Thursday, November 19, 2009

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Huntington's chorea CSF

The cerebrospinal fluid (CSF), also known as cerebrospinal fluid (1) is a clear, colorless substance that protects the brain and spinal cord of physical and chemical damage. It also carries oxygen and glucose from the blood to neurons and glia (2). CSF continuously circulates through the cavities of the brain and spinal cord in an area called "subarachnoid. Both cerebral and spinal level, this space is between the arachnoid and pia mater meninges.

Figure # 1: Diagram with the meninges at the level of spinal cord Taken C3% 93N + DE + LA + M. + E.

fluid consists of water (main constituent), protein, glucose, cells, electrolytes and peptides (1)

CSF examination is of great value in neurologic diagnosis. Lumbar puncture, performed at the L3-L4 vertebrae can extract liquid for purposes of analysis, measuring the pressure or introduce therapeutic agents, anesthetics or contrast material (3).

This liquid is known for a long time. The Egyptians documented the presence of intracranial fluid in Ebers Papyrus (1500 BC). Hippocrates (450 BC), also described some conditions associated with excess water inside the skull (4). Features

CSF helps to maintain an internal condition of balance (homeostasis) in the Central Nervous System (2). Has three main functions

1. Mechanical protection: Represents a medium that absorbs shocks received by the skull and vertebrae. This means that helps protect the nerve tissue of the spinal cord and brain. The latter essentially "floats" in the cranial cavity (2).

2. Chemical Protection: Provides an optimal chemical environment for the transmission of impulses at neuronal (2). Its composition is relatively stable, even when there are noticeable changes in the chemical structure of plasma. (1)

3. Circulation: The CSF allows the exchange of nutrients and waste products between blood and nervous tissue (2).

Figure # 2: Diagram with the ventricles in the brain Taken C3% ADculo + side & lang = 2

Training Most of the LCR (60%) is produced by the choroid plexus (1), especially those found on the roof of the third ventricle. These plexuses are a network of capillaries (blood vessels) on the walls of the ventricles. The capillaries are covered in turn by ependymal cells are ultimately those that generate CSF from blood plasma (2). Ependymal cells have very close bonds, therefore, the substances that pass from plasma to CSF \u200b\u200bshould be through them. The barrier formed by the ependymal cells prevents the ingress of undesirable elements and the LCR called Hematocefalorraquídea Barrera (2).

Some authors explain the formation of CSF as an "ultrafiltration" of plasma, however recent evidence attributed their formation to the processes of diffusion and active transport (1). In that there is consensus is that it occurs at a rate of 0.35ml per minute (20ml/hr). If the normal volume in adults is 100 to 150ml, then estimated that the CSF is replaced every 5 - 7 hours (1) (2) (4).

Other CSF production sites, such as the pial brain surface, brain intracellular space and perineural space (1). Resorption

CSF is gradually reabsorbed into the blood by the arachnoid villi. These in turn are projected onto the dural venous sinuses, especially in the superior sagittal sinus. In this cluster is called arachnoid granulation or Pacchioni (2).

alternative sites have been reported resorption (1) such as the arachnoid membrane, sleeves roots cranial and spinal nerves (1) (5), the capillary endothelium and choroid plexus even themselves.

Normally, the fluid is reabsorbed as fast as it is formed in the choroid plexus (20 ml / hr), which makes the pressure remains constant.

Animation CSF Circulation Taken from


The mechanism that moves the CSF through its route is not fully understood (5), however there is consensus that most of the liquid flowing the following structures (1) (2):

a. Lateral ventricles
b. C.
foramen of Monro D. Third Ventricle
Cerebral aqueduct of Sylvius or foramen
e. Fourth ventricle
f. Magendic hole (central) and holes
Lushka g. Subarachnoid Space of the Brain and Spinal Cord

There are several factors that contribute to their movement are the following (1):

1. Momentum: The movement of CSF from the areas where it occurs to areas where it is absorbed. This process is called diffusion of CSF positive balance areas to areas of negative balance (1). Some authors indicate that the fluid is mobilized to the nearest point of resorption, implying that there is no flow in the conventional sense (4).

2. Swing: The CSF is in continuous state of oscillation, with swinging movements whose amplitude increases as the liquid approaches the fourth ventricle (1).

3. Pulsatile Movement: Usually described rhythmic movements synchronized with the arterial pulse. It is thought that these oscillations are caused by the expansion of the brain and arteries during systole rather than by pulsations of the choroid plexus as previously believed (1). In fact, these palpitations occur almost simultaneously with the intracranial pulse (150 msec in the cardiac cycle). In the atlas of anatomy can be seen that there are irrigation and drainage at that level, for example, the anterior spinal vein, located in the anterior median fissure (6). There

an additional factor, although it has not been scientifically proven, may be related to CSF \u200b\u200bcirculation. We refer to the difference in the density of the liquid at the ventricular and lumbar level. The protein quantitative analysis shows that the concentration of albumin increased 2.2 times from the ventricular to lumbar CSF LCR (4). This means that the liquid along with proteins tends to decrease, which in turn cause an upward momentum part of it.

To read more

(1) Afifi, Adel. Ronald Bergman. 2006. Functional Neuroanatomy. 2nd. Edition. Editorial McGrawHill. Mexico. Cap 29.

(2) Tortora, Gerald. Derrickson, Bryan. 2006. Principles of Anatomy and Physiology. 11 th. Edition. Editorial Médica Panamericana. Mexico DF. Mexico. Cap 14.

(3) Young, Paul. 2001. Clinical Functional Neuroanatomy. First Edition. Editorial Masson. Spain. Cap 2.

(4) Wilson, E. Oehninger, C. 2007. Evolution of Knowledge from Antiquity CSF to the Present Day. Archives of the Institute of Neurology. Volume 10, Number 1-2. Online. Date of Consultation: 19/Nov/2009.
Available at:

(5) Killer, H. Jaggi, G. Flammer, J. Miller, N. Huber, A. Mironov, A. 2006. Between Cerebrospinal fluid dynamics and the intracranial subarachnoid space of the optic nerve. Brain (2006). Online. Date of Consultation: 19/Nov/2009.
Available at:

(6) Netter, Frank. 2007. Atlas of Human Anatomy. 4 ª. Edition. Editorial Masson. Barcelona, \u200b\u200bSpain. Lam 173.


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