Cerebrospinal Fluid Physiology And Its Role In Neurologic Disease

Idiopathic normal pressure hydrocephalus appears to be a `two hit' disease starting out as benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood. The arachnoid granulations in infants with benign external hydrocephalus may never mature, leading to a parallel pathway for cerebrospinal fluid resorption through the extracellular space of the brain. This works well until deep white matter ischemia develops in which the myelin protein attracts the polar water molecules, leading to increased resistance to outflow of cerebrospinal fluid and hydrocephalus. (C) 2015 S. Karger AG, Basel