Achieve Mastery of Medical Concepts

Study for medical school and boards with Lecturio

Ventricular System: Anatomy

The ventricular system is an extension Extension Examination of the Upper Limbs of the subarachnoid space Subarachnoid space The space between the arachnoid membrane and pia mater, filled with cerebrospinal fluid. It contains large blood vessels that supply the brain and spinal cord. Subarachnoid Hemorrhage into the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification consisting of a series of interconnecting spaces and channels Channels The Cell: Cell Membrane. Four chambers are filled with cerebrospinal fluid (CSF): the paired lateral ventricles, the unpaired 3rd ventricle, and the unpaired 4th ventricle. Connections between the structures occur via the interventricular foramen of Monro and the cerebral aqueduct (sylvian aqueduct). The foramen of Magendie and the foramen of Luschka, are additional channels Channels The Cell: Cell Membrane present in the 4th ventricle.

Last updated: 9 Mar, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Topography and Relations of the Ventricular System

The ventricular system consists of 4 ventricles with an aqueduct connecting the 3rd and 4th ventricles. Cerebrospinal fluid (CSF) flows through the ventricles before entering the subarachnoid space Subarachnoid space The space between the arachnoid membrane and pia mater, filled with cerebrospinal fluid. It contains large blood vessels that supply the brain and spinal cord. Subarachnoid Hemorrhage of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification and spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy from the 4th ventricle:

  • Lateral ventricles:
    • Body:
      • Contained in the frontal Frontal The bone that forms the frontal aspect of the skull. Its flat part forms the forehead, articulating inferiorly with the nasal bone and the cheek bone on each side of the face. Skull: Anatomy and parietal Parietal One of a pair of irregularly shaped quadrilateral bones situated between the frontal bone and occipital bone, which together form the sides of the cranium. Skull: Anatomy lobes 
      • Extends from the interventricular foramen of Monro to the splenium of the corpus callosum
    • Anterior horn Anterior horn One of three central columns of the spinal cord. It is composed of gray matter spinal laminae VIII and ix. Brown-Séquard Syndrome: in the frontal Frontal The bone that forms the frontal aspect of the skull. Its flat part forms the forehead, articulating inferiorly with the nasal bone and the cheek bone on each side of the face. Skull: Anatomy lobe
    • Posterior horn Posterior horn One of three central columns of the spinal cord. It is composed of gray matter spinal laminae i-vi. Brown-Séquard Syndrome: curves posteromedially into the occipital Occipital Part of the back and base of the cranium that encloses the foramen magnum. Skull: Anatomy lobe
    • Inferior horn:
      • Largest compartment of the lateral ventricle
      • Extends forward into the temporal lobe Temporal lobe Lower lateral part of the cerebral hemisphere responsible for auditory, olfactory, and semantic processing. It is located inferior to the lateral fissure and anterior to the occipital lobe. Cerebral Cortex: Anatomy
  • 3rd ventricle:
  • Cerebral aqueduct (of Sylvius): 
    • Small tube extending throughout the dorsal quarter of the midbrain Midbrain The middle of the three primitive cerebral vesicles of the embryonic brain. Without further subdivision, midbrain develops into a short, constricted portion connecting the pons and the diencephalon. Midbrain contains two major parts, the dorsal tectum mesencephali and the ventral tegmentum mesencephali, housing components of auditory, visual, and other sensorimotor systems. Brain Stem: Anatomy
    • Surrounded by periaqueductal gray
    • Connects the 3rd and 4th ventricles
  • 4th ventricle: 
    • Between the brainstem and the cerebellum Cerebellum The cerebellum, Latin for “little brain,” is located in the posterior cranial fossa, dorsal to the pons and midbrain, and its principal role is in the coordination of movements. The cerebellum consists of 3 lobes on either side of its 2 hemispheres and is connected in the middle by the vermis. Cerebellum: Anatomy
    • The foramen of Luschka (lateral aperture) and the foramen of Magendie ( median Median After arranging the data from loWest to highest, the median is the middle value, separating the lower half from the upper half of the data set. Measures of Central Tendency and Dispersion aperture) allow newly produced CSF to enter the subarachnoid space Subarachnoid space The space between the arachnoid membrane and pia mater, filled with cerebrospinal fluid. It contains large blood vessels that supply the brain and spinal cord. Subarachnoid Hemorrhage.
  • Circumventricular organs:
    • Structures characterized by extensive, highly permeable capillaries Capillaries Capillaries are the primary structures in the circulatory system that allow the exchange of gas, nutrients, and other materials between the blood and the extracellular fluid (ECF). Capillaries are the smallest of the blood vessels. Because a capillary diameter is so small, only 1 RBC may pass through at a time. Capillaries: Histology
    • Surround the 3rd and 4th ventricles
    • Regions do not typically contain a blood-brain barrier Blood-brain barrier Specialized non-fenestrated tightly-joined endothelial cells with tight junctions that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. Systemic and Special Circulations, which allows for communication Communication The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups. Decision-making Capacity and Legal Competence between the peripheral blood and the CSF.
Ventricles of the brain

Ventricles of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification

Image: “Ventricles of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification” by Bruce Blaus. License: CC BY 3.0, edited by Lecturio.

