F2: CSF (Part 1: Intro-Composition) Flashcards by Geno Alinsub

A clear bodily fluid that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord
the brain “floats” in it
Makes our head lighter because of buoyancy
provides a physiological system to supply nutrients to the nervous tissue, remove metabolic wastes, maintain intracranial pressure, and produce a mechanical barrier to cushion the brain and spinal cord against trauma

CEREBROSPINAL FLUID

How well did you know this?

Not at all

Perfectly

T or F

Cerebrospinal fluid makes out head lighter due to buoyancy

How well did you know this?

Not at all

Perfectly

Which is false about Cerebrospinal fluid

a. a physiological system to supply supply nutrients to the nervous
tissue
b. remove metabolic wastes
c. maintain extracranial pressure
d. produce a mechanical barrier to cushion the brain and spinal cord against trauma

c. maintain extracranial pressure

c. maintain extracranial pressure - should ba INTRACRANIAL

How well did you know this?

Not at all

Perfectly

Occupies the space between the arachnoid mater and the pia mater

MENINGES

How well did you know this?

Not at all

Perfectly

MENINGES

What are the 4 parts of meninges?

Dura mater
Arachnoid mater
Subarachnoid space
Pia mater

How well did you know this?

Not at all

Perfectly

4 parts of meninges

Outer layer lining skull
Very hard
Latin for “hard mother”

Dura mater

How well did you know this?

Not at all

Perfectly

4 parts of meninges

Contains blood vessels
“Spiderweb-like filamentous”

Arachnoid (mater)

How well did you know this?

Not at all

Perfectly

4 parts of meninges

filled with csf

Subarachnoid space

How well did you know this?

Not at all

Perfectly

4 parts of meninges

Covers the brain
Adhesive to the brain
Latin for “gentle mother”

Pia mater

How well did you know this?

Not at all

Perfectly

Production of CSF

CSF is produced in the (blank) by modified ependymal cells in the (blank) and small amount is formed around (blank) and along (blank)

CSF is produced in the brain by modified ependymal cells in the choroid plexus and small amount is formed around blood vessels and along ventricular walls

How well did you know this?

Not at all

Perfectly

Production of CSF

T or F

CSF is produced in the brain by simple ependymal cells in the choroid plexus

F (produced in the brain by modified ependymal cells in the choroid plexus)

How well did you know this?

Not at all

Perfectly

Production of CSF

T or F

Small amount of CSF is formed around blood vessels and along ventricular walls

How well did you know this?

Not at all

Perfectly

Circulation of CSF

(1) CSF circulates from ?

lateral ventricles

How well did you know this?

Not at all

Perfectly

Circulation of CSF

(2) Blood in CSF circulates from lateral ventricles to the ?

a. foramen of monro
b. third ventricle
c. aqueduct of Sylvius
d. fourth ventricle
e. foramina of Magendie and Luschka
f. ALL
g. NOTA

f. ALL

How well did you know this?

Not at all

Perfectly

Circulation of CSF

(3) After circulation trhough monro, 3rd ventricle, aqueduct of slyvius, 4th ventricle and foramina, it returns to the?

vascular system

How well did you know this?

Not at all

Perfectly

Circulation of CSF

(4) After returning to vascular system, it enters through?

dural venous sinuses via the arachnoid granulations or villi

How well did you know this?

Not at all

Perfectly

Circulation of CSF

(5) Circulation also flows along what two (2) parts of the brain into lymphatic channels (in neonate)?

Cranial nerves
Spinal nerve roots

How well did you know this?

Not at all

Perfectly

Circulation of CSF

Familiarize the circulation of CSF

Circulates from the lateral ventricles to the foramen of Monro, third ventricle, aqueduct of Sylvius, fourth ventricle, and foramina of Magendie and Luschka
Returns to the vascular system by entering the dural venous sinuses via the arachnoid granulations or villi
Also flows along the cranial nerves and spinal nerve roots
into the lymphatic channels (in the neonate)

How well did you know this?

Not at all

Perfectly

Volume

Production rate in mL/day and mL/hour

500 ml/day
20ml/hour

How well did you know this?

Not at all

Perfectly

Volume

Space in the brain can only contain how much volume of CSF?

clue: range

135 to 150 ml

How well did you know this?

Not at all

Perfectly

Volume

Space in the brain can only contain how much volume of CSF? (in ventricles)

25 ml in ventricles

How well did you know this?

Not at all

Perfectly

Volume

Adult volume of CSF

clue: range din

90-150 ml

How well did you know this?

