Body position and cerebrospinal fluid pressure

Changes in body position cause pressure changes in the fluid spaces of the body. The postural pressure changes in the cerebrospinal fluid (CSF) space have been the subject of numerous clinical investigations from the beginning of this century. An important early finding was that in any position of the body, the level of CSF in manometers connected to lumbar, cisternal, and ventricular needles was the same (for references, see Masserman25). This means that when there is no block in the course of the CSF pathways, the craniospinal system acts as a continuous fluid medium (Fig. 1). This is also the case in patients with medium-pressure CSF shunts,23 so apparently the drainage of CSF in such patients does not cause collapse and block of any part of the CSF space. Thus, in the craniospinal system, the pressure is equal at all points in a horizontal plane, and the difference in pressure between two different horizontal planes equals the weight of the corresponding vertical column of CSF. If the pressure is measured at one level in the system, the pressure at all other horizontal planes can be calculated. In other words, Pascal’s laws are valid for the craniospinal system.

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