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MSC > C.S.F. Circulation > Flashcards

C.S.F. Circulation Flashcards

1
Q

csf is present in the

A

brain cavity subarachnoid space and central canal of spinal cord

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2
Q

function of csf

A
  • acts a cushion for cns
  • csf creates buoyancy
  • csf acts as a reservoir regulates contents of skull
  • csf nourishes cns
  • removes waste products
  • moves hormones around
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3
Q

healthy amount of csf present in the brain at one given time is

A

130ml

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4
Q

csf pressure is

A

60-160 mm h2o

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5
Q

csf is measured with a

A

manometer

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6
Q

which structures are pierced in a lumbar puncture

A
  • skin
  • subcutaneous fascia
  • ligaments supraspinous
  • ligament interspinous
  • ligament flavum
  • space outside dura matter is epidural space dura matter subdural space arachnid matter
  • subarachnoid space containing csf
  • pia matter is not pierced XXX
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7
Q

what happens if pia matter is pierced in a lumbar puncture

A

damage to spinal cord

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8
Q

how much ml can be safely drawn during a lumbar puncture

A

30 ml

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9
Q

signs of high intracranial pressure

A
  1. history of unexplained constant headache if patient wakes up with headache high csf should always be considered
  2. papilledema - optic nerve at the back of the eye becomes swollen. symptoms can include visual disturbances, headaches, and nausea papilldema
    - csf accumulates around optic disk margined blurred don’t do lumbar puncture
  3. projectile vomiting
    - git regulating centres of medulla vagus nerve from medulla is disturbed vagus nerve controls motility of git causing projectile vomiting
  4. progressively rising blood pressure and progressively falling pulse rate
    - because vagus is stimulated vagus is a cardio inhibitor heart rate is reduced heart rate goes down blood pressure goes up struggles to pump ischaemia develops in cns which triggers immense sympathetic overflow which constricts many vessels in body raising body up ischemic brain is important to save
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10
Q

is optic nerve really a nerve or a tract of cns

A

optic nerve is technically not a nerve its a cns tract proof is that its covered in meninges and its myelinated by oligodendrocytes and not schwann cells

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11
Q

csf lumbar puncture needle is pushed up towards

A

navel umbilicus

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12
Q

circulation of csf

A
  • csf circulates from the two lateral ventricles through the foramen of monro (inter ventricular foramen) to the third ventricle
  • down the aqueduct of sylvius
  • to the fourth ventricle
  • and into subarachoiud space via median foramen magendie (most pass through this) but also foramen lusaka on either side of fourth ventricle
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13
Q

spaces form openings in the subarachnoid space an anatomic space in the meninges of the brain the space separates two of the meninges the arachnoid mater and the pia mater and are filled with cerebrospinal fluid

A

cisterns

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14
Q

how many cisterns are there in the cns and there names

A
  1. chiasmatic
  2. interpenduncular
  3. pontine
  4. superior
  5. cerebellomedullary
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15
Q

inter ventricular foramen

A

the foramen of monro

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16
Q

how much csf is secreted per min and per day

A

0.5ml per min and 720 ml per day

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17
Q

increases intracranial pressure

A
  • coughing and crying increases the pressure by decreasing absorption of csf
  • compression of internal jugular vein
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18
Q

pressure is highest and lowest on csf when

A

siting and lateral recumbent

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19
Q

weight if brain in and out of csf

A
  • brain weighs: 1400 g

- but in csf it weighs: 50g

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20
Q

csf collection happens at these two spots

A
  • cisternal puncture : between occipital and atlas cistern magna
  • lumbar : subarachnoid space in lumbar region between L3-4
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21
Q

connects lateral ventricle to third ventricle

A

foramen monro

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22
Q

what is the terminal ventricle

A

is located at the end of the spine it is a little dilated also a dead end

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23
Q

ventricle that lies between the thalami is the

A

third ventricle

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24
Q

the ventricle of the telencephalon

A

the lateral ventricles

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25
Q

the ventricle of the diencephalon

A

third ventricle

26
Q

the ventricle of the midbrain aka mesencephalon

A

cerebral aqueduct

27
Q

the two expanded ends from the third ventricle and the central cavity make which ventricle

A

the fourth ventricle

28
Q

where is the fourth ventricle located

A

located on the posterior aspect of pons and upper medulla and anterior to cerebellum