Not at all

Perfectly

Volume

Neonates volume of CSF

10-60 ml

How well did you know this?

Not at all

Perfectly

Volume

Turns over per day?

3.7x

How well did you know this?

Not at all

Perfectly

# Volume To maintain the volume in adults and neonates, the circulating fluid is reabsorbed back into blood capillaries by what structure?

Arachnoid granulations/villae

Familiarize the (4) functions of CSF

* Buoyancy * Protection * Chemical stability * Prevention of brain ischemia

# (4) functions of CSF * Actual mass of brain 1400 gm, suspended in CSF equals 25 gm

Buoyancy ## Footnote This buoyant force reduces the brain’s effective weight from 1400 grams to just 25 grams

# (4) functions of CSF * Protects the brain tissue from injury when jolted or hit * Cushion when head is hit

Protection

# (4) functions of CSF * Rinses metabolic waste through the blood-brain barrier * Stability and filteration

Chemical stability

# (4) functions of CSF * Decreases total ICP and facilitates blood perfusion * Important in maintaining brain oxygenation

Prevention of brain ischemia

Are capillary networks that form the CSF from plasma by mechanisms of selective filtration under hydrostatic pressure and active transport secretion

Choroid plexuses

Choroid plexuses are capillary networks that form the CSF from plasma by using what (2) mechanisms of selective filtration

* Hydrostatic pressure * Active transport secretion

* Endothelial cells in choroid plexus with tight junctures * Prevents passage of large, water-soluble molecules, and high-electrical charged molecules

BLOOD BRAIN BARRIER

# BLOOD BRAIN BARRIER T or F CSF comes from blood from endothelial cells

# BLOOD BRAIN BARRIER T or F CSF is an ultrafiltrate of plasma, there are gap junctures to allow fluid

F (CSF is **not an ultrafiltrate of plasma**, **does not have gap junctures**) ## Footnote Nothing goes in and out without active transport

# BLOOD BRAIN BARRIER T or F Maintaining the integrity of the BBB is important to protect the brain from chemicals and other substances circulation the blood that could harm the brain tissue

Familiarize the (7) factors resulting in decreased blood brain barrier

* Hypertension due to old age * Immaturity/Young age * Hyperosmolality * Microwaves * Radiation * Infection * Injury

# (7) factors resulting in decreased blood brain barrier The most important factor is ? | mamili ka lang sa pito teh

infection

T or F The reason why CSF is ordered is to diagnose disorders that affect the CNS

# Disorders that affect the CNS Familiarize the disorders that affect the CNS ## Footnote reason why CSF is ordered

* Infections * Neoplasia * Bleeding * Others (GBS, Post-viral infection)

# Disorders that affect the CNS Infections in brain include? | clue: ME ## Footnote reason why CSF is ordered

* Meningitis * Encephalitis

# Disorders that affect the CNS * Refer to Inflammation of meninges (in linings such pia mater and dura mater) | Infections

Meningitis

# Disorders that affect the CNS The brain has an infection | Infections

Encephalitis

# Disorders that affect the CNS This refers to metastasis to the brain such as leukemia, lymphoma, melanoma

Neoplasia

# Disorders that affect the CNS What are the 3 metastasis? | Neoplasia

* Leukemia * Lymphoma * Melanoma

# Disorders that affect the CNS Neoplasia of WBC | Neoplasia ## Footnote 3 metastasis

Leukemia

# Disorders that affect the CNS Lymph node neoplasm | Neoplasia ## Footnote 3 metastasis

Lymphoma

# Disorders that affect the CNS * Common in old people (Distance of blood vessels in brain is very far because it has thinned out) * Subarachnoid * Malformation of blood vessels in brain * Symptom: headache

Bleeding

# Disorders that affect the CNS T or F Bleeding in CNS is common in old people since distance of blood vessels in brain is very far because it has thickened | Bleeding

F (Bleeding in CNS is common in old people since distance of blood vessels in brain is very far because it has **thinned out**)

# Disorders that affect the CNS Bleeding commonly occurs where? | Bleeding

Subarachnoid

# Disorders that affect the CNS T or F Common symptom of bleeding in subarachnoid is headache | Bleeding

# Disorders that affect the CNS Other diseases affecting CNS are? | dalawa

* Guillain-Barré syndrome (GBS) * Post-viral infection

# Disorders that affect the CNS Immune system mistakenly attacks their peripheral nervous system | Other diseases affecting CNS

Guillain-Barré syndrome (GBS)

