Cerebrospinal Fluid

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Cerebrospinal fluid has several important functions.

Cushing delicate neural structures
Supporting the brain. In essence, the brain suspended inside
the cranium & floats in the CSF. A human brain weight about
1400 g in air but only about 50 g when supported by CSF
Transporting nutrients, chemical messengers, and waste
products

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Teori Pembentukan CSF (Teori Osmotik)

Sel epitel plexus choroidalis
mensekresi Na+
Na + menarik ion Cl Pe
NaCl me osmolaritas CSF
dan menarik air
Glukosa, K+, HCO3 - keluar dari
CSF ke kapiler sehingga komposisi
CSF & plasma berbeda (tabel)

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Sirkulasi CSF
Choroid plexus yg terdapat di ventrikel lateral, III, dan
IV membentuk CSF.
Dari sistem ventrikel, CSF ke ruang subarachnoid yang
mengelilingi otak dan sumsum tlg belakang melalui
medial aperture (of Magendie) dan lateral aparture (of
Luscha).
Sebagian besar CSF direabsorpsi melalui arachnoid villi
ke dural venous sinuses di cranium
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Pembentukan CSF

Pembentukan CSF 500 ml/hari

Total volume CSF 150 ml, jadi CSF diganti tiap 8 jam.
Tek. CSF pada posisi berbaring 120-180 mmH2O

Pembentukan CSF tidak dipengaruhi oleh tekanan di

ventrikel, ruang subarachnoid, dan tekanan darah
sistemik.
Namun, absorpsi CSF dipengaruhi tekanan CSF (gambar)

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Hydrocephalus
The vol. CSF will increase if the rate of formation
accelerates or the rate of removal (absorption)
decreases.
Increased rates of formation can accompany head
injuries, but the most common problems arise from
masses, such as tumors or abscess, or from
abnormalities.
Because CSF production continues, the ventricle
gradually expand, distorting the surrounding neural
tissue causing brain function to deteriorate.
In infants, cranial sutures have yet to fuse, so the
skull can enlarge to accommodate the extra fluid
volume.
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Hydrocephalus in Infant
Infants are especially sensitive to changes in intracranial pressure,
because the arachnoid granulation do not appear until roughly 3
years of age. (until then, CSF is reabsorbed into small vessels in the
subarachnoid space & beneath the ependyma lining the ventricle.
results from blockage of mesencephalic aqueduct, constriction of
the connection between the subarachnoid spaces of the cranial &
spinal meninges.
untreated
mental degradation
Treatment: installation of a shunt. The shunt may be removed if
arachnoid granulation develope (3 years old age), growth of the
brain eliminates the blockages
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 Spinal tap/lumbar puncture; 3-9 ml of

fluid is taken from subarachnoid space
between vertebrae L3 & L4 .
Spinal tap are performed when CNS
infection is suspected, headaches, and
some types of stroke are diagnosis
Spinal anastesi; anastesi dimasukkan
ke subarachnoid space untuk
menghambat transmisi impuls sensorik.
Epidural anastesi
anastesi dimasukkan ke ruang epidural,
cara ini umum digunakan pada partus
Queckenstedt
teknik mendeteksi sumbatan pada CSF

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CSF Analysis
Laboratory test

Normal Value

Pressure

200 cm H2O

Brain tumor, blood clots

Color

Clear & colorness

Hemorrhage, infection, faulty puncture technique

Glucose

50 70 mg/dl

Decreased levels occur in some infection & CNS

tumors

Protein

15 45 mg/dl

Elevated level occur in encephalitis, meningitis, brain

tumor formation

Cells

No RBCs present,
WBC count 5 per
mm3

RBCs appear with subarachnoid hemorrhage

Increased in lymphocyte number occurs in viral
meningitis.

Culture
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Significance of abnormal value

Culture can determine causative agent in meningitis or

brain abcess
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Myelography is the
introduction of radiopaque
dyes into the CSF of the
subrachnoid space. Because
the dyes are opaque to x-ray ,
the CSF appears white on an
x-ray image. Any tumors,
inflamation, distort CSF
circulation can be detected.

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Blood Brain Barrier

Neural tissue in the CNS is isolated from the general
circulation by the blood brain barrier.
Endothelial cells that line the capilaries of the CNS are
interconnected by tight junction.
Only lipid soluble compound (CO 2, O2, alcohol, steroid,
prostaglandin) can difuse across endothelial cells into
interstitial fluid of the brain & spinal cord.
Water & ions must pass through channels.
Water soluble compound
active transport
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Fungsi BBB
Memelihara lingk. Internal neuron di SSP
Proteksi otak thd toxin yg ada di darah
Cegah escape neurotransmiter ke sirkulasi darah
Implikasi klinis
Meningitis/CNS infections
Th/ erythromycin, sulfaxozale,
sulfadiazine.
Parkinson
obat L-dopa
BBB dapat rusak pada area yang terinfeksi, tumor, diiradiasi
Pada janin/bayi, BBB belum terbentuk. Pada bayi kuning,
bilirubin merusak basal ganglia/otak.
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BBB terdapat di plexus choroideus dan semua bagian

parenchym otak, kecuali: hipotalamus, pineal gland dan
area postrema (organ-organ sensorik yg berespons
terhadap perubahan cairan tubuh seperti kadar glukosa
dan osmolaritas).

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Lymphatic Function of Perivascular Space

Oleh karena tdk ada sirkulasi
limfatik di otak, protein yg
keluar dari kapiler ke ruang
interstitial akan lewat
perivascular space ke CSF
lalu diabsorpsi oleh
arachnoid villi. Selain
protein, zat-zat lain misalnya
leukosit mati juga lewat
perivascular space.
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