Choroid Plexus and Cerebrospinal Fluid

Choroid Choroid The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. Eye: Anatomy plexus

  • Vascular pia mater Pia mater The innermost layer of the three meninges covering the brain and spinal cord. It is the fine vascular membrane that lies under the arachnoid and the dura mater. Meninges: Anatomy in all ventricles
  • Location:
    • Roof of the temporal horns of the lateral ventricles
    • Floor of the body of the lateral ventricles
    • Foramen of Monro
    • Roof of the 3rd ventricle
    • Medullary of the 4th ventricle, extending through the foramen of Luschka
  • Actively secretes CSF in the lateral, 3rd, and 4th ventricles
Choroid plexus development

Choroid Choroid The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. Eye: Anatomy plexus development: The choroid Choroid The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. Eye: Anatomy plexus is located throughout the ventricular system and is responsible for the secretion Secretion Coagulation Studies of cerebrospinal fluid.

Image by Lecturio.

Cerebrospinal Fluid

  • Clear, colorless liquid containing a small amount of protein
  • Provides buoyancy and protection for the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification
  • Regulates chemical concentration of neurotransmitters and metabolic waste

Subarachnoid Space and Circulation of Cerebrospinal Fluid

Subarachnoid space Subarachnoid space The space between the arachnoid membrane and pia mater, filled with cerebrospinal fluid. It contains large blood vessels that supply the brain and spinal cord. Subarachnoid Hemorrhage

  • Between the arachnoid and the pia mater Pia mater The innermost layer of the three meninges covering the brain and spinal cord. It is the fine vascular membrane that lies under the arachnoid and the dura mater. Meninges: Anatomy
  • Contains CSF, larger arteries and veins Arteries And Veins ACES and RUSH: Resuscitation Ultrasound Protocols, and intracranial and intervertebral portions of the cranial and spinal nerves Spinal nerves The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. Spinal Cord: Anatomy

Circulation Circulation The movement of the blood as it is pumped through the cardiovascular system. ABCDE Assessment of cerebrospinal fluid

  • After production in the ventricles, CSF flows into the subarachnoid space Subarachnoid space The space between the arachnoid membrane and pia mater, filled with cerebrospinal fluid. It contains large blood vessels that supply the brain and spinal cord. Subarachnoid Hemorrhage.
  • CSF flows freely within the subarachnoid space Subarachnoid space The space between the arachnoid membrane and pia mater, filled with cerebrospinal fluid. It contains large blood vessels that supply the brain and spinal cord. Subarachnoid Hemorrhage of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification and spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy.
  • CSF is reabsorbed by arachnoid granulations into the venous circulation Circulation The movement of the blood as it is pumped through the cardiovascular system. ABCDE Assessment.
Circulation

Circulation Circulation The movement of the blood as it is pumped through the cardiovascular system. ABCDE Assessment of the cerebrospinal fluid (CSF):
Note the emergence of CSF from the choroid Choroid The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. Eye: Anatomy plexus into the ventricles. Cerebrospinal fluid is reabsorbed by arachnoid granulations into the venous circulation Circulation The movement of the blood as it is pumped through the cardiovascular system. ABCDE Assessment.

Image: “ Circulation Circulation The movement of the blood as it is pumped through the cardiovascular system. ABCDE Assessment” by OpenStax. License: CC BY 4.0, edited by Lecturio.

