Sequential Cerebrospinal Fluid Sampling in Horses: Comparison of Sampling Times and Two Different Collection Sites

Andrade, Danilo Giorgi Abranches de; Cerri, Fabrício Moreira; Barbosa, Giovanna Valverde Magalhães; Basso, Roberta Martíns; Takahira, Regina Kiomi; Pantoja, José Carlos de Figueiredo; Oliveira-Filho, José Paes de; Borges, Alexandre Secorun

doi:10.1016/j.jevs.2021.103794

Cited by 4 publications

(7 citation statements)

References 19 publications

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“…The subarachnoid space accessed between the first and second cervical vertebrae (AA space) is anatomically separate from the cerebromedullary cistern accessed through AO puncture ( 4 ). Recent literature has shown no difference in nucleated cell count in CSF from horses with no evidence of neurological disease when sampling the AA and the AO sites, but did show higher TP in samples from the AA site ( 14 ). While CSF collected from the AA and LS sites ( 8 ) and CSF from the AO and AA sites have previously been compared ( 14 ), there are no published comparisons between all three collection sites.…”

Section: Introductionmentioning

confidence: 83%

“…Recent literature has shown no difference in nucleated cell count in CSF from horses with no evidence of neurological disease when sampling the AA and the AO sites, but did show higher TP in samples from the AA site ( 14 ). While CSF collected from the AA and LS sites ( 8 ) and CSF from the AO and AA sites have previously been compared ( 14 ), there are no published comparisons between all three collection sites. Separate reference ranges for albumin have been proposed in human literature based on sample site, but specific reference ranges for CSF collected from the AA site in horses have not yet been established ( 10 ).…”

Section: Introductionmentioning

confidence: 83%

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Comparison of Fluid Analysis and Cytologic Findings of Cerebrospinal Fluid Between Three Collection Sites in Adult Equids With Neurological Disease

2022

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Cerebrospinal fluid (CSF) is routinely collected from three sites in the horse, the atlanto-occipital (AO), atlantoaxial (AA), and lumbosacral (LS) space. A comparison between fluid analysis parameters [total protein, total nucleated cell count (TNCC), red blood cell (RBC) count, and morphologic analysis] from samples obtained at each of the three sites has not previously been performed. A retrospective analysis was performed to evaluate the differences in fluid analysis of CSF between the AO, AA, and LS sites in equids presented to a referral service for evaluation of suspected neurological disease. A total of 113 equids aged ≥1 year that underwent CSF collection between 2008 and 2020 were included. Total nucleated cell count, RBC concentration, total protein (TP), and morphologic evaluation between CSF samples obtained from the three sites were compared. When comparing all samples, LS centesis was associated with higher RBC compared to other sites (p < 0.05); TP was lower in the AA group than in the LS group (p < 0.05). Within a subset of cytologically unremarkable samples, RBC concentration was highest in LS samples (p < 0.01); TP was higher in LS samples compared to AA samples (p < 0.05) and TNCC was higher (p < 0.01) in AA and LS groups compared to the AO. In cytologically abnormal samples, there were no significant differences between sites in any parameter. Abnormal cytology was correlated with non-survival (p = 0.0002). Non-survival was associated with higher TNCC (p < 0.01). The receiver operating characteristic (ROC) curve for TNCC had an area under the curve of 0.67 (95% CI, 0.55–0.79) and indicated that a cutoff value of 24 cells/μL maximized specificity (72%) and sensitivity (54%) to predict non-survival in all horses. Positive predictive value was 45%; negative predictive value was 78%. The concentration of RBC was higher in samples from the LS site. This has clinical implications due to the importance of comparative diagnostics and its potential impact on cytologic evaluation. There were minimal differences in multiple other parameters between sites, which are likely clinically insignificant.

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Section: Introductionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 83%

Comparison of Fluid Analysis and Cytologic Findings of Cerebrospinal Fluid Between Three Collection Sites in Adult Equids With Neurological Disease

2022

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“…These signs have been presumptively attributed to local inflammation, CSF leakage, or a combination of both, into the epidural and deep cervical fascial spaces. Severe headaches and neck pain are frequently observed in human patients with CSF leakage from the subarachnoid space and are hypothesized to result from pain‐sensitive meningeal structures, CSF hypovolemia, and intracranial hypotension 19 . In this study, no neck pain or headache‐like signs were noted at any horses after CSF collections.…”