29
Q

tube connecting third and fourth ventricle is called

A

cerebral aqueduct

30
Q

the ventricle for pons medulla and cerebellum aka rhombencephalon

A

fourth ventricle

31
Q

where is csf formed

A

within the ventricles by chorid plexuses

32
Q

all cavities within cns are lined with which type of cells

A

ependymal cells

33
Q

glucose ratio from cns to blood is

A

cns glucose level is 2/3 of the blood

34
Q

epithelial cells covering choroid plexuses have a specialised pump for

A

sodium (they actively secret sodium attracting chlorine)

35
Q

in csf how are sodium and chlorine exchanged

A

sodium is actively pushed by sodium pumps whilst chloride is passively pushed

36
Q

transported in reverse from csf to blood is

A

potassium (naturally low in csf)

37
Q

foramen between fourth ventricle and the subarachnoid space at the cerebellopontine angle (pontine cistern/ cerebellopontine cistern)

A

foramen of luschka

38
Q

foramen located on posterior aspect of the fourth ventricle creates cerebellomedullary cistern

A

foramen magendie (median foramen median aperture)

39
Q

drains csf

A

dural venous sinuses lined with epithelial cells

40
Q

cavity where the arachnoid extends across between the two temporal lobes it encloses the cerebral peduncles and the structures contained in the interpeduncular fossa, and contains the arterial circle of Willis.

A

interpeduncular cistern

41
Q

cavity subarachnoid cistern of the subarachnoid space between the splenium of the corpus callosum and the superior surface of the cerebellum it extends between the layers of the tela choroidea of the third ventricle and contains the great cerebral vein and the pineal gland

A

superior cistern

42
Q

is formed as the interpeduncular cistern extends forward across the optic chiasm and onto the upper surface of the corpus callosum

A

chiasmatic cistern

43
Q

large area in subarachnoid space between medulla and cerebellum

A

cistern magna

44
Q

pressure of csf is at 10-18 cm H20

A

lateral recumbent position

45
Q

pressure of csf is at 13 cm H20

A

lying position

46
Q

pressure of csf is at 30 cm H20

A

sitting position

47
Q

ph of csf

A

7.28 -7.32

48
Q

noncommunicating (internal) hydrocephalus

A

obstruction of any foramen

49
Q

communicating (external) hydrocephalus

A

blockage of arachnoid villi

50
Q

gait instability urinary incontinence dementia symptoms of

A

normal pressure hydrocephalus

51
Q

hydrocephalous ex vacuo is due to

A

brain atrophy

52
Q

congenital hydrocephalus includes

A
  • aqueduct stenosis narrowing of aqueduct
  • brain extends to spinal cord
  • dandy walker malformation no cerebellar vermis
53
Q

tapping on the skull near the junction of the frontal temporal and parietal bones yielding resonant sound

A

macewan sign a result of hydrocephalus in children

54
Q

sign hydrocephalus in children

A
  • failure of upward gaze: due to pressure on the tectal plate through the supra pineal recess imitation of upward gaze is of supranuclear origin
  • macewen sign
  • unsteady gait
  • large head: sutures are closed, but chronic increased icp will lead to progressive macrocephaly.
  • unilateral or bilateral sixth nerve palsy is secondary to increased icp
55
Q

ophthalmologic sign in young children resulting from upward-gaze paresis eyes appear driven downward, the sclera may be seen between the upper eyelid and the iris, and part of the lower pupil may be covered by the lower eyelid

A

setting-sun sign of hydrocephalus

56
Q

visual impairment seen in adults with hydrocephalus

A
  • Parinaud’s syndrome inability to move the eyes up and down caused by compression of the vertical gaze center at the rostral interstitial nucleus of medial longitudinal fasciculus (riMLF)
57
Q

drug of choice for hydrocephalus

A

acetazolamide and frusemide

58
Q

foramen monro blocked

A

leads to asymmetrical enlargement

59
Q

cerebral aqueduct blocked

A

symmetrical enlargement

60
Q

symptoms of hydrocephalus ex vacu where the brain shrinks

A

urinary incontinuence - wet
gait - wobbly
dementia - whacky

61
Q

queckenstedt sign

A

pressing on internal jugular vein test

MSC (6 decks)

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