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Cerebrospinal Fluid

The cerebrospinal fluid is found in the ventricles of the brain and in the
subarachnoid space around the brain and spinal cord.
It has a volume of about 150mL. Its a clear, colorless fluid and possesses, in
solution, inorganic salts similar to those in the blood plasma.
The glucose content is about half that of blood, and there is only a trace of
protein.
Only a few cells are present, and these are lymphocytes. The normal
lymphocyte count is 0-3 cells per cubic milimeter.
The pressure of the cerebrospinal fluid is kept remarkably constant. This
pressure may be raised by straining, coughing, or compressing the internal
jugular veins in the neck.
Physical Characteristic and Composition of the Cerebrospinal
Fluid
Appearance Clear and colorless
Volume 150mL
Rate of production 0,5mL/minute
Pressure 60-150mm of water
Composition
Protein 15-45mg/100mL
Glucose 50-85mg/100ml
Chloride 720-750mg/100mL
Number of cells 0-3 Lymphocytes/cumm

Functions
o The cerebrospinal fluid, which bathes the external and internal surfaces of the
brain and spinal cord, serves as a cushion between the central nervous
system and the surrounding bones, thus protecting it against mechnical
trauma.
o Because the density of the brain is only slightly greater than that of the
cerebrospinal fluid, it provides mechanical buoyancy and support for the
brain.
o The close relationship of the fluid to the nervous tissue and the blood enables
it to serve as a reservoir and assist in the regulation of the contents of the
skull. For example, if the brain volume or the blood volume increasers, the
cerebrospinal fluid volume decreases.
o Since the cerebrospinal fluid is an ideal physiologic substrate, it probably
plays an active part in the nourishment of the nervous tissue; it almost
certainly assists in the removal of products of neuronal metabolism.
o Its possible that the secretions of the pineal gland influence the activities of
the pituitary gland by circulating through the cerebrospinal fluid in the third
ventricle.

Formation
The cerebrospinal fluid is formed mainly in the choroid plexuses of the lateral,
third, and fourth ventricles; some originates from the ependymal cells lining
the ventricles and from the brain substance through the perivascular spaces.
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The blood of the capillaries is separated from the ventricular lumen by

endothelium, a basement membrane, and the surface epithelium. The
epithelial cells are permeable to large molecules.

Its important to realize that the production of cerebrospinal fluid isnt

pressure regulated, and it continues to be produced even if the reabsorption
mechanism are obstructed.

Circulation
The circulation begins with its secretion from the choroid plexuses in the
ventricles. The fluid passes from the lateral ventricles onto the third ventricle
through the interventricular foramina.

It then passes from the lateral ventricle into the third ventricle through the
narrow cerebral aqueduct. The circulation is aided by the arterial pulsations of
the choroid plexuses and by the cilia on the ependymal cells lining the
ventricles.

From the fourth ventricle, the fluid passes slowly through the median aperture
and the lateral foramina of the lateral recesses of the fourth ventricle and
enters the subarachnoid space.

The fluid then moves through the cerebellomedullary cistern and pontine
cisterns and flows superiorly through the tentorial notch of the tentorium
cerebelli to reach the inferior surface of the cerebrum.

It then moves superiorly over the lateral aspect of each cerebral hemisphere,
assisted by the pulsations of the cerebral arteries. Some of the cerebrospinal
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fluid moves inferiorly in the subarachnoid space around the spinal cord and
cauda equina. Here, the fluid is at a dead end, and its further circulation relies
on the pulsations of the spinal arteries and the movements of the vertebral
column, respiration, coughing, and the changing of the position of the body.

The cerebrospinal fluid not only bathes the ependymal and pial surfaces of
the brain and spinal cord but also penetrates the nervous tissue along the
blood vessels.

Absorption
The main sites for the absorption of the cerebrospinal fluid are the arachnoid
villi that project into the dural venous sinuses, especially the superior
sagittal sinus. The arachnoid villi tend to be grouped together to form
elevations known as arachnoid granulations. The arachnoid granulations
increase in number and size with age and tend to become calcified with
advanced age.

The absorption of cerebrospinal fluid into the venous sinuses occurs when the
cerebrospinal fluid pressure exceeds the venous pressure in the sinus.
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Should the venous pressure rise and exceed the cerebrospinal fluid pressure,
compression of the tips of the villi closes the tubules and prevents the reflux
of blood into the subarachnoid space. The arachnoid villi thus serve as valves.

Because the production of cerebrospinal fluid from the choroid plexuses is

constant, the rate of absorption of cerebrospinal fluid through the arachnoid
villi controls the cerebrospinal fluid pressure.

Blood-Cerebrospinal Fluid Barrier

There is free passage of water, gases, and lipid-soluble substances from the
blood to the cerebrospinal fluid. Macromolecules such as proteins and most
hexoses other than glucose are unable to enter the cerebrospinal fluid. It has
been suggested that a barrier similar to the blood-brain barrier exists in the
choroid plexuses.
Structure
Electron-microscopic examination of a illus of a choroid plexus shows that the
lumen of a blood capillary is separated from the lumen of the ventricle by the
following structures: (1) the endothelial cells, which are fenestrated and have
very thin walls (the fenestrations arent true perforations but are filled by a
thin diaphragm); (2) a continuous basement membrane surrounding the
capillary outside the
endothelial cells; (3) scattered
pale cells with flattened
processes; and (4) a
continuous basement
membrane, on which rest (5)
the choroidal epithelial cells.
Its probable that the tight
junction between the
choroidal epithelial cells
serve as the barrier.

Cerebrospinal Fluid-
Brain Interface
There is no comparable
physiologic barrier between
the cerebrospinal fluid and the
extracellular compartment of
the central nervous system.
Its interesting, however, to consider the structures that separate the
cerebrospinal fluid from the nervous tissue. Three sites must be examined: (1)
the pia-covered surface of the brain and spinal cord, (2) the perivascular
extensions of the subarachnoidspace into the nervous tissue, and (3) the
ependymal surface of the ventricles.

The pia-covered surface of the brain consists of a loosely arranged layer of

pial cells resting on a basement membrane. Beneath the basement
membrane are astrocytic foot processes. No intercellular junctions exist
between adjacent pial cells or between ajacent astrocytes; therefore, the
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extracellular spaces of the nervous tissue are in almost direct continuity with
the subarachnoid space.

The ventricular surface of the brain is covered with columnar ependymal cells
with localized tight junctions.

Intracellular channels exist that permit free communication between the

ventricular civity and the extracellular neuronal space. The ependymal
doenst have a basement membrane, and there are no specialized astrocytic
foot processes because the neuroglial cells are loosely arranged.