Section: Discussionmentioning

confidence: 46%

“…Severe headaches and neck pain are frequently observed in human patients with CSF leakage from the subarachnoid space and are hypothesized to result from pain-sensitive meningeal structures, CSF hypovolemia, and intracranial hypotension. 19 In this study, no neck pain or headache-like signs were noted at any horses after CSF collections. To prevent local inflammation and pain, all horses received 2 doses of flunixin meglumine, a non-steroidal anti-inflammatory.…”

Section: Discussionmentioning

confidence: 47%

Opioid‐free sedation for atlantoaxial cerebrospinal fluid collection in adult horses

Cock

Blakeney

Hernández

et al. 2022

Veterinary Internal Medicne

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Background Atlantoaxial (AA) cerebrospinal fluid (CSF) collection in standing horses utilizes the controlled narcotic morphine, thereby limiting feasibility in field practice settings. Objectives To compare AA CSF collection time and reaction scores in horses sedated with morphine‐containing and opioid‐free sedation protocols: detomidine + morphine (DM), detomidine + xylazine (DX), detomidine + detomidine (DD), detomidine alone (D0); To develop a novel method for assessing sedation in standing horses using open‐source motion‐tracking software. Animals Six healthy adult horses. Methods Randomized crossover. Atlantoaxial CSF collections were performed weekly for 4 weeks. Horses received sedation protocols in random order. Procedure time and procedure reaction scores were compared between groups using Friedman test. Associations between procedure reaction scores and motion tracking variables (total distance and farthest excursion traveled by horse's head) were examined using scatter diagrams and linear regression. Results Procedure times were lower in horses sedated with DX (median: 36 seconds; range: 28 − 188), compared to D0 (121; 35 − 196; P = 0.04). Procedure reaction scores were lower in horses sedated with DX (median 1.0, range 1.0 to 2.0), or DM (1.8; 1.3 − 3.0) compared to DO (3.0; 2.3 − 3.0; P = .03). Reactions to dura mater puncture were recorded in 3 of 6 horses in D0 and DD groups, and 0 of 6 horses in DX and DM groups. Positive associations were observed between reaction score vs total distance or farthest excursion distance from baseline. Conclusions and Clinical Importance Both opioid‐free and morphine‐containing sedation protocols are acceptable for AA CSF collection. Motion‐tracking software represents a novel method for assessing sedation in standing horses.

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“…The difference between CSF collected from Horse 2 at different dates and by different routes is stark. There is a lower protein concentration and red cell count in CSF collected from the C1‐C2 space as compared to the LS space, whereas there is a higher protein concentration in CSF collected from C1 to C2 as compared to atlanto‐ocipital (AO) 2,7 . However, while there are differences between centesis methods for protein, values remain within reference ranges 2,7 .…”

Section: Discussionmentioning

confidence: 99%

Subarachnoid hemorrhage and axonal degeneration after C1‐C2 cervical centesis in 2 horses

Luethy

Colmer

Jodzio

et al. 2023

Veterinary Internal Medicne

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Ultrasound-guided cervical centesis has gained popularity as a method for collecting cerebrospinal fluid (CSF) from standing horses. There are anecdotal reports of neck stiffness, regional swelling, sensitivity to palpation, and fever after the procedure. We report 2 horses with complications that occurred within days of C1-C2 centesis and ultimately resulted in euthanasia. Both C1-C2 centesis were performed routinely, with CSF cytologic analysis providing no evidence of blood contamination. Postmortem examination revealed equine degenerative myeloencephalopathy as the primary disorder causing Horse 1's initial neurologic deficits, whereas Horse 2 did not have a distinct lesion explaining the horse's deficits. Both horses had evidence of subarachnoid hemorrhage at or near the centesis site with Wallerian axonal degeneration in the cranial cervical spinal cord. Although hemorrhage with associated axonal degeneration at the cervical centesis site appears to be rare, this complication of C1-C2 centesis should be considered as this technique gains popularity.

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Sequential Cerebrospinal Fluid Sampling in Horses: Comparison of Sampling Times and Two Different Collection Sites

Cited by 4 publications

References 19 publications

Comparison of Fluid Analysis and Cytologic Findings of Cerebrospinal Fluid Between Three Collection Sites in Adult Equids With Neurological Disease

Comparison of Fluid Analysis and Cytologic Findings of Cerebrospinal Fluid Between Three Collection Sites in Adult Equids With Neurological Disease

Opioid‐free sedation for atlantoaxial cerebrospinal fluid collection in adult horses

Subarachnoid hemorrhage and axonal degeneration after C1‐C2 cervical centesis in 2 horses

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