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Cerebrospinal fluid

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Cerebrospinal fluid

Cerebrospinal fluid (CSF) is a clear, colorless transcellular body fluid found within the meningeal tissue that surrounds the vertebrate brain and spinal cord, and in the ventricles of the brain.

CSF is mostly produced by specialized ependymal cells in the choroid plexuses of the ventricles of the brain, and absorbed in the arachnoid granulations. It is also produced by ependymal cells in the lining of the ventricles. In humans, there is about 125 mL of CSF at any one time, and about 500 mL is generated every day. CSF acts as a shock absorber, cushion or buffer, providing basic mechanical and immunological protection to the brain inside the skull. CSF also serves a vital function in the cerebral autoregulation of cerebral blood flow.

CSF occupies the subarachnoid space (between the arachnoid mater and the pia mater) and the ventricular system around and inside the brain and spinal cord. It fills the ventricles of the brain, cisterns, and sulci, as well as the central canal of the spinal cord. There is also a connection from the subarachnoid space to the bony labyrinth of the inner ear via the perilymphatic duct where the perilymph is continuous with the cerebrospinal fluid. The ependymal cells of the choroid plexus have multiple motile cilia on their apical surfaces that beat to move the CSF through the ventricles.

A sample of CSF can be taken from around the spinal cord via lumbar puncture. This can be used to test the intracranial pressure, as well as indicate diseases including infections of the brain or the surrounding meninges.

Although noted by Hippocrates, it was forgotten for centuries, though later was described in the 18th century by Emanuel Swedenborg. In 1914, Harvey Cushing demonstrated that CSF is secreted by the choroid plexus.

In humans, there is about 125–150 mL of CSF at any one time. This CSF circulates within the ventricular system of the brain. The ventricles are a series of cavities filled with CSF. The majority of CSF is produced from within the two lateral ventricles. From here, CSF passes through the interventricular foramina to the third ventricle, then the cerebral aqueduct to the fourth ventricle. From the fourth ventricle, the fluid passes into the subarachnoid space through four openings – the central canal of the spinal cord, the median aperture, and the two lateral apertures. CSF is present within the subarachnoid space, which covers the brain and spinal cord, and stretches below the end of the spinal cord to the sacrum. There is a connection from the subarachnoid space to the bony labyrinth of the inner ear making the cerebrospinal fluid continuous with the perilymph in 93% of people.

CSF moves in a single outward direction from the ventricles, but multidirectionally in the subarachnoid space. The flow of cerebrospinal fluid is pulsatile, driven by the cardiac cycle. The flow of CSF through perivascular spaces in the brain (surrounding the cerebral arteries) is obtained through the pumping movements of the walls of the arteries.

CSF is derived from blood plasma and is largely similar to it, except that CSF is nearly protein-free compared with plasma and has some different electrolyte levels. Due to the way it is produced, CSF has a lower chloride level than plasma, and a higher sodium level.

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