrocephalus?

A

Brain tumour

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25
What is idiopathic intracranial hypertension?
A special case where the CSF is elevated in the absence of hydrocephalus or intracranial mass lesion
26
What does the treatment of hydrocephalus depend on?
Cause
27
What might the treatment of hydrocephalus include?
- Resection of intracranial obstruction - Placing of stent in stenosed aqueduct - Removal of excess CSF
28
How can excess CSF be removed in hydrocephalus?
Insertion of a one-way valved ventriculoperitoneal shunt
29
What does the insertion of a ventriculoperitoneal shunt form?
A direct drainage route for CSF from the cranial vault to the low pressure of the peritoneal cavity
30
What do the clinical features of hydrocephalus depend on?
- Site of the obstruction | - Capacity of the cranial vault to expand
31
Why might the cranial vault be able to expand?
If the sutures are not yet fused
32
Are the symptoms of hydrocephalus acute or chronic?
Can be either
33
What are the acute symptoms of hydrocephalus?
- Vomiting - Irritability - Headaches - Change in consciousness
34
What are the chronic symptoms of hydrocephalus?
- Visual disturbance - 'Sunsetting eyes' - Deterioration in school performance
35
Give an example of a cause of acute hydrocephalus?
Blocked ventriculoperitoneal shunt
36
What can acute hydrocephalus lead to if untreated?
Brainstem herniation and death
37
In what disorders might CSF analysis be of value?
- Meningitis - Metabolic disorders - Leukaemia - Neurodegenerative conditions - Autoimmune disorders
38
What is the limitation of CSF analysis in meningitis?
It may initially be normal, so clinical impression is of prime importance
39
What is the normal CSF neutrophil count in a term neonate?
<5
40
What is the normal CSF lymphocyte count in a term neonate?
<20
41
What is the normal CSF protein count in a term neonate?
<1.0
42
What is the normal CSF glucose in a term neonate?
≥2.5mmol/L
43
What is the normal CSF neutrophil count in a child >1 month?
0
44
What is the normal CSF lymphocyte count in a child >1 month of age?
≤5
45
What is the normal CSF protein count in a child >1 month of age?
<0.4
46
What is the normal CSF glucose in a child >1 month of age?
≥2.5mmol/L
47
What is the CSF neutrophils in bacterial meningitis?
100-10,000 (but may be normal)
48
What is the CSF neutrophils in bacterial meningitis?
Usually <100
49
What is the CSF protein in bacterial meningitis?
>1.0 (but may be normal)
50
What is the CSF glucose in bacterial meningitis?
<0.4 (but may be normal)
51
What is the CSF neutrophils in viral meningitis?
Usually <100
52
What is the CSF lymphocytes in viral meningitis?
10-1000 (but may be normal)
53
What is the CSF protein in viral meningitis?
0.4-1 (but may be normal
54
What is the CSF glucose in viral meningitis?
Usually normal
55
What is the CSF neutrophils in TB meningitis?
<100
56
What is the CSF lymphocyte count in TB meningitis?
50-1000 (but may be normal)
57
What is the CSF protein in TB meningitis?
1-5 (but may be normal)
58
What is the CSF glucose in TB meningitis?
<0.3 (but may be normal)
59
What is the significance of finding neutrophils in the CSF?
It is unusual to find neutrophils in the CSF beyond the neonatal period, and so finding them should raise suspicion of a bacterial infection
60
How does CSF white cell count and protein level differ at birth from in later infancy?
It is higher
61
What kind of white cells are found in viral meningitis?
Lymphocytes are more characteristic, but neutrophils may predominate
62
Do antibiotics significantly change CSF cell count or§ biochemistry?
Not if taken within 24 hours of initial dose
63
When is meningococcal PCR testing on CSF samples particularly useful?
In patients with a clinical picture consistent with meningococcal meningitis, but who have received prior antibiotics
64
What might be found in CSF in patients with central nervous inflammatory diseases?
CSF IgG
65
Give 2 examples of CNS inflammatory diseases?
- Multiple sclerosis | - Sub-acute sclerosing panencephalitis
66
What is the most commonly used diagnostic test for MS?
- CSF index | - Oligoclonal band detection
67
What is CSF index?
The ratio of CSF IgG to CSF albumin, compared to serum IgG to serum albumin
68
What happens to the CSF index in MS?
It is raised
69
What are monoamine neurotransmitter disorders caused by?
Defects in the synthesis, degradation, or transport of dopamine, noradrenaline, adrenaline, or serotonin
70
What are monoamine neurotransmitter disorders implicated in?
A varied group of conditions, including; - Mitochondrial disorders - Rett's syndrome - Leukodystrophies
71
How do monoamine neurotransmitter disorders usually present?
With abnormal neurological features, e.g. encephalopathy, epilepsy, and pyramidal and extrapyramidal motor disorders
72
What might the diagnosis of monoamine neurotransmitter disorders include?
Analysis of neurotransmitters in CSF
73
What does the analysis of neurotransmitters in CSF involve?
A precise protocol for collection and rapid freezing of samples, and specialised laboratory analysis

TAS Neurology (11 decks)

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