CASE REPORT

• A 9 year old boy was brought to his GP by his parents who noted that

he was having difficulty with his balance and was complaining of head

aches.

• He was referred to the neurosurgical unit and a CT scan was perform

of his head region.

• This showed the presence of dilated lateral and III ventricles with a

normal IV ventricle.

• There was effacement of the overlying cortical sulci in the brain and a

diagnosis of Hydrocephalus was made.

• MRI showed the cerebral aqueduct was stenosed.

• The boy subsequently had a III ventriculostomy performed, and his

symptoms resolved rapidly

Few drops………Aristotle

"water" surrounding the brain

when describing congenital

hydrocephalus,

Galen

"excremental liquid" in the ventricles of the

brain, which he believed was purged into the

nose

• Emanuel Swedenborg.• "spirituous lymph" secreted from the roof

of the fourth ventricle down to the medulla oblongata and spinal cord

Albrecht von Haller,

"water" in the brain was secreted into the

ventricles and absorbed in the veins, and

when secreted in excess, could lead to

hydrocephalus

• Francois Magendie

• William Mestrezat

• Harvey Cushing

CEREBROSPINAL FLUID

IntroductionAnatomyFormationCirculationApplied

Choroid plexus

Circulation

Composition

Absorption

Function

APPLIED

Applied • Hydrocephalus

Meningitis

• Blood brain barrier

• Blood- CSF barrier

Spinal tap(lumbar puncture)

CASE CHALLENGE

• A 4-year-old girl was found to have tuberculous meningitis.

• She was immediately admitted to the hospital,and administration of streptomycin and isoniazid was commenced.

• As soon as this therapy was started, she was also administered steroid hormones to reduce the incidence of adhesions.

• She recovered fully, with no complications. • Explain why it is important to prevent the formation of

adhesions in the subarachnoid space.

CASE REPORT

• 46-year-old man who had recently undergone right-sided pneumonectomy for carcinoma of the bronchus was seen by his thoracic surgeon for follow-up after the operation.

• His wife commented that about 1 week ago, the upper lid of his right eye tended to droop slightly when he was tired at the end of the day.

• After a careful physical examination, the surgeon noticed that in addition to the ptosis of the right eye, the patient’s right pupil was constricted and that his face was slightly flushed on the right side.

• Further examination revealed that the skin on the right side of the face appeared to be warmer and drier than normal.

• Palpation of the deep cervical group of lymph nodes revealed a large, hard, fixed node just above the right clavicle

NERVOUS SYSTEM

CNS PNS

SNS ANS

Symp parasymp

AUTONOMIC NERVOUS SYSTEM

Function

IMPORTANT PHYSIOLOGICAL REFLEXES INVOLVING ANS

• Light reflex• Accommodation reflex• Carotid sinus and aortic arch reflexes• Bainbridge reflex

APPLIED

• Injuries to ANS • Diseases involving ANS- Diabetes - Horner syndrome- Frey’s syndrome - Crocodile tears• Sympathectomy - Raynaud’s disease- Intermittent claudication

CASE CHALLENGE

• A 3-year-old boy with a history since infancy of chronic constipation and abdominal distention was taken to a pediatrician.

• The child’s mother said that the constipation was getting progressively worse. It was not responding to laxatives, and she was finding it necessary to give her son an enema once a week to relieve his abdominal distention.

• On physical examination, the child’s abdomen was obviously distended, and a doughlike mass could be palpated along the course of the descending colon in the left iliac fossa.

• Examination of the rectum showed it to be empty and not dilated. Following an enema and repeated colonic irrigation with saline solution, the patient was given a barium enema followed by a radiographic examination.

• The radiograph showed a grossly distended descending colon and an abrupt change in lumen diameter where the descending colon joined the sigmoid colon. It was interesting to note that the child failed to empty the colon of the barium. Using your knowledge of the autonomic nerve supply to the colon, what is the diagnosis?