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Neuro > Blood Brain Barrier and intracranial pressure > Flashcards

Blood Brain Barrier and intracranial pressure Flashcards

1
Q

Which ion is at higher concentrations in the CSF than blood?

A

Sodium ions

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2
Q

The main difference of the choroid epithelia compared to other epithelia is

A

The apical location of Na+, K+ ATPase, and Na+, K+, 2Cl- cotransporter, and high CA activity. In normal epithelia, only Cl- is on the apical side.

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3
Q
A
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4
Q

What are 3 drugs that inhibits CSF secretion by the choroid plexus?

A

Acetazolamide, Bumetanide, Furosemide

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5
Q

Acetazolamide

A

Decreases CSF secretion by inhibiting the carbonic anhydrase enz

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6
Q

Furosemide

A

Blocks K-Cl cotransport by KCC3

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7
Q

Bumetanide

A

Blocks the Na-K-2Cl cotransporter of the choroid plexus (BCSFB)

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8
Q

difference between the choroid plexus blood-csf barrier and the blood brain barrier

A

The BCSFB has fenestrated capillaries and ependymal cells that produce CSF.
The BBB has tight junctions in their endothelial cells and don’t cell much pass. They also have astrocytic foot processes.

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9
Q

Absorption of CSF

A

Arachnoid villi, massive vacuoles

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10
Q

Venous thrombosis

A

E.g. cerebral venous thrombosis (CVT) can increase intracranial pressure, but rarely cause hydrocephalus

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11
Q

Glymphatic system

A

The glymphatic system is a recently discovered macroscopic waste clearance system that utilizes a unique system of perivascular channels, formed by astroglial cells, to promote efficient elimination of soluble proteins and metabolites from the central nervous system, which is more active during REM sleep and may be involved with Alzheimer’s and depression.

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12
Q

What is the pathological change in the glympathic system that causes Alzheimer’s or normal pressure hydrocephalus?

A

Altered AQP4 expression

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13
Q

Obstruction of CSF causes

A

Dilation of the venticular system proximal to the obstruction with profound effect on intracranial pressure.

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14
Q

Choroid plexus papilloma

A

causes increased production of CSF, and causes communicating hydrocephalus

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15
Q

Normal pressure hydrocephalus

A

Adam’s triad: Gait disturbances, dementia, urinary incontinence. Can be cured. Probable etiology is decreased reabsorption of CSF through arachnoid granulations.

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16
Q

The CSF tap test, also called a large-volume
lumbar puncture, involves the

A

withdrawal of
40–50 ml of CSF by means of lumbar puncture.

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17
Q

Symptomatic improvement after the CSF tap test means that

A

Increased likelihood of a favorable
response to shunt placement (positive predictive value 73–100%).

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18
Q

Ventriculoperitoneal Shunt

A

Shunt from lateral ventricles into peritoneal cavity, helps with normal pressure hydrocephalus

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19
Q

Virchow-Robin space

A

Space betweem the capillaries in the brain and the glial endfeet

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20
Q

Intrathecal drug delivery applications

A

Chemotherapy (methotrexate, cystosine arabinoside, meningeal spread - leukemia), spinal anesthesia, steroids for pain relief, antisense oligonucleotides

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21
Q

Clinical application of CNS immune privilege

A

Nerve cell transplant e.g. ventral midbrain cells can survive up to 14 years in PD patients

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22
Q

4 possible theories behind how CNS has immune privilege

A
  1. BBB, 2. Lack of lymphatic drainage, 3. Lack of potent APCs, 4. Presence of immunosuppressive factors e.g. TGF-beta, FASL, ganglioside, PDL1
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23
Q

Blood brain barrier

A
  1. Endothelial cells with TIGHT JUNCTIONS 2. Continuous capillaries 3. Foot processes of astrocytes (not a barrier)
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24
Q

Two regions in the brain lacking BBB (with fenestrated capillaries)

A

the area postrema, posterior pituitary area

25
Q

Which cells can release vasoactive compounds directly to SMCs located around blood vessels near the surface of the brain?

A
  1. Excitatory neurons 2. Interneurons 3. Astrocytes
26
Q

Extravasation process

A

Occurs due to inflammation, CNS infection.
Causes upregulation of
1. ICAM1
2. VCAM1

27
Q

Why can penicillin or other drugs sometimes be used to fight infections in the brain?

