It is made in the choroid plexuses located at the base of the ventricles. A very small amount is also made by the ependymal cells lining the floor of the ventricles.
Total circulating volume is 50 ml in newborns and 150 ml in adults. CSF enters the general circulation from the superior sagittal sinus and is absorbed in the arachnoid villi and arachnoid granulation region.
It passes from the 4th ventricle to the spinal cord with 2 Luschka and 1 Magendi holes.
CSF tasks
Protects the brain from trauma.
It clears the residues of neuronal metabolism.
It acts as a reserve.
CSF pressure is 8-18 cm H2O, and 9-12 cmHp in newborns.
If the lactic acid level in CSF is above 30 mg, organic acidemia and mitochondrial myopathy are considered.
Measles antibodies are over 1/8 in SSPE. Antibodies to GM1 gangliosides can be demonstrated in Guillain-Barre.
The CSF/blood ratio of IgG is about 0.6. If this rate increases, CNS disease and collagen tissue diseases should be considered.
30% of the CSF protein is globulins. IgG/albumin=0.21. If this rate increases, multiple sclerosis, SSPE, neurosyphilis, postinfectious encephalomyelitis should be considered.
Causes of xanthochromic CSF
Subarachnoid hemorrhage (if hemorrhagic CSF is centrifuged, if the upper serum is yellow, it is subarachnoid hemorrhage, if it is clear, it is hemorrhagic because it is traumatic)
hyperbilirubinemia
carotenemia
Significantly elevated CSF protein (like tuberculosis)
LP contraindications
Findings suggestive of an intracranial mass or presence of an intracranial mass
Skin infection in the LP area
Platelet count <20,000 /mm3
hydrocephalus
It is an enlargement of the cerebral ventricles with excessive accumulation of CSF. It is the most common cause of head circumference enlargement in newborns. There are two types:
Causes of Communicated Hydrocephalus
Achondroplasia
basilar impression
Choroid plexus papilloma tumors
meningitis
Post hemorrhagic cases
Leukemic cell invasion into the subarachnoid space
Meningeal malignancy
Benign development of the subarachnoid space
Causes of Non-Communicated Hydrocephalus
Aquaductal stenosis
Arnold-Chiari malformation
Klippel-Feil syndrome
Dandy-Walker malformation
Mass lesions (abscess, hematoma, tumor)
vein of galen aneurysm
Walker-Warburg syndrome
Infection (toxoplasma, neurocysticercosis, mumps)
NF-1/2
LlCAM mutation
X bound/OD/OR
mitochondrial
Neurocutaneous diseases
The presence of abnormal head circumference increase and symptoms of CRPS, which constitute the clinical features, are diagnostic.
Although hydrocephalus can be diagnosed with CT, USG is useful if the anterior fontanelle is open.
The causes of hydrocephalus are related to the time of its occurrence. the most common causes in the prenatal period or in the first month of life; Congenital malformations such as intraventricular hemorrhage, infection or aqueductal stenosis.
Depending on the etiology, mannitol, acetazolamide, furosemide can be used in treatment. Serial lumbar punctures, CSF drainage from the fontanel (tap method) and external drainage applications can also be performed.
The best treatment method is ventriculoperitoneal shunt placement.
Increased Intracranial Pressure Syndrome (CIBAS)
Some important causes of CRPS in children
Benign Intracranial Hypertension (Pseudotumor Cerebri)
It is an increase in intracranial pressure without a mass occupying space in the head.
When the intracranial mass is excluded, LP is performed and the pressure is found to be high (>20 cm Hp in infants, >25 cmH2O in children, >28 cm in obese and sedentary children).
Due to prolonged papilledema, it may cause optic nerve damage and cause vision loss, and the enlarged blind spot in the vision test is an early finding.
It may very rarely cause herniation (manifested as a mass in the posterior fossa).
The most common finding is headache. Vomiting and diplopia due to 6th nerve palsy are common. The first affected cranial nerve is the 6th nerve.
In treatment, B05 pressure is lowered with LP. Acetazolamide and corticosteroids are used.
