Cerebrospinal fluid, or CSF, is a transparent, colorless liquid that performs an important function in sustaining the well being and performance of your central nervous system. It cushions the mind and spinal twine, offers vitamins and removes waste merchandise.
Regardless of its significance, issues associated to CSF typically go unnoticed till one thing goes fallacious.
Not too long ago, cerebrospinal fluid problems drew public consideration with the announcement that musician Billy Joel had been recognized with regular stress hydrocephalus. On this situation, extra CSF accumulates within the mind’s cavities, enlarging them and placing stress on surrounding mind tissue regardless that diagnostic readings seem regular. As a result of regular stress hydrocephalus usually develops step by step and might mimic signs of different neurodegenerative ailments, equivalent to Alzheimer’s or Parkinson’s illness, it’s typically misdiagnosed.
I’m a neurologist and headache specialist. In my work treating sufferers with CSF stress problems, I’ve seen these circumstances current in many alternative methods. Right here’s what occurs when your cerebrospinal fluid stops working.
What’s cerebrospinal fluid?
CSF is product of water, proteins, sugars, ions and neurotransmitters. It’s primarily produced by a community of cells referred to as the choroid plexus, which is situated within the mind’s ventricles, or cavities.
The choroid plexus produces roughly 500 milliliters (17 ounces) of CSF every day, however solely about 150 milliliters (5 ounces) are current throughout the central nervous system at any given time as a result of fixed absorption and replenishment within the mind. This fluid circulates by means of the ventricles of the mind, the central canal of the spinal twine and the subarachnoid area surrounding the mind and spinal twine.
Cerebrospinal fluid circulates all through the mind and spinal twine.
OpenStax, CC BY-SA
CSF has a number of important capabilities. It protects the mind and spinal twine from damage by absorbing shocks. Suspending the mind on this fluid reduces its efficient weight and prevents it from being crushed underneath its personal mass. Moreover, CSF helps preserve a secure chemical setting within the central nervous system, facilitating the elimination of metabolic waste and the distribution of vitamins and hormones.
If the manufacturing, circulation or absorption of cerebrospinal fluid is disrupted, it might result in vital well being points. Two notable circumstances are CSF leaks and idiopathic intracranial hypertension.
Cerebrospinal fluid leak
A CSF leak happens when the fluid escapes by means of a tear or gap within the dura mater – the powerful, outermost layer of the meninges that surrounds the mind and spinal twine.
The dura will be broken from head accidents or punctured throughout surgical procedures involving the sinuses, mind or backbone, equivalent to lumbar puncture, epidurals, spinal anesthesia or myelogram. Spontaneous CSF leaks also can happen with none identifiable trigger.
CSF leaks had been initially regarded as comparatively uncommon, with an estimated annual incidence of 5 per 100,000 individuals. Nonetheless, with elevated consciousness and advances in imaging, well being care suppliers are discovering increasingly more leaks. They have a tendency to happen extra steadily in middle-aged adults and are extra widespread in girls than males.
Danger components for the situation embrace connective tissue problems equivalent to Ehlers-Danlos syndrome in addition to postural orthostatic tachycardia syndrome.
An upright headache may very well be an indication of a CSF leak.
Sadly, it’s widespread for well being care suppliers to misdiagnose a CSF leak as one other situation, like migraine, sinus infections or allergy symptoms. What could make diagnosing a CSF leak difficult is its broad signs. Most individuals with a CSF leak have a positional headache that improves when mendacity down and worsens when standing. Ache is often felt at the back of the top and will contain the neck and between the shoulder blades. Along with complications, sufferers might expertise ringing within the ears, imaginative and prescient disturbances, reminiscence issues, mind fog, dizziness and nausea.
Imaging might assist information analysis, together with an MRI of your mind or total backbone, or a myelogram of the area surrounding your spinal twine. Options of a CSF leak which might be seen in a scan embrace your mind sagging down within the base of your cranium in addition to a fluid assortment outdoors of your dura. Nonetheless, an estimated 19% of individuals with a CSF leak can have regular scans, so not seeing indicators of a leak on imaging doesn’t totally rule it out.
Conservative remedy for a CSF leak entails relaxation, mendacity flat and rising your fluid consumption to offer your backbone time to heal the puncture. Growing your caffeine consumption to an equal of three to 4 cups of espresso per day also can assist by rising CSF manufacturing by means of stimulating the choroid plexus. Caffeine additionally relieves ache by interacting with adenosine receptors, that are key gamers within the physique’s ache notion mechanisms.
If a conservative method will not be profitable, an epidural blood patch could also be mandatory. On this process, blood is drawn out of your arm and injected into your backbone. The injected blood may also help kind a protecting over the opening and promote the therapeutic course of. Headache enchancment will be quick, but when the patch doesn’t work or the outcomes are short-lived, extra testing could also be wanted to higher find the location of the leak. In uncommon instances, surgical procedure could also be beneficial. Most sufferers with a CSF leak reply to some type of these therapies.
Idiopathic intracranial hypertension
Idiopathic intracranial hypertension is a dysfunction involving an extra of CSF that elevates stress contained in the cranium and compresses the mind. The time period “idiopathic” signifies that the reason for the raised stress is unknown.
Most sufferers with idiopathic intracranial hypertension have a historical past of weight problems or current weight acquire. Different danger components embrace taking sure drugs equivalent to tetracycline, extreme vitamin A, tretinoin, steroids and progress hormone. Center-aged overweight girls are 20 occasions extra more likely to be recognized with idiopathic intracranial hypertension than different affected person teams. As weight problems turns into extra prevalent, so too does the incidence of this situation.
Idiopathic intracranial hypertension outcomes from elevated intracranial stress.
Sufferers with idiopathic intracranial hypertension usually expertise complications and imaginative and prescient adjustments, tinnitus or eye ache. Papilledema, or swelling of the optic disc, is the hallmark discovering on a fundoscopic examination of the again of the attention. Clinicians can also observe paralysis of the affected person’s eye muscular tissues.
Regular stress hydrocephalus, Joel’s analysis, is a type of this situation that generally leads to issue strolling, lack of bladder management and cognitive impairment, generally known as the “wet, wobbly and wacky” triad. Joel’s analysis has introduced consciousness to this underrecognized however doubtlessly treatable dysfunction, which is commonly managed by means of surgically putting a shunt to divert extra fluid and relieve signs.
Mind imaging of sufferers suspected of getting idiopathic intracranial hypertension is essential to excluding different causes of elevated CSF stress, equivalent to mind tumors or blood clots within the mind. A lumbar puncture or spinal faucet to measure the stress and composition of CSF can be central to analysis.
Since excessive intracranial stress can harm the optic nerve and result in everlasting imaginative and prescient loss, the first objective of remedy is to lower stress and protect the optic nerve. Remedy choices embrace weight reduction, dietary adjustments and drugs to scale back CSF manufacturing. Surgical procedures also can scale back intracranial stress.
Future instructions and unknowns
Cerebrospinal fluid is indispensable for mind well being. Regardless of advances in understanding ailments associated to CSF, a number of elements stay unclear.
The precise mechanisms that result in circumstances like CSF leaks and idiopathic intracranial hypertension will not be totally understood, although there are lots of theories. Additional analysis is significant to boost diagnostic accuracy and efficient therapies for CSF problems.
That is an up to date model of an article initially revealed on Aug. 14, 2024.