A

Extravasation or cytokine release after CNS infection allows leakier blood vessels

28
Q

Which part of the brain has lymphatic drainage?

A

Meninges, or inside the dura mater

29
Q

What molecules can pass the BBB?

A

Lipid soluble, negatively charged > positively charged, hypoxia, injury or inflammation decreases Bbb resistance

30
Q

Adsorptive-mediated transcytosis

A

Allows positively charged molecules to pass in vesicles e.g. albumin, other plasma proteins

31
Q

Carrier-mediated transcytosis

A

Glucose, neutral amino acids, purines e.g. adenosine, monocarboxylic acids

32
Q

Receptor-mediated transcytosis

A

Specific receptor allows Insulin, transferrin to enter the CNS

33
Q

Cell migration through the BBB

A

some viruses use cell migration in the brain to enter the CNS

34
Q

Transcellular lipophilic pathway

A

Lipid soluble agents esp. free fatty acids can pass into the brain

35
Q

Amino acids transport into the CNS

A

L system – large neutral amino acid, Na+ independent, facilitative transporter

A system – glycine, energy-dependent Na+ dependent

ASC system alanine, serine, cysteine
energy-dependent Na+ dependent

36
Q

Some drugs do not work as effectively on the brain because

A
  1. They cannot cross the BBB 2. They are actively transported out
37
Q

Epileptic patients have … drug resistance

A

Increased, due to multidrug transporter overexpression

38
Q

When is the BBB functional and working?

A

Since the first few days of NS development.

39
Q

The best way to see brain tumors is to use …

A

T2 weighted MRI or FLAIR image

40
Q

Vasogenic edema

A

extravasation and extracellular accumulation of fluid into the cerebral parenchyma caused by disruption of the blood-brain barrier (BBB)

41
Q

Cytotoxic edema

A

intracellular accumulation of fluid and Na+ resulting in cell swelling

42
Q

How to treat cytotoxic edema?

A

Give hypertonic saline solution e.g. mannitol to draw water out of the brain and into the blood

43
Q

How to treat vasogenic edema?

A

Steroids, to decrease BBB leakiness

44
Q

Normal ICP

A

0-15 mmHg

45
Q

Average intracranial volume

A

1700 mL

46
Q

Cerebral perfusion pressure

A

CPP = MAP - ICP

47
Q

MAP

A

= 2/3 of diastolic + 1/3 of systolic

48
Q

Normal CPP

A

70-100 mmHg

49
Q

CBF, cerebral blood flow

A

750 mL/min, higher need in gray matter, highest in neurohypophysis, used to maintain neurotransmitter homeostasis

50
Q

Ischemia values

A

CPP < 50 mmHg

51
Q

Hypercapnia, defined as an elevation in the arterial carbon dioxide tension, causes…

A

Increased CBF, decreased plateau phase (less autoregulation ability to maintain CBF)

52
Q

Acute mountain sickness AMS

A

Acute mountain sickness is caused by reduced air pressure and lower oxygen levels at high altitudes. The faster you climb to a high altitude, the more likely you will get acute mountain sickness. The best way to prevent altitude illness is to ascend gradually.

53
Q

Biphasic nature of brain tumors

A

There is a compensation phase, where the brain tumor does not produce symptoms. Then the decompensated phase seems like a sudden onset of symptoms.

54
Q

Cushing’s triad in increased ICP due to brain tumor (end-stage, decompensation stage)

A
  1. Systolic pressure increases (diastolic decreases, increased Pulse pressure)
  2. Bradycardia
  3. Tachypnea, Cheyne-Stokes (waxing and waning in cycles)
55
Q

Common causes of I-ICP

A

• Vascular abnormalities: AV malformations, aneurisms, stroke

• Diffuse cerebral ischemia: Closed head trauma, shaken baby, vasospasm

• CNS infections

• Tumors

• Trauma

• Obstruction of CSF flow

56
Q

I-ICP diagnosis

A
  1. Papilledema
  2. Nuchal rigidity
  3. Lumbar puncture (limited indications due to risk of brain herniation, should do brain imaging first)
57
Q

ICP monitoring can show A, B, C Lundberg waves

A

A waves are pathological plateau waves. Means loss of autoregulation.

58
Q

How does the choroid plexus create CSF?

the BCSFB

A
59
Q

What is the turnover rate of CSF?

A

3-5 times per day

0.35 ml/min, 500 ml/day

Neuro (18 decks)

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