Course: Nervous System

Semester 4 (Medical Sciences)

MMS on Blood-brain barrier, headache, raised ICP

Answers

1. What are the structures that prevent blood constituents from entering the ECF
surrounding / bathing the neurons?
Ans: endothelium, basement membrane, foot processes of astrocytes

2. What constitutes the blood-CSF barrier?

Ans: Endothelium, basement membrane, ependymal cells.

3. Is CSF formation an active/passive process?

Ans: It is both an active and passive process. Active secretion of filtrate occurs
in the choroid plexuses. Fluid is first filtered through the core capillaries of the
choroid plexus into the extracellular space surrounding the choroidal cells.
This fluid is a plasma ultrafiltrate. Then sodium is actively transported by
sodiumpotassium activated adenosine triphosphatase (ATPase) across the
choroidal cells into the CSF ; water follows down an osmotic: gradient. Passive
formation occurs due to the pressure difference between the cavity and the
capillaries.

4. How much CSF is formed per day? What factors influence its formation?
Ans: CSF is secreted by the choroid plexus at the rate of about 500 ml per day,
0.35 ml per minute, and a turnover of 14% per hour.

Cholinergic stimulation increases production and adrenergic stimulation

decreases production. Drugs that inhibit sodiumpotassium ATPase or carbonic
anhydrase decrease production. Furosemide also slows CSF production due to
its effect on chloride flux

5. How does it circulate in the brain and spinal cord?

The CSF is formed in the lateral ventricles, circulates through the
interventricular foramens into the third ventricle, and then via the cerebral
aqueduct into the fourth ventricle. Here the fluid escapes via the lateral
apertures of the fourth ventricle and the medial foramen of the fourth ventricle
into the subaracnoid spaces, where it difuses over the brain and spinal cord.
Respiratory and circulatory changes are believed to change the pressure within
the closed system and promote the mixing and diffusion of fluid.

The fluid flows through the interventricular foramen (of Monro) into the third
ventricle, is augmented by fluid formed by the choroid plexus of this ventricle,
and passes through the cerebral aqueduct (of Sylvius) to the fourth ventricle,
which also possesses a choroid plexus. The CSF from all theses sources , as
well as any formed in the central canal of the spinal cord, escapes from the
 fourth ventricle into the subarachnoid space through the median aperture (of
Magendie) and lateral aperture (of Luschka).

The CSF then circulates through the freely communicating subaracchnoid

cisterns at the base of the brain. From the cisterns, most of the CSF is directed
upward over the cerebral hemispheres and smaller amounts pass downward
around the spinal cord.

6. What inference can you draw regarding the ease/ difficulty with which substances
can leave the blood to enter the CSF?

Ans: The CSF contains very little protein compared to plasma. Glucose is also
lower, but potassium in CSF is very low. Carbon dioxide is high, contributing
towards the fall in pH. The inference that may be drawn from these
observations is that the blood-brain barrier does not allow macromolecules like
proteins to cross it. Potassium entry into the CSF is restricted, but carbon dixide
diffuses easily into the CSF.

7. Why can some substances cross the blood-brain barrier easily ?

Ans: Lipi-soluble substances can cross the barrier easily because they can bind
with the phospholipid layer of cell membranes.

8. What is the significance of their being outside the blood-brain barrier?

Ans: These organs that lie outside the barrier come into closer contact with the
blood and they can therefore regulate plasma osmolality and blood chemistry.
The vomiting centre is sensitive to changes in blood chemistry (chemo-sensitive
receptor zone) and the hypothalamic nuclei regulating plasma osmolality and
the secretion of anterior pituitary hormones lie outside the barrier.

9. What are the conditions in which the barrier breaks down?

Ans: inflammation , cerebral oedema, meningitis, septic encephalopathy,
multiple myeloma, Alzheimers Disease.

hyy/Apil 2013