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TAS Neurology > Cerebrospinal Fluid > Flashcards

Cerebrospinal Fluid Flashcards

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
Q

What is idiopathic intracranial hypertension?

A

A special case where the CSF is elevated in the absence of hydrocephalus or intracranial mass lesion

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26
Q

What does the treatment of hydrocephalus depend on?

A

Cause

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27
Q

What might the treatment of hydrocephalus include?

A
  • Resection of intracranial obstruction
  • Placing of stent in stenosed aqueduct
  • Removal of excess CSF
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28
Q

How can excess CSF be removed in hydrocephalus?

A

Insertion of a one-way valved ventriculoperitoneal shunt

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29
Q

What does the insertion of a ventriculoperitoneal shunt form?

A

A direct drainage route for CSF from the cranial vault to the low pressure of the peritoneal cavity

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30
Q

What do the clinical features of hydrocephalus depend on?

A
  • Site of the obstruction

- Capacity of the cranial vault to expand

31
Q

Why might the cranial vault be able to expand?

A

If the sutures are not yet fused

32
Q

Are the symptoms of hydrocephalus acute or chronic?

A

Can be either

33
Q

What are the acute symptoms of hydrocephalus?

A
  • Vomiting
  • Irritability
  • Headaches
  • Change in consciousness
34
Q

What are the chronic symptoms of hydrocephalus?

A
  • Visual disturbance
  • ‘Sunsetting eyes’
  • Deterioration in school performance
35
Q

Give an example of a cause of acute hydrocephalus?

A

Blocked ventriculoperitoneal shunt

36
Q

What can acute hydrocephalus lead to if untreated?

A

Brainstem herniation and death

37
Q

In what disorders might CSF analysis be of value?

A
  • Meningitis
  • Metabolic disorders
  • Leukaemia
  • Neurodegenerative conditions
  • Autoimmune disorders
38
Q

What is the limitation of CSF analysis in meningitis?

A

It may initially be normal, so clinical impression is of prime importance

39
Q

What is the normal CSF neutrophil count in a term neonate?

A

<5

40
Q

What is the normal CSF lymphocyte count in a term neonate?

A

<20

41
Q

What is the normal CSF protein count in a term neonate?

A

<1.0

42
Q

What is the normal CSF glucose in a term neonate?

A

≥2.5mmol/L

43
Q

What is the normal CSF neutrophil count in a child >1 month?

A

0

44
Q

What is the normal CSF lymphocyte count in a child >1 month of age?

A

≤5

45
Q

What is the normal CSF protein count in a child >1 month of age?

A

<0.4

46
Q

What is the normal CSF glucose in a child >1 month of age?

A

≥2.5mmol/L

47
Q

What is the CSF neutrophils in bacterial meningitis?

A

100-10,000 (but may be normal)

48
Q

What is the CSF neutrophils in bacterial meningitis?

A

Usually <100

49
Q

What is the CSF protein in bacterial meningitis?

A

> 1.0 (but may be normal)

50
Q

What is the CSF glucose in bacterial meningitis?

A

<0.4 (but may be normal)

51
Q

What is the CSF neutrophils in viral meningitis?

A

Usually <100

52
Q

What is the CSF lymphocytes in viral meningitis?

A

10-1000 (but may be normal)

53
Q

What is the CSF protein in viral meningitis?

A

0.4-1 (but may be normal

54
Q

What is the CSF glucose in viral meningitis?

A

Usually normal

55
Q

What is the CSF neutrophils in TB meningitis?

A

<100

56
Q

What is the CSF lymphocyte count in TB meningitis?

A

50-1000 (but may be normal)

57
Q

What is the CSF protein in TB meningitis?

A

1-5 (but may be normal)

58
Q

What is the CSF glucose in TB meningitis?

A

<0.3 (but may be normal)

59
Q

What is the significance of finding neutrophils in the CSF?

A

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
Q

How does CSF white cell count and protein level differ at birth from in later infancy?

A

It is higher

61
Q

What kind of white cells are found in viral meningitis?

A

Lymphocytes are more characteristic, but neutrophils may predominate

62
Q

Do antibiotics significantly change CSF cell count or§ biochemistry?

A

Not if taken within 24 hours of initial dose

63
Q

When is meningococcal PCR testing on CSF samples particularly useful?

A

In patients with a clinical picture consistent with meningococcal meningitis, but who have received prior antibiotics

64
Q

What might be found in CSF in patients with central nervous inflammatory diseases?

A

CSF IgG

65
Q

Give 2 examples of CNS inflammatory diseases?

A
  • Multiple sclerosis

- Sub-acute sclerosing panencephalitis

66
Q

What is the most commonly used diagnostic test for MS?

A
  • CSF index

- Oligoclonal band detection

67
Q

What is CSF index?

A

The ratio of CSF IgG to CSF albumin, compared to serum IgG to serum albumin

68
Q

What happens to the CSF index in MS?

A

It is raised

69
Q

What are monoamine neurotransmitter disorders caused by?

A

Defects in the synthesis, degradation, or transport of dopamine, noradrenaline, adrenaline, or serotonin

70
Q

What are monoamine neurotransmitter disorders implicated in?

A

A varied group of conditions, including;

  • Mitochondrial disorders
  • Rett’s syndrome
  • Leukodystrophies
71
Q

How do monoamine neurotransmitter disorders usually present?

A

With abnormal neurological features, e.g. encephalopathy, epilepsy, and pyramidal and extrapyramidal motor disorders

72
Q

What might the diagnosis of monoamine neurotransmitter disorders include?

A

Analysis of neurotransmitters in CSF

73
Q

What does the analysis of neurotransmitters in CSF involve?

A

A precise protocol for collection and rapid freezing of samples, and specialised laboratory analysis

TAS Neurology (11 decks)

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