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Ventricular Size

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Ventricular Size

Considering how important the brain is, it is important to be protected from possible trauma. A blow to the head, if bad enough, can even be fatal. Fortunately, the brain has a few tricks up its sleeve to protect itself from damage.

Cerebrospinal fluid (CSF) is one example. It’s a fluid surrounding the brain and spinal cord produced by your four brain ventricles.

The ventricles are cavities in the brain that produce, transport and drain CSF.

CSF contains nutrients and helps remove waste. It is integral to our central nervous system (CNS). The brain itself is a bit heavy. Therefore, CSF also serves as a cushion to prevent the brain from being crushed by its weight (the average male brain weighs about 1,350 grams, while a female one weighs about 1,200 grams). It also helps keep the brain buoyant (CSF reduces its weight to about 50 grams, so the brain is not pressured by its density).

In this article we will analyse the ventricular system of our brain, ventricular size in people with schizophrenia, and the positive and negative symptoms in these cases.

What are brain ventricles?

Here is a concise list of the ventricular system in the brain. There are four ventricles in total.

  • Lateral ventricles: these are the largest of the ventricles. The lateral ventricles have a left side and a right side, as shown in the figure below, and have a horn that curves into the different lobes of the brain (temporal, occipital and frontal lobes).
  • Third ventricle: the lateral ventricles open into the third ventricle, which lies between the thalamus, via the foramen Monro. It is the thin, slit-like structure seen between the lateral ventricles.
  • Fourth ventricle: the third ventricle connects to the fourth ventricle and directs cerebrospinal fluid to it (this is what the cerebral aqueduct is for, shown in the figure below). The fourth ventricle is located in the brainstem (right at the junction of the pons and medulla oblongata) and drains CSF into the central canal and subarachnoid cisterns.

Think of the four ventricles as the lateral, third and fourth the lateral ventricles are the first two!

The ventricles are lined with ependymal cells, which form the choroid plexus (which is responsible for producing the CSF).

Ventriculat Size Ventricular systems of the brain, lateral and anterior view StudySmarterVentricular systems of the brain, lateral and anterior view, BruceBlaus, Wikimedia Commons

Problems can arise when these ventricles have specific dysfunctions. We are concerned with how the enlargement of the ventricular system is related to schizophrenia.

Do people with schizophrenia have enlarged ventricles?

Studies show that schizophrenic patients have enlarged ventricles. A recent meta-analysis of brain volumes in people with schizophrenia by Wright et al. (2000), involving 1,588 patients with schizophrenia, found that ventricular volume was 26% greater in people with schizophrenia than healthy controls.The greatest difference was found in the right and left bodies of the lateral ventricle, with volumes 16% greater in each of the schizophrenic patients compared with the control subjects. Gender did not appear to impact effect size significantly. The large sample size means the results are reliable.Similarly, Johnstone et al. (1976) demonstrated increased cerebral ventricle size in 17 schizophrenic patients compared with healthy control subjects. This was detected by computerised axial tomography (or a CAT scan for those more familiar with that term). It is important to note that this is a relatively small sample.

This larger ventricular size in schizophrenic patients has been significantly associated with cognitive impairment.

Ventricular Size Brain analysis  Schizophrenia StudySmarterBrain analysis, Flaticon

Most studies agree that schizophrenic patients have enlarged ventricles in their brains, which is associated with shrinkage or loss of brain tissue. This means that the functions of these lost or shrunken areas are also affected, which is associated with the development or occurrence of positive and negative symptoms in schizophrenia.Any increase in size of anything in the brain that is not intended puts pressure on the brain! This pressure is called intracranial pressure and can have serious health implications.

Are enlarged ventricles the cause or product of schizophrenia?

Enlargement of the ventricles has been shown in schizophrenia patients. So we have to wonder whether or not this is a possible cause or product of the development of schizophrenia.In the Narr et al. (2006) study, patients with schizophrenia showed a small enlargement of the ventricles in the first episode. The study suggests this enlargement occurs with the progression of the disease after its initial onset and that the early changes are concentrated in the dorsal superior horn, rather than the enlargement of the ventricles being an immediate presence and sign of schizophrenia.

