Cerebrospinal malformation:
Ventricles of the brain: Develop from the hollow of the primitive neural tube.
• Four ventricles:
• Two lateral (right and left, one in each hemisphere, they are C‐shaped and have 3 horns)
• Third ventricle (near the center of the brain).
• Fourth ventricle (deep to the cerebellum).
• Filled with (CSF): 99% water, 1% protein, ions neurotransmitters & glucose.
• Flows inside and around CNS and in subarachnoid space.
• Functions: cushioning of brain against trauma and necrosis of the base,
provides nutrients, excretory medium for respiring brain cells.
• Normally rate of formation=rate of absorption. This assists the continuous
flow of CSF which maintains biochemical homeostasis.
• Production: in ependymal cells and choroid plexus of ventricles (mainly
lateral ventricles) by filtration of blood.
• Circulation: Lateral ventricles (through Foramen of Monro)→ third ventricle
(through aqueduct of Sylvius)→ fourth ventricle (through foramina of
Luschka)→ cisterna magna and subarachnoid space overlying the brain. And
(through foramen of Magendie → spinal cord subarachnoid space
• Reabsorption: Superior sagittal sinus to the blood.
, Hydrocephalus:
Increased CSF in the ventricular system ‐> ventricular enlargement.
Causes:
1. Increased production: choroid plexus papilloma (rare)
2. Obstruction (non‐communicating, obstructive):
Congenital: Aqueduct stenosis (X‐linked recessive), Chiari II malformation, Dandy‐ Walker
malformation, spina bifida.
Traumatic: posthemorrhagic hydrocephalus (e.g. premature baby) followed by fibrosis.
Inflammatory: meningitis followed by fibrosis, TORCH, zika virus.
Neoplastic: space‐occupying lesion.
Miscellaneous: Achondroplasia (narrow foramen magnum)
3. Decreased absorption (communicating‐non obstructive):
• Traumatic (fracture base of skull), Inflammatory: (basal meningitis), Neoplastic (Leukemia).
Enlarging head Open sutures & fontanelles
signs of raised ICP (esp after sutures closure) Developmental delay
Poor feeding Bowel & bladder incontinence
Cranial nerve palsies Limb weakness/paralysis
▪ Head CT/brain MRI: Ventriculomegaly, enlarged sulci.
▪ Neurological examination.
▪ High pressure on lumber puncture.
Ventricles of the brain: Develop from the hollow of the primitive neural tube.
• Four ventricles:
• Two lateral (right and left, one in each hemisphere, they are C‐shaped and have 3 horns)
• Third ventricle (near the center of the brain).
• Fourth ventricle (deep to the cerebellum).
• Filled with (CSF): 99% water, 1% protein, ions neurotransmitters & glucose.
• Flows inside and around CNS and in subarachnoid space.
• Functions: cushioning of brain against trauma and necrosis of the base,
provides nutrients, excretory medium for respiring brain cells.
• Normally rate of formation=rate of absorption. This assists the continuous
flow of CSF which maintains biochemical homeostasis.
• Production: in ependymal cells and choroid plexus of ventricles (mainly
lateral ventricles) by filtration of blood.
• Circulation: Lateral ventricles (through Foramen of Monro)→ third ventricle
(through aqueduct of Sylvius)→ fourth ventricle (through foramina of
Luschka)→ cisterna magna and subarachnoid space overlying the brain. And
(through foramen of Magendie → spinal cord subarachnoid space
• Reabsorption: Superior sagittal sinus to the blood.
, Hydrocephalus:
Increased CSF in the ventricular system ‐> ventricular enlargement.
Causes:
1. Increased production: choroid plexus papilloma (rare)
2. Obstruction (non‐communicating, obstructive):
Congenital: Aqueduct stenosis (X‐linked recessive), Chiari II malformation, Dandy‐ Walker
malformation, spina bifida.
Traumatic: posthemorrhagic hydrocephalus (e.g. premature baby) followed by fibrosis.
Inflammatory: meningitis followed by fibrosis, TORCH, zika virus.
Neoplastic: space‐occupying lesion.
Miscellaneous: Achondroplasia (narrow foramen magnum)
3. Decreased absorption (communicating‐non obstructive):
• Traumatic (fracture base of skull), Inflammatory: (basal meningitis), Neoplastic (Leukemia).
Enlarging head Open sutures & fontanelles
signs of raised ICP (esp after sutures closure) Developmental delay
Poor feeding Bowel & bladder incontinence
Cranial nerve palsies Limb weakness/paralysis
▪ Head CT/brain MRI: Ventriculomegaly, enlarged sulci.
▪ Neurological examination.
▪ High pressure on lumber puncture.
