A Disequilibrium Oncotic Model of Brain Fluid Flux

Application of the revised Starling model proposed by Levick and Michel (2010) suggests that cerebrospinal fluid (CSF) production is essential for maintenance of a low interstitial protein content in brain irrespective of any role in waste clearance. The anatomy of the brain, ventricles and choroid suggests that CSF enters brain by net bulk diffusion through both internal ependymal and external pial surfaces as part of a continual refreshment of low protein intertitium in the manner of a repeatedly squeezed sponge or mop, under forces such as arterial pulsation.