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The primary function of the CSF appears to be a mechanical one; it serves as a kind of water jacket for the spinal cord and brain, protecting them from potentially injurious blows to the spinal column and skull and acute changes in venous pressure Also, it provides the brain with buoyancy As pointed out by Fishman, the 1500-g brain, which has a water content of approximately 80 percent, weighs only 50 g when suspended in CSF, so the brain virtually oats in its CSF jacket Many of the physiologic and chemical mechanisms described below are committed to maintaining the relatively constant volume-pressure relationships of the CSF In

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Marks a file that can be opened only for reading This file cannot be edited or deleted unless this attribute is changed Marks a file as an important system file Prevents the file from being displayed with normal directory or file management commands Many systems files are marked as hidden to prevent accidental deletion Hidden files can be viewed by changing view options in Explorer or by using the DIR command to display hidden files

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formation (Cutler and Spertell) Electrolytes enter the ventricles somewhat more readily than they enter the subarachnoid space (water does the opposite) It is also known that the penetration of certain drugs and metabolites is in direct relation to their lipid solubility Ionized compounds, such as hexoses and amino acids, being relatively insoluble in lipids, enter the CSF slowly unless facilitated by a membrane transport system This type of facilitated (carrier) diffusion is stereospeci c; ie, the carrier (a speci c protein or proteolipid) binds only with a solute having a speci c con guration and carries it across the membrane, where it is released into the CSF and intercellular uid Diffusion gradients appear to determine the entry of serum proteins into the CSF and also the exchanges of CO2 Water and sodium diffuse as readily from blood to CSF and intercellular spaces as in the reverse direction This explains the rapid effects of intravenously injected hypotonic and hypertonic uids Studies using radioisotopic tracer techniques have shown that the various constituents of the CSF (see Table 2-1) are in dynamic equilibrium with the blood Similarly, CSF in the ventricles and subarachnoid spaces is in equilibrium with the intercellular uid of the brain, spinal cord, and olfactory and optic nerves Certain structures that were thought to maintain this equilibrium namely, the blood-CSF barrier and brain CSF barrier are now subsumed under the term blood-brain barrier, which is used to designate all of the interfaces between blood, brain, and CSF The site of the barrier varies for the different plasma constituents One is the endothelium of the choroidal and brain capillaries; another is the plasma membrane and adventitia (Rouget cells) of these vessels; a third is the pericapillary foot processes of astrocytes Large molecules such as albumin are prevented from entry by the capillary endothelium, and this is the barrier also for such molecules as are bound to albumin, eg, aniline dyes (trypan blue), bilirubin, and many drugs Other smaller molecules are blocked from entering the brain by the capillary plasma membrane or astrocytes The various substances formed in the nervous system during its metabolic activity diffuse rapidly into the CSF Thus, the CSF has a kind of sink action, to use Davson s term, by which the products of brain metabolism are removed into the bloodstream as CSF is absorbed Circulation Harvey Cushing aptly termed the CSF the third circulation, comparable to that of the blood and lymph From its principal site of formation in the choroid plexus of the lateral ventricles, the CSF ows downward through the third ventricle, aqueduct, fourth ventricle, and foramens of Magendie (medially) and Luschka (laterally) at the base of the medulla, to the perimedullary and perispinal subarachnoid spaces, thence around the brainstem and rostrally to the basal and ambient cisterns, through the tentorial aperture, and nally to the lateral and superior surfaces of the cerebral hemispheres, where most of it is absorbed (Fig 30-1) The pressure is highest in the ventricles and diminishes successively along the subarachnoid pathways Arterial pulsations of the choroid plexuses help drive the uid from the ventricular system The spinal uid is everywhere in contact with the extracellular uid of the brain and spinal cord, but the extent of bulk ow of the CSF through the brain parenchyma is small under normal conditions The periventricular tissues offer considerable resistance to the entrance of CSF, and although the pressure difference between the ventricles and the subarachnoid spaces (transmantle pressure) is only slightly above zero, the open ventricular-foraminal-subarachnoid pathway directs the bulk of CSF ow in this direction.

Figure 30-1 A Schematic representation of the three components of the intracranial contents: the incompressible brain tissue (shaded); the vascular system; and the CSF (dotted) B With ventricular obstruction C With obstruction at or near the points of outlet of the CSF D With obstruction of the venous out ow (Redrawn by permission from Foley)

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