A.

Normal Physiology
The brain is made up of billion of neurons and is one of the largest organs of the body. Its divided into four principal parts: brain stem, diencephalon, cerebrum, and cerebellum. The lower end of the brain stem is a continuation of the spinal cord. The brain is protected by the cranial bones called skull, the brain is also protected by the meninges. The Cranial meninges surround the brain, are continuous with spinal meninges. Tortora, Geral J. and Anagnostakos, Nicholas P. (2005).

The spinal cord is a cylindrical structure that is slightly flattened anteriorly and posteriorly. Its located within the vertebral (spinal) cavity of the vertebral column. The cansal is formed by the vertebral foramina of all the vertebrae arrange on top of each other, form the vertebral cavity. Vertebral canal is essentially a ring of bones surrounding the spinal cord, the cord is well protected. A certain degree of protection is also provided by the, meninges, and cerebrospinal spinal fluid and the vertebral ligaments. Tortora, Geral J. and Grabowski, Anagnostakos. (2005). The meninges are three connective tissue coverings that encircle the spinal cord and brain. The spinal meninges surround the spinal cord and are continuous with the cranial meninges, which encircle the brain. The most superficial of the three spinal meninges, the dura mater means tough mother, is composed of dense, fibrous connective tissue. It forms a tube from the level of the second sacral vertebra, where it fused with the filum terminale, to the foramen magnum, where it is continuous with the dura mater of the brain, to the second sacral vertebra. The spinal cord is also protected by a cushion of fat and connective tissue located in the epidural space, a space between the dura mater and the wall of the vertebral cavity.

The middle meninx is an avascular covering called the arachnoid mater because of its speders web arrangement of delicate collagen fibers and some elastic fibers. It is deep to the dura mater and is continuous with the arachnoid mater of the brain. Between the dura mater and the aracnoid mater is a thin subdural space, which contains serous fluid. Black, Joyce M. and Hawks, Jane Hokanson. (2005) Pia matter, is the third deepes meningeal layer, thin, transparent connective tissue layer is bound very tightly to the surface of the spinal cord and brain. It consists of interlacing bundles of collagen fibers and some fine elastic fibers. Within the pia mater are many blood vessels that supply oxygen and nutrients to the spinal cord. Between the arachnoid mater and the pia mater is the subarachnoid space, which contains cerebrospinal fluid. (R.R. Selly and LeMone, Priscilla. (2007). All three spinal meninges cover the spinal nerve roots up to the point where they exit the spinal column through the intervertebral foramina. Triangular-shaped membranous extensions of the pia mater suspend the spinal cord in the middle of dural sheath. These extensions is called denticulate ligaments are thickenings of the pia mater. They project laterally and fuse with the arachnoid mater and inner surface of the spinal nerves on either side. Extending all along the length of the spinal cord, the denticulate ligaments protect the spinal cord against sudden displacement that could result in shock. (Tortora, 2007) The brain is well supplied with oxygen and nutrients by blood vessels. Blood vessels that enter brain tissue passes along the surface of the brain, on inward penetration, between the blood vessels and pia matter is called perivascular space. The brain is one of the most metabolically organ of the body because it varies the degree of mental activity. The brain also contains glucose, the principal source of energy for brain cells. Because virtually no glucose is stored in the brain, the supply of glucose also must be continuous. If blood entering the brain has a low level of glucose, mental confusion, dizziness, convulsions, and loss of consciousness may occur.( R.R. Selly 2006)

Neurons synthesize ATP almost exclusively from glucose via reactions that use oxygen. Even a brief slowing of brain blood flow may cause unconsciousness. Typically, an interruption in blood flow for 1 or 2 minutes impairs neuronal function, and total deprivation of oxygen for about 4 minutes causes permanent injury. The endothelial cells with their tight junctions form the bloodbrain barrier, which determines what substances can pass from the blood into the nervous tissue of the brain and spinal cord. It protects neurons from toxic substances into the blood, allows the exchange of nutrients and waste products between neuronsand the blood. The processes of many astrocytes are one type of neuroglia, press up against the capillaries and secrete chemicals that maintain the permeability characteristics of the tight junctions. A few water-soluble substances, such as glucose, cross the BBB by active transport. The substances, such as cratinine, urea, and most ions, cross the BBB very slowly. Still other substances proteins and most antibiotic drugsdo not pass at all from the blood into brain tissue. However, lipidsoluble substances, such as oxygen, carbon dioxide, alcohol, and most anesthetic agents, easily cross the blood-brain barrier. Trauma, certain toxins, and inflammation can cause a breakdown of the bloodbarrier. Krapp, Kristine. 2002.

Cerebrospinal fluid it is a clear, colorless liquid of water consistency that protects the brain and spinal cord from chemical and physical injuries. CSF continuously circulates through cavities in the brain and spinal cord and around the brain and spinal cord in the subarachnoid space (between the arachnoid mater and pia mater). Normally, any excess of CSF drains away into the cardiovascular system. However, blockages can occur. In infant, the brain can enlarge due to CSF accumulation, resulting in a condition called Hydrocephalus (Sylvia S. Mader).

The total volume of CSF is 80 to 150 ml (3 to 5 oz) in an adult. CSF contains glucose, proteins, lactic acid, urea, cations (Sodium, Potassium, Calcium and Magnesium) and anions (Cl and HCO) it also contains some white blood cells lympocytes from the blood to neurons and neuroglia. The CSF contributes to homeostasi in three main ways: Mechanical Protection, Chemical protection and Circulation. Formation of cerebrospinal fluid occurs mainly by separation of fluid from the blood in the choroid plexuses. Choroid plexuses are networks of capillaries that project from the pia mater into the lateral ventricles and into the roofs of the third and fourth ventricles. Each choroid plexus is covered with a sheet of a special type of ependymal (glial) cell that releases the cerebrospinal fluid into the fluid spaces. From each lateral ventricle the fluid seeps through an opening, the ventricular foramen (of Monro), into the fourth ventricle. Some of the fluids move from the fourth ventricle directly into the central canal of the cord. Some of it moves out of the fourth ventricle through openings in its roof, two lateral foramena (foramina of Luschka) and one median foramen (foramen of magendie). These openings allow cerebrospinal fluid to move into the cistern magna, a space behind the medulla that is continuous with the subarachnoid space around the brain and cord. The fluid circulates in the subarachnoid space, and then is absorbed into venous blood through the arachnoid villi (fingerlike projections of the arachnoid membrane into the brains venous sinuses). Briefly, here is the circulation route of cerebrospinal fluid: it is formed by separation of fluid from blood in the choroid plexuses into the ventricles of the brain, circulates through the ventricles and into the central canal and subarachnoid spaces, and is absorbed back into blood. The amount of cerebrospinal fluid in the average adult is about 140 ml (about 23 ml in the ventricles and 17 ml in sthe subarachnoid space of brain and cord). (Gerard G. Tortora, 2005)