Cerebrospinal Fluid - Fremont-Smith

Question 1

central cord

Answer 1

opens superiorly into 4th ventricle

lined with ependymal cells

Question 2

blood supply to choroid plexus

Answer 2

arterial

lateral and third ventricle - internal carotid and basilar artery

fourth ventricle - posterior inferior cerebellar artery

Question 3

calcifications of CSF

Answer 3

seen on CT

Question 4

formation of CSF

Answer 4

choroid plexus - mainly in lateral ventricles

some from ependymal cells - lining ventricles

some from brain substances through perivascular spaces

Question 5

movement of CSF

Answer 5

pulsation of artery and choroid plexus
aid of cilia and microvilli of ependymal cells
respiration and coughing
changing position

Question 6

absorption of CSF

Answer 6

dural venous sinuses via subarachnoid granulations

Question 7

break bridging vessels

Answer 7

subdural hematoma

Question 8

blood in CSF

Answer 8

subarachnoid bleed

Question 9

lumbar puncture

Answer 9

blood in CSF - but will go away

traumatic tap

if doesn’t clear - indicates SA bleed

Question 10

virchow-robbin space

Answer 10

space around vessels - ends at capillaries

• CSF extends to this space
• into brain parenchyma

perivascular space

Question 11

xanthochromia

Answer 11

blonde colored CSF

• 4-6 hours after SA hemorrhage - oxyhemoglobin
• 2 days after SA hemorrhage - bilirubin

Question 12

causes of bloody CSF

Answer 12

subarachnoid hemorrhage
intracerebral hemorrhage
cerebral infarct
traumatic spinal tap

Question 13

neutrophils in virchow robbins space

Answer 13

extends inflammation into the perivascular space into brain parenchyma

leads to edema of brain

Question 14

brown xanthochromia

Answer 14

seen in meningeal metastatic melanoma

Question 15

siderphage

Answer 15

hemosiderin macrophage

-in patient with SAH

Question 16

CSF neutrophilia

Answer 16

bacterial meningitis and other infections

abscess
after seizure, CNS hemorrhage, CNS infarct, repeat lumbar punctures

Question 17

CSF lymphocytosis

Answer 17

viral meningitis
degenerative disorder
MS, drug abuse, guillan barre
inflammatory disorders

Question 18

scant blue cytoplasm, fine chromatin, and 1-2 nuclei cells in CSF

Answer 18

with tumor cells

-acute lymphoblastic leukemia

Question 19

most common metastatic tumor to brain

Answer 19

carcinomas

ex/ breast carcinoma

Question 20

CSF rhinorrhea

Answer 20

out of nose

-with trauma - fx of skull

Question 21

beta-2 transferrin

Answer 21

test to determine if CSF

Question 22

prostaglandin D synthase

Answer 22

aka beta-trace protein - another test for CSF

Question 23

spontaneous CSF rhinorrhea

Answer 23

with elevated intracranial pressure

manifest in adulthood - with increasing CSF pressure

Question 24

meningocele

Answer 24

dura herniates

Question 25

encephalocele

Answer 25

brain parenchyma herniates

Question 26

double ring sign on filter paper

Answer 26

CSF

Question 27

localization of CSF leak

Answer 27

intrathecal fluorescein

Question 28

choroid plexus papilloma

Answer 28

rare

children - lateral ventricle
adult - 4th ventricle

increased CSF production (communicating)
obstruction (obstructive)

both produce hydrocephalus

Question 29

communicating and non-communicating hydrocephalus

Answer 29

Hydrocephalus may also be communicating or non-communicating. Communicating hydrocephalus occurs when the flow of CSF is blocked after it exits the ventricles. This form is called communicating because the CSF can still flow between the ventricles, which remain open. Non-communicating hydrocephalus — also called “obstructive” hydrocephalus — occurs when the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles.

Question 30

ependymoma

Answer 30

children and adolescents

mostly in 4th ventricle - cause hydrocephalus - block CSF

most common primary tumor in spinal cord and filum terminale

well demarcated, intra-axial mass - form true rosettes and pseudorosettes**

benign lesion - but location can be problematic

Question 31

kid playing soccer, loses coordination, has hydrocephalus

Answer 31

ependymoma

tx - shunt

Question 32

shunts

Answer 32

VP - to peritoneal cavity

VA - to atrium

Question 33

guillan barre CSF

Answer 33

CSF lymphocytosis

Question 34

MS CSF

Answer 34

CSF lymphocytosis

Question 35

choroid plexus carcinoma

Answer 35

rare