Talk:Cerebrospinal fluid

From Wikipedia, the free encyclopedia
Jump to navigation Jump to search

CSF relationship to BBB[edit]

It seems like a few sentences should be added explaining the relationship of CSF with regard to the blood brain barrier. I don't think I saw any formal statement that blood constituents found in the CSF via filtration from plasma must cross the blood brain barrier. Realizing this is the case could be important for non-scientists trying to better understand the CSF from a broader perspective. GusDin (talk) 13:06, 21 October 2016 (UTC)

Thanks for your comment @GusDin. Wikipedia is made by volunteers like you or I, and I encourage you to make these edits :). If there's anything that I can do to help, please let me know. --Tom (LT) (talk) 06:53, 22 October 2016 (UTC)

SAS?[edit]

The article says "The flow of CSF to the nasal submucosal lymphatic channels through the cribriform plate seems to be especially important.[6] The Orešković and Klarica hypothesis, on the other hand, suggests that the CSF does not flow unidirectionally to cortical SAS to..."

So, what is SAS? I suppose it must stand for Sub-Arachnoid Something, but a search of Wikipedia or Google doesn't reveal what the Something is. Could someone supply this gloss, before the first use of SAS? 66.215.34.6 (talk) 17:38, 4 January 2017 (UTC)

 Done It is spelt out in the ref. --Iztwoz (talk) 18:15, 4 January 2017 (UTC)

Cranio-Sacral Pulse and Cranio-Sacral Therapy[edit]

There is an allied/alternative health profession called Cranio-Sacral Therapy, first developed, or at least popularized, by Upledger. Most medical doctors and neuroscientists probably either haven't heard of it, or would regard it as controversial (if they're being polite). A central feature, or the central feature, of this discipline is something called the "cranio-sacral pulse". I have asked numerous spine surgeons about this and none of them had ever heard of it.

This is distinct from, but in my opinion somewhat related to, the "...new hypothesis (2014) by Klarica and Oreskovic".... that there is no unidirectional CSF circulation, but cardiac cycle-dependent bi-directional systolic-diastolic to-and-fro cranio-spinal CSF movements." (!)  ;-) So, OK, they think the CSF "circulates", or more properly moves, back and forth according to the cardiac pulse. I have to disagree with that, because the cranio-sacral pulse has a very different frequency from the blood circulation or respiration. (see below) However, clearly, both of these processes, as well as things like intracranial pressure, intra-abdominal pressure, Valsalva maneuver, body posture and movement would all have some effect on the movement or circulation of CSF.

I once attended a weekend introductory workshop, put on by the Upledger Institute, in cranio-sacral therapy, specifically to see if there really is such a thing as the cranio-sacral pulse, and absolutely there is. I came from a skeptical position, but left having no doubt that it exists, and can be manipulated. Whether there's any great health benefit in such manipulations is another question. I will say that I had a cranio-sacral therapy session (I'll call it CST hereafter) not too long ago, probably a year or two, and I came out of it feeling fantastic, but didn't notice any lasting benefit.

One of the first things we did in the workshop was this: half the class lay down on tables, and the other half moved down the room, finding the pulse on each person, and then the two groups reversed roles, so we had a chance to feel the pulse on a dozen more people in a short time. We also were trained to feel the pulse in ourselves, and finally to actually manipulate the pulse. You can stop the pulse on someone else; when the pulse is stopped it's a wonderful, peaceful, blissful feeling. It starts up again in a few tens of seconds. You can also stop the pulse on one side of the head, and that is a wild and crazy feeling, not at all unpleasant. The way you stop the pulse is by exerting gentle pressure on the sides of the head. The theory of CST is that the cranial bones, which are considered to be fused in adults but actually are capable of very small movement, like the sacroiliac joint, get "stuck" and need to be freed up to facilitate the cranio-sacral pulse (CSP hereafter). Upledger was an osteopath, and has a colorful origin story about assisting in a spine surgery, and being unable to perform a simple task of holding the dura still, because it pulsed! This pulse, of course, being unknown to medical science. And then, as an osteopath, it was natural for him to manipulate the cranial bones to affect the cranio-sacral pulse (so named because it was presumed to move from the cranial to the sacral end of the CNS). Again, I have no idea whether there is any actual health benefit in manipulating or facilitating the CSP; I can only testify that it does exist, and can be temporarily modified.

In order to feel the CSP on yourself, it's best to lie down, and you have to become very quiet and gradually tune out other body sensations such as cardiac pulse and respiration. The CSP is slower than the pulse or breathing, maybe about one pulse every four seconds. It occurs to me now, after reading this article, that the CSP might not be occurring as regularly as what I experienced in the workshop, when a person is standing, walking, hanging upside down, excreting, doing cartwheels, etc.

At the time, I was assuming that the flow of CSF in the CSP originated in the ventricular system of the brain, continued down to the sacral region (lumbar intumescence, cauda equina, conus medullaris) and the fluid was reabsorbed in the latter region, which would be consistent with Upledger's view as far as I understand it. I also thought I knew how it worked: by the Bernoulli effect, exactly like phonation. As more CSF is generated in the choroid plexus, pressure builds up in the ventricles until it blows the aqueduct open, comparable to the opening of the glottis in phonation, and then the intraventricular pressure drops, so the aqueduct closes up again. OK, there's no structure analagous to the epiglottis over the aqueduct, as far as I know, but still, when there's more pressure on the rostral side, there will be a flow, and when the pressure on that side drops, the flow will stop. Or, OK, reverse, maybe. So I'm no longer so sure that the "cranio-sacral pulse" goes all the way down to the sacral region, or is unidirectional. I don't think anything I'm saying is necessarily in conflict with the theories mentioned in the article-- except what I said about the relative frequency of CSP and cardiac pulse.

