Cerebrospinal fluid (CSF)is a clear, colorless liquid that plays a vital role in maintaining the health and function of the central nervous system: protecting the brain and spinal cord, providing nutrients, and removing waste products.
Despite their importance, problems related to cerebrospinal fluid (CSF) often go unnoticed until something goes wrong.
I Neurologist and headache specialistIn my work treating patients with CSF pressure disorders, I have seen these symptoms manifest in many different ways. When CSF stops working, it can:
What is cerebrospinal fluid?
CBF It is made of It is composed of water, proteins, sugars, ions, neurotransmitters, etc. Choroid plexusIt is located within the ventricles or cavities of the brain.
The choroid plexus is approximately 500 milliliters of cerebrospinal fluid dailyBecause the brain is constantly absorbing and replenishing it, only about 150 milliliters of this fluid is present in the central nervous system at any one time. This fluid circulates throughout the brain. Ventricles, Central canal of the spinal cord,and Subarachnoid space It surrounds the brain and spinal cord.
Cerebrospinal fluid circulates throughout the brain and spinal cord. OpenStax, CC BY-SA
CSFs are Some important featuresThis protects the brain and spinal cord from injury by absorbing shock. Effective weight CSF protects the brain from being overwhelmed by its own mass. In addition, CSF maintains a stable chemical environment within the central nervous system and facilitates the removal of metabolic waste products and the distribution of nutrients and hormones.
Any disruption to the production, circulation, or absorption of cerebrospinal fluid can lead to serious health problems. Two conditions to look out for are cerebrospinal fluid leak and idiopathic intracranial hypertension.
Cerebrospinal fluid leak
a Cerebrospinal fluid leak It occurs when fluid leaks through a tear or hole in the dura (the outermost, tough layer). Meningeal It surrounds the brain and spinal cord.
The dura mater can be damaged by head trauma or perforated during surgical procedures involving the sinuses, brain, or spine, such as lumbar puncture, epidural anesthesia, spinal anesthesia, and myelogram. Spontaneous CSF leak Sometimes it occurs without any identified cause.
CSF leakage is originally considered a relatively rare disease, with an estimated annual incidence of Incidence of 5 per 100,000But with increased awareness and advances in imaging, health care workers are finding more leaks. Occurs more frequently It is most common in middle-aged adults and is more common in women than men.
Risk factors for this disease include connective tissue disorders such as: Ehlers-Danlos syndrome Similarly Postural orthostatic tachycardia syndrome.
Persistent headaches may be a sign of a cerebrospinal fluid leak.
Unfortunately, medical professionals Misdiagnosing a cerebrospinal fluid leakOther conditions such as migraines, sinusitis, or allergies may be the cause. Diagnosis of Cerebrospinal Fluid Leak Challenging Symptoms vary widely. Most people with CSF leaks Positional headache The pain is relieved by lying down and worsens when standing. The pain is usually felt in the back of the head, but may also extend to the neck and between the shoulder blades. In addition to headaches, other symptoms may include ringing in the ears, visual disturbances, memory problems, brain fog, dizziness, and nausea.
Imaging may aid in diagnosisIncludes MRI of the entire brain and spine Or myelography A leak of cerebrospinal fluid in the space surrounding the spinal cord. Characteristics of a cerebrospinal fluid leak that can be seen on a scan include: Brain sagging under Fluid accumulates at the base of the skull and on the outer surface of the dura mater. 19% of people with CSF leaks may have normal scansTherefore, even if there is no sign of leakage on the image, it does not mean that there is no leakage at all.
Conservative treatment Treatment of CSF leaks includes rest, lying down, and increasing fluid intake to allow time for the spinal puncture site to heal. Increasing caffeine intake to the equivalent of 3 to 4 cups of coffee per day may also help. Increased cerebrospinal fluid productionCaffeine relieves pain by stimulating the choroid plexus. Caffeine also: Adenosine ReceptorsThey play an important role in the body’s pain perception mechanism.
If a conservative approach doesn’t work, Epidural blood patch You may need patch therapy. This procedure involves drawing blood from your arm and injecting it into your spine. The blood forms a membrane over the hole, promoting healing. Your headache should improve quickly, but if the patch doesn’t work or doesn’t last long, you may need additional testing to more precisely pinpoint the location of the leak. In rare cases, Surgery may be recommendedMost patients with CSF leak respond to some form of these treatments.
Idiopathic intracranial hypertension
Idiopathic intracranial hypertension This is a condition in which excess cerebrospinal fluid causes increased pressure within the skull, compressing the brain. The term “idiopathic” indicates that the cause of the increased pressure is unknown.
Many patients with idiopathic intracranial hypertension history obesity or recent weight gain. Other risk factors include taking certain medications such as tetracycline, excess vitamin A, tretinoin, steroids, and growth hormone. Middle-aged and obese women More than 20 times probably Obese patients are more likely to be diagnosed with idiopathic intracranial hypertension than other patient groups, and as obesity becomes more prevalent, the incidence of this condition is also increasing.
Idiopathic intracranial hypertension is caused by increased pressure within the skull.
Patients with idiopathic intracranial hypertension typically have headachechanges in visionringing in the ears, or eye pain. Papilledemaor optic disc swelling, Fundus examination Paralysis of the muscles behind the eye may also be observed.
Brain imaging of patients suspected of having idiopathic intracranial hypertension Excluding others Cause This is caused by increased cerebrospinal fluid pressure due to a brain tumor or blood clot. Lumbar puncture or spinal tap Measurement of cerebrospinal fluid pressure and composition is also central to the diagnosis.
Increased intracranial pressure can damage the optic nerve, Leading to permanent vision lossThe main goal of treatment is to reduce intraocular pressure and protect the optic nerve. process option Treatment includes weight loss, dietary changes, and medications that reduce cerebrospinal fluid production. Surgery It can also reduce intracranial pressure.
Future Directions and Unknowns
Cerebrospinal fluid is essential for brain health, and although there are advances in our understanding of diseases related to cerebrospinal fluid, some aspects remain unclear.
The exact mechanisms that cause symptoms such as cerebrospinal fluid leakage and idiopathic intracranial hypertension are not fully understood, but Many theoriesFurther research is essential to improve diagnostic accuracy and effective treatment of CSF disorders.
Daniel Wilhour is an assistant professor of neurology at the University of Colorado Anschutz Medical Campus. This article is reprinted from conversation Under Creative Commons License.Please read Original article.