Clinical Relevance

  • Hydrocephalus: a potentially life-threatening condition caused by the excess accumulation of CSF within the ventricular system. The clinical presentation is nonspecific and may include headache, behavioral changes, developmental delays, or nausea and vomiting. Diagnosis is confirmed with neuroimaging (ultrasound, head CT, or MRI) showing ventriculomegaly. Treatment is placement of a CSF shunt.
  • Normal pressure hydrocephalus (NPH): enlargement of the ventricles without detectable elevations in intracranial pressure. Normal pressure hydrocephalus occurs most commonly in adults > 60 years of age. Symptoms include a triad of urinary incontinence, ataxia, and cognitive dysfunction and may be remembered by the mnemonic “wet, wobbly, and wacky.”
  • Chronic microvascular ischemic disease: chronic atherosclerotic disease typically resulting in hypoperfusion to symmetric areas of the cerebral cortex Cerebral cortex The cerebral cortex is the largest and most developed part of the human brain and CNS. Occupying the upper part of the cranial cavity, the cerebral cortex has 4 lobes and is divided into 2 hemispheres that are joined centrally by the corpus callosum. Cerebral Cortex: Anatomy and causing cerebral atrophy Atrophy Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. Cellular Adaptation or other brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification malformations. Unlike hydrocephalus Hydrocephalus Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial. Subarachnoid Hemorrhage, the intracranial pressure Intracranial Pressure Idiopathic Intracranial Hypertension is not elevated. 
  • Chiari malformations Chiari Malformations Chiari malformations (CMs) are a group of central nervous system (CNS) conditions characterized by the underdevelopment of the posterior cranial fossa with subsequent protrusion of neural structures through the foramen magnum. Chiari Malformations (CM): a group of disorders defined by structural deficits in the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification and spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy leading to limited space in the posterior fossa and forcing cerebellar structures to protrude through the foramen magnum. Type II Chiari malformations Chiari Malformations Chiari malformations (CMs) are a group of central nervous system (CNS) conditions characterized by the underdevelopment of the posterior cranial fossa with subsequent protrusion of neural structures through the foramen magnum. Chiari Malformations are seen in combination with herniation Herniation Omphalocele of the cerebellar vermis, the brainstem, and the 4th ventricle into the foramen magnum. An association exists with myelomeningocele and multiple brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification anomalies, including hydrocephalus Hydrocephalus Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial. Subarachnoid Hemorrhage and syringomyelia Syringomyelia Longitudinal cavities in the spinal cord, most often in the cervical region, which may extend for multiple spinal levels. The cavities are lined by dense, gliogenous tissue and may be associated with spinal cord neoplasms; spinal cord traumatic injuries; and vascular malformations. Syringomyelia is marked clinically by pain and paresthesia, muscular atrophy of the hands, and analgesia with thermoanesthesia of the hands and arms, but with the tactile sense preserved (sensory dissociation). Lower extremity spasticity and incontinence may also develop. Central Cord Syndrome.

References

  1. Kahle, K. T., Kulkarni, A. V., Limbrick, D. D., & Warf, B. C. (2016). Hydrocephalus in children. Lancet, The, 387(10020), 788–799. http://dx.doi.org/10.1016/S0140-6736(15)60694-8
  2. Blázquez, M., & Zarranz, J. J. (2018). Síndrome meníngeo. edema cerebral. hipertensión intracraneal. hidrocefalias. hipotensión intracraneal. In J. J. Zarranz (Ed.), Neurología (pp. 219-233). https://www.clinicalkey.es/#!/content/3-s2.0-B978849113071000012X
  3. Sato, O., Yamguchi, T., Kittaka, M., & Toyama, H. (2001). Hydrocephalus and epilepsy. Child’s nervous system: ChNS: official journal of the International Society for Pediatric Neurosurgery, 17(1-2), 76–86.
  4. Tubbs, R. S., & Oakes, W. J. (2017). Chiari malformations. Neurological surgery. pp. 1531–1540. http://dx.doi.org/10.1016/B978-0-323-28782-1.00190-8
  5. Schijman, E. History, anatomic forms, and pathogenesis of Chiari I malformations. Childs Nerv Syst 20, 323–328 (2004). https://doi.org/10.1007/s00381-003-0878-y
  6. Khoury, C. (2020). Chiari malformations. UpToDate. Retrieved December 1, 2020 from https://www.uptodate.com/contents/chiari-malformations
  7. Abd-El-Barr M. M., Strong C.I., Groff M. W. Chiari malformations: diagnosis, treatments and failures. J Neurosurg Sci. 2014 Dec. 58 (4):215–21.
  8. McClugage, S and Oakes, J. The Chiari I malformation. JNSPG 75th Anniversary Invited Review Article. https://doi.org/10.3171/2019.5.PEDS18382

USMLE™ is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). MCAT is a registered trademark of the Association of American Medical Colleges (AAMC). NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc (NCSBN®). None of the trademark holders are endorsed by nor affiliated with Lecturio.

Study on the Go

Lecturio Medical complements your studies with evidence-based learning strategies, video lectures, quiz questions, and more – all combined in one easy-to-use resource.

Learn even more with Lecturio:

Complement your med school studies with Lecturio’s all-in-one study companion, delivered with evidence-based learning strategies.

User Reviews

¡Hola!

Esta página está disponible en Español.

🍪 Lecturio is using cookies to improve your user experience. By continuing use of our service you agree upon our Data Privacy Statement.

Details