Enlarged ventricles usually mean loss of brain tissue.

With enlarged ventricles in schizophrenia, loss of brain tissue is obvious.Structural MRIs have identified volume deficits in the prefrontal lobes, temporal lobes, and thalamus (Lawrie et al., 2008). The thalamus is located near the anterior horn of the lateral ventricles. First-episode patients had similar abnormalities to patients in chronic cases, suggesting these structural changes (particularly the enlargement of the ventricles) are present early in the illness.Horga et al. (2011) found that enlargement of the ventricular system in schizophrenic patients was associated with reducing grey matter volume and displacement. They found enlargement in the anterior, lateral, and temporal horns, and these larger ventricles are associated with grey matter loss in the lateral temporal, cingulate, and occipital cortices. However, they concluded that the enlargement of the ventricles is not associated with a reduction in the volume of the surrounding structures. They suggested this enlargement of the ventricles could be due to brain development and neurodegeneration, which occurs with age and affects patients with schizophrenia.

Enlargement of ventricular size in schizophrenia: positive and negative symptoms

Studies have shown that enlargement of the ventricles leads to impairment of brain regions associated with the interpretation of sensory stimuli (Andreasen et al., 1982). They also showed a higher number of negative symptoms:

  • Affective flattening (absence of emotion evidenced by unchanged facial expression or voice).

  • Alogia (poverty of speech).

  • Avolition (severe lack of motivation).

Conversely, patients with a smaller size enlarged ventricles showed positive symptoms:

  • Delusions.

  • Hallucinations.

  • Abnormal behaviour.

This ventricular enlargement shown in the above studies may precede the development of positive and negative symptoms in schizophrenia.

Ventricular Size Enlargement of ventricular size in schizophrenia: Different emotions StudySmarterDifferent emotions, Flaticon

Although you do not need to know this for your exam, hydrocephalus is an enlargement of the ventricles in which cerebrospinal fluid accumulates in the brain’s ventricular system. This amount is larger than normal, so the ventricles increase and pressure the brain. Usually, this pressure can be relieved with a shunt. However, early diagnosis is critical for effective treatment and prevention of permanent brain damage.So you see how important normal CSF levels and normal ventricle size are!

Does ventricle size increase with age in people with schizophrenia?

Ventricular volume increases with age, regardless of the presence of schizophrenia. Nevertheless, enlargement is a factor, as Horga et al. (2011) suggest that ventricular enlargement may result from brain development and neurodegeneration, which occurs with age and affects patients with schizophrenia.Studies have shown that age correlates significantly with lateral ventricle size, with institutionalised schizophrenic patients having significantly larger ventricles than neurotics, according to Owens et al. (1985). The enlargement of the ventricles was not related to previous physical treatments (as they were concerned that this might affect the structure of the areas in question, especially if the treatments involved electroconvulsive therapy).


Ventricular Size - Key takeaways

  • Cerebrospinal fluid (CSF) is a fluid that surrounds the brain and spinal cord, and our four brain ventricles produce it.
  • The ventricles are cavities in the brain that produce, transport, and drain CSF.
  • Studies show that schizophrenic patients have enlarged ventricles.
  • A meta-analysis of brain volumes in people with schizophrenia by Wright et al. (2000) found that ventricles were 26% larger in patients with schizophrenia compared to healthy controls.
  • Similarly, according to Johnstone et al. (1976), 17 schizophrenic patients had increased cerebral ventricle size than healthy controls.
  • Studies showed that patients with schizophrenia had a small increase in ventricular size during the first episode. It has been suggested that this enlargement occurs with the progression of the disease after its initial onset and that the early changes are concentrated in the dorsal superior horn, rather than the enlargement of the ventricles being an immediate presence and sign of schizophrenia.
  • This enlargement of the ventricles may be due to both brain development and neurodegeneration that occurs with age in patients with schizophrenia.
  • Studies have shown that enlargement of the ventricles leads to impairment in brain areas associated with the interpretation of sensory stimuli. This ventricular enlargement may precede the development of positive and negative symptoms in schizophrenia.