# Sampling CSF is obtained by doing what procedure?

lumbar puncture

# Sampling Lumbar segment punctured if adult?

L3 and L4

# Sampling Lumbar segment punctured if child?

L4 and L5

# Sampling Positioning of patient during lumbar puncture a. Missionary b. Lateral c. Knee-to-chest position d. a and c e. b and c f. ALL g. NOTA

e. b and c | search niyu nalang ano itsura basta nakatagilid

# Sampling T or F Lumbar puncture is not complicated and requires no precaution

F (not complicated but **requires precaution**)

# Sampling Tool used for lumbar puncture

Very long stylus with long needles

# Sampling Stylus with long needle is inserted in ?

Vertebrae ## Footnote very close to the spinal cord

# Sampling Stylus with long needle must go to what space?

subarachnoid space ## Footnote not too far in or out

# Sampling T or F The area where the sample is obtained is under pressure

# Sampling Possible complications in CSF lumbar puncture a. Hitting spinal cord b. lipemic sample c. ALL d. NOTA

a. Hitting spinal cord ## Footnote 2 complications: 1. Hitting spinal cord 2. Bubbling

# Sampling T or F The volume collected is based on the volume available in the patient and closing pressure of the CSF

F (The volume collected is based on the **volume available in the patient** and **opening pressure** of the CSF)

# Sampling Usual volume collected for CSF?

10mL

# Sampling Usual volume collected for CSF is 10 mL, if sample reaches 20 mL what may be done?

normally be removed | remove excess

# Sampling If opening pressure is >200mm H2O, what volume of CSF should be removed?

2 mL

# Sampling If pressure reaches this percentage, procedure should be stopped | what percentage

reaches 50%

# Sampling If pressure drops rapidly after 1-2 mL is removed, what (2) conditions are suggested?

* Herniation (Brain falls through a hole in the bone) * Spinal block

# Sampling Match the condition to the following: If opening pressure is >200mm H20 a. Remove 2L b. Stop c. Herniation or spinal block d. ALL e. NOTA

e. NOTA ## Footnote a. Remove 2L - should be **remove 2mL** ot be correct

# Sampling Match the condition to the following: If pressure reaches 50% of opening a. Remove 2mL b. Stop c. Herniation or spinal block d. ALL e. NOTA

b. Stop

# Sampling Match the condition to the following: Pressure drops rapidly after 1-2 mL is removed a. Herniation b. Spinal block c. ALL d. NOTA

c. ALL

# Sampling a condition where brain falls through a hole in the bone ## Footnote Pressure drops rapidly after 1-2 mL is removed

Herniation

# Sampling CSF sample is extracted by?

Neurologist

# Sampling T or F If CSF chemistry or cell count is requested. First, get a blood sample for Chemistry & Complete Blood Count

# Sampling T or F One must remind the doctor in case he forgets to collect blood before CSF sample extraction

This factor in CSF depends on position, BP, venous return, Valsalva, cerebral blood flow, and weight of the patient

Pressure

# Pressure * Moving of bowels in the morning * Increases CSF flow

Vasalva

# Pressure Normal pressure for < 6 years old

10-100 mm H2O

# Pressure Normal pressure for > 6 years old

<200mm H20

# Pressure T or F 250mm H2O diagnostic of increased intracranial pressure

# Composition CSF composes of what percentage and volume of plasma proteins?

0.3% plasma proteins 15 to 40 mg/dL

# Composition T or F Diffusion of plasma proteins depends on molecular size

F (depends on **molecular weight**)

# Composition * Component of CSF which is Less than 1% * Very small amount * Diffusion will be very small

Plasma protein

These (3) other component of CSF diffuses freely

Glucose, urea, creatinine approximate blood levels

# COMPOSITION OF CSF Based on the lower and upper limit given, what is the apporpriate substance present in CSF: 45-80 mg/dL

Glucose

# COMPOSITION OF CSF Based on the lower and upper limit given, what is the apporpriate substance present in CSF: 15-45 mg/dL

Protein

# COMPOSITION OF CSF Based on the lower and upper limit given, what is the apporpriate substance present in CSF: 0 cells/uL

RBC

# COMPOSITION OF CSF Based on the lower and upper limit given, what is the apporpriate substance present in CSF: 0-3 cells/uL

WBC

# COMPOSITION OF CSF g/dL a. Glucose b. Protein c. ALL d. nOTA

d. nOTA (**mg/dL** both)

# COMPOSITION OF CSF cells/uL a. RBC b. Protein c. ALL d. nOTA

a. RBC (**RBC and WBC** ang cells/uL)