CSF & BBB

„ Cerebrospinal fluid
„ Blood Brain Barrier

Ventricular System
„ Ependymal cells
„ Left & right
… Foramen of Monro
„ Third
… Aqueduct of Sylvius
„ Fourth
„ Contiguous with
subarachnoid space

Ventricular System

1
 Lateral Ventricles
„ Anterior horn
„ Body
„ Atrium
„ Posterior horn
„ Inferior horn

Third Ventricle

„ Suprapineal recess
„ Optic recess
„ Infundibular recess

Aqueduct of Silvius
„ Narrow canal between third and fourth
ventricles
„ Stenosis (narrowing) or obstruction
… Accumulation of CSF
… Increase in cerebrospinal pressure
… Ventricular dilation rostral to the obstruction

2
 Fourth Ventricle
„ Connects with Subarachnoid space
… Foramen of Magendie
„ Midline
… Foramen of Luschka
„ 2 lateral

Ventricle Lining
„ Ependymal epithelium
„ Choroid plexus
… Vascular pial involding
… Body, atrium, inferior horn of lateral ventricle
… Foramen of Monro
… Roof of third ventricle
… Posterior part of roof of fourth ventricle

„ Not present in anterior horn of lateral ventricles

… Location of shunts for draining CSF in hydrocephalus

Subarachnoid Cisterns
„ Cisterna magna
… Largest
„ Between medulla,
cerebellum and
occipital bone
… Cisternal puncture
„ Medullary cistern
… Vertebral arteries
run through it

3
 Subarachnoid Cisterns
„ Cisterna pontis
… Basis pontis
… Midline segment
„ Determien pontine
tumors
…2 laterals
„ Tumors in
cerebellopontine
angle
… Basilar artery &
CNVI (abducens)
runs through it

Subarachnoid Cisterns
„ Cisterna
interpeduncularis
… Between
cerebral
peduncles
… Oculomotor
nerve

Subarachnoid Cisterns
„ Suprasellar
cistern
… Pathology
around optic
chiasm
„ Superior cistern
… Vein of Galen
„ Spinal cistern:
… Lumbar cistern
„ Spinal tap

4
 Choroid Plexus
„ Produces CSF
„ Villi extend into CSF
„ Fenestrated
capillaries in
connective tissue
„ Cuboidal epithelium
line villi
… Microvilli
… Tight junctions
„ Prevent
macromolecular
substances from
entering CSF

CSF
„ Made by choroid plexus & ependymal lining
„ Turns over 4-5 times/day
„ Formed by:
… Diffusion
„ Water, respiratory gases, chloride, alcohol, and some
CNS drugs
… Active transport
„ Sodium, potassium, glucose, amino acids, proteins

CSF: Circulation
„ AG: arachnoid
granulations
„ SSS: superior
sagittal sinus

5
CSF: Circulation
„ Drift
… Positive to negative balance
„ Oscillation
… To-and-fro movement
„ Pulstaile movement
… Rhythmic movements synchronous with pulse
… Up-and-down in 4th ventricle

CSF: Resorption
„ Arachnoid granulations into superior sagittal
sinus
„ Arachnoid membrane
„ Meningeal blood vessels
„ Choroid plexus
„ Ependyma of ventricles
„ Capillary endothelium
„ Cranial/spinal nerve sheaths

CSF: Functions
„ Buoyancy/support
„ Cushion/buffer between brain and skull
„ Stable chemical environment

6
 CSF: Composition
„ Water
„ Protein
… If you find myelin products: multiple sclerosis
„ Sugar
„ Cells
… WBCs
„ Leukocytes
… Increase in bacterial meningitis
„ Lymphocytes
… Increase in viral meningitis
… RBCs
„ Only in trauma/hemorrhage
„ Electrolytes
… Sodium, potassium, chloride, magnesium, and calcium
„ Peptides

Barrier System
„ Blood-brain barrier
… Interface between
capillaries and
brain ECM
„ Blood-CSF barrier
… Interface between
choroid plexus and
CSF

Meningitis
„ Bacterial meningitis „ Viral meningitis
… Cloudy … Clear
… Increased pressure … Normal pressure
… Leukocytes … Normal (or slightly
… Increased protein increased) cells
… Low glucose
(lymphocytes)
… Normal protein
… Normal glucose

7
Multiple Sclerosis
„ Clear
„ Normal pressure
„ Normal or increased cells (lymphocytes)
„ Normal or moderately increased protein
(myelin basic proteins)
„ Normal glucose

Tumors
„ Clear
„ Increased pressure
„ Normal or increased cells (tumor)
„ Increased protein
„ Normal glucose

CSF In Disease

8
Ventriculomegaly
„ Overproduction of
CSF
… Choroid plexus
tumor

Ventriculomegaly
„ Overproduction of
CSF
… Choroid plexus
tumor
„ Cerebral atrophy
… E.g. Alzheimer’s or
infarct

Ventriculomegaly
„ Overproduction of
CSF
… Choroid plexus
tumor
„ Cerebral atrophy
… E.g. Alzheimer’s or
infarct
„ Developmental

9
Ventriculomegaly
„ Overproduction of
CSF
… Choroid plexus tumor
„ Cerebral atrophy
… E.g. Alzheimer’s or
infarct
„ Developmental
„ Obstruction of CSF
flow

Hydrocephalus
„ Increased CSF in „ Noncommunicating
ventricles … Obstruction in
„ Communicating „ Foramen of monro
„ Aqueduct of sylvius
… Free communication
„ Foramina of Magendie
between ventricles and Luschka
and SAS.
… Obstruction in
„ SAS (fibrosis from
infection)
„ Arachnoid granulations

Foramen of Monro Obstruction

10
Aqueduct of Sylvius Obstruction

Bobble Head Doll Syndrome

„ Childhood disorder
„ Rhythmic nodding of head
… Not while lying on back and sleeping
„ Intermittent obstruction of the foramen of
Monro by an intraventricular cyst
„ Bobbing head
… Learned behavior that relieves obstruction

Bobble Head Doll Syndrome

11