I know from personal experience that the CSP exists; I think it's too bad that it's unknown to Western scientific medicine and research. I'd like to see it mentioned in the article; I don't think there's any point in my putting it in because it would be immediately redacted. — Preceding unsigned comment added by 66.215.34.6 (talk) 18:27, 4 January 2017 (UTC)

There is a page craniosacral therapy and the pulse is mentioned. You could add material there. --Iztwoz (talk) 20:44, 4 January 2017 (UTC)

OK, thanks. I will consider. — Preceding unsigned comment added by 66.215.34.6 (talk) 21:03, 4 January 2017 (UTC)

"Circulation[edit]

There is no need to title this section "Circulation or movement".

  • "Movement to and fro or around something, especially that of fluid in a closed system" [1]
  • "(of air and water) free movement within an area or volume" [2]

It is a tautology and nitpicking, and also against the conventional use of 'circulation' to describe CSF, to describe otherwise. --Tom (LT) (talk) 08:19, 12 April 2017 (UTC)

  • Tom, as a member of WikiProject Anatomy/Physiology/Medicine etc, I'm surprised to that you're objecting to this title. The title "Movement and circulation" is entirely appropriate considering the classical theory of unidirectional CSF "circulation" is currently being challenged by Klarica and Oreskovic's theory that CSF exhibits an oscillatory "movement" to-and-fro, with a net flow of nearly zero. Where two prominemt and plausible (yet competing) theories are available to explain a phenomenon, it is appropriate to highlight this in the title. Perhaps a more appropriate title would be "circulation OR movement".Jkokavec (talk) 09:17, 12 April 2017 (UTC)
    • These two ideas should not be treated on equal footing. The conventional, and widely accepted method of describing the movement of CSF is "circulation", not "movement". The large number of references to a new hypothesis that is not yet widely accepted in this article is almost a textbook example of given WP:UNDUE attention to something. I do not think we should be structuring our article around this new hypothesis until it is widely accepted, nor changing terminology or article titles to match what these two authors propose... if this becomes widely accepted, then we can indeed change the article.
    • In addition, "circulate" is a widely accepted English-language term used to describe the movement of fluids, as I have demonstrated above through dictionary definitions. The term "Circulation or movement" is a tautology, as both circulation and movement describe the movement of fluids. It is just as accurate to say "fluid circulates from A to B and back" as it is to say "moves".
    • Lastly, the term movement is necessarily laden with directionality, as one moves from A to B, but does not move if remaining only at A. I do not agree that changing circulation term to "movement" helps the reader understand this new hypothesis.
      • I hope this more fully elucidates my rationale. Happy to discuss further if needed. Cheers --Tom (LT) (talk) 21:05, 12 April 2017 (UTC)
  • Good response. Both circulation and oscillation are forms of movement, but oscillation is not a form of circulation (and visa versa).Jkokavec (talk) 21:32, 12 April 2017 (UTC)

GA Review[edit]

This review is transcluded from Talk:Cerebrospinal fluid/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Kostas20142 (talk · contribs) 14:00, 17 September 2017 (UTC)

Looks very good at first glance, I will gladly provide a review --Kostas20142 (talk) 14:00, 17 September 2017 (UTC)
Thanks for the review, Kostas20142, I will address your concerns within the next few days :). --Tom (LT) (talk) 10:43, 18 September 2017 (UTC)
Kostas20142;  Done --Tom (LT) (talk) 10:38, 20 September 2017 (UTC)


Rate Attribute Review Comment
1. Well written:
1a. the prose is clear and concise, and the spelling and grammar are correct.

Well-written.

1b. it complies with the manual of style guidelines for lead sections, layout, words to watch, fiction, and list incorporation.

Article complies with all relevant manual of style guidelines.

2. Verifiable with no original research:
2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline.

references layout guideline is followed

2b. all in-line citations are from reliable sources, including those for direct quotations, statistics, published opinion, counter-intuitive or controversial statements that are challenged or likely to be challenged, and contentious material relating to living persons—science-based articles should follow the scientific citation guidelines.

All in-line citations are from reliable sources.

2c. it contains no original research.

The article includes no original research

2d. it contains no copyright violations nor plagiarism.

No copyright violations found.

3. Broad in its coverage:
3a. it addresses the main aspects of the topic.

All significant aspects of the topic are covered sufficiently.

3b. it stays focused on the topic without going into unnecessary detail (see summary style).

Article's size is appropriate. It stays focused on the topic

4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each.

No neutrality problems found

5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute.

No recent edit warring or significant dispute found

6. Illustrated, if possible, by media such as images, video, or audio:
6a. media are tagged with their copyright statuses, and valid fair use rationales are provided for non-free content.

All images are properly tagged and attributed.

6b. media are relevant to the topic, and have suitable captions.

Images are relevant to the topic, and have suitable captions

7. Overall assessment.

comments[edit]

  • I see that a "citation needed" template is still pending. Could you please find a source to fix this??

other modifications[edit]

  • "CSF has also been seen to drain into lymphatic vessels,[16] particularly those surrounding the nose via drainage along the olfactory nerve through the cribriform plate; however the pathway and extent are currently not known,[1] but may involve CSF flow along some cranial nerves and be more prominent in the neonate." → "CSF has also been seen to drain into lymphatic vessels,[16] particularly those surrounding the nose via drainage along the olfactory nerve through the cribriform plate. The pathway and extent are currently not known,[1] but may involve CSF flow along some cranial nerves and be more prominent in the neonate." I believe that this syntax would be better.
    •  Done good point. --Tom (LT) (talk) 10:38, 20 September 2017 (UTC)