Frequently Asked Questions about Ventricular Size

The ventricles are cavities in the brain that produce, transport and drain CSF.

Yes. Lateral ventricular volume increases with age.

Ventricular size essentially refers to the size of the cavities in specific brain areas. 

Around 25% of cerebrospinal fluid resides in the ventricle system in a  young adult at any given time (despite 500ml being produced daily), and the total space available for CSF in young adults is around 150ml.  

In a fetus, the average ventricular size is around 10mm wide.

Final Ventricular Size Quiz

Question

What is cerebrospinal fluid (CSF)?

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Answer

Cerebrospinal fluid (CSF) is a fluid surrounding the brain and spinal cord produced by your four brain ventricles.

Show question

Question

What are ventricles in the brain?

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Answer

The ventricles are cavities in the brain that produce, transport, and drain CSF.

Show question

Question

What are the four ventricles within the brain?

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Answer

  1. Lateral ventricles (left and right).
  2. Third ventricle.
  3. Fourth ventricle. 

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Question

What cells produce cerebrospinal fluid (CSF) in your ventricles?

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Answer

Ependymal cells.

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Question

The _______ of Monro connects the lateral ventricles to the third ventricle. 

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Answer

Foramen.

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Question

Do schizophrenic patients have enlarged ventricles when compared to healthy controls?

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Answer

Yes.

Show question

Question

What did Wright et al. (2000) find in their meta-analysis of brain volumes in schizophrenic patients?

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Answer

They found that ventricular volume was 26% greater in people with schizophrenia than healthy controls. They had enlarged ventricles. 

Show question

Question

What did Johnstone et al. (1976) find in their study on schizophrenic patients?

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Answer

When compared with healthy controls, 17 schizophrenic patients had increased cerebral ventricle size than healthy controls.

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Question

Most studies agree that schizophrenic patients show enlarged ventricles within their brains, and this is associated with brain tissue shrinkage or loss. True or false?

Show answer

Answer

True. 

Show question

Question

What did Narr et al. (2006) find in their study on first-episode schizophrenic patients?

Show answer

Answer

In the Narr et al. (2006) study, patients with schizophrenia showed a small enlargement of the ventricles in the first episode. The study suggests this enlargement occurs with the progression of the disease after its initial onset and that the early changes are concentrated in the dorsal superior horn, rather than the enlargement of the ventricles being an immediate presence and sign of schizophrenia.

Show question

Question

Did Lawrie et al. (2008) find that first-episode patients had similar abnormalities to those in chronic cases of schizophrenia?

Show answer

Answer

Yes. Structural MRIs have identified volume deficits in the prefrontal lobes, temporal lobes, and thalamus (Lawrie et al., 2008). The thalamus is located near the anterior horn of the lateral ventricles. First-episode patients had similar abnormalities to patients in chronic cases, suggesting these structural changes (particularly the enlargement of the ventricles) are present early in the illness.

Show question

Question

Studies have shown that increased ventricular size results in impairment in the areas of the brain associated with interpreting sensory stimuli. True or false?

Show answer

Answer

True.

Show question

Question

True or false: Andreasen et al. (1982) found patients with an increased ventricular size showed a higher amount of negative symptoms, such as:


  • Affective flattening.
  • Alogia.
  • Avolition.

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Answer

True.

Show question

Question

What is hydrocephalus?

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Answer

Hydrocephalus is a condition where CSF collects within the ventricular system in the brain. This is usually larger than the average amount and can cause several issues as it puts a lot of pressure on the brain.

Show question

Question

Does lateral ventricular volume increase with age?

Show answer

Answer

Yes. This was also found to be the case more so in schizophrenic patients. Studies have shown that age is significantly correlated with lateral ventricular size, with institutionalised schizophrenic patients showing significantly larger ventricles than neurotics, according to Owens et al. (1985).  

Show question

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