equis - Articles
CSF: collection
Synonym(s): Cerebrospinal fluid sampling, Spinal tap, Lumbar puncture
Introduction
- To aid in diagnosis of neurologic disease.
- Normal CSF analysis does not rule out the possibility of CNS disease.
- CSF is an ultrafiltrate of plasma derived from the ventricular choroid plexuses and ependymal lining of ventricles, pia arachoid and meningeal blood vessels. It provides a physical support medium for the CNS.
- CSF can be collected from the atlanto-occipital (cisternal) or the lumbosacral site.
Uses
- Suspected brain lesions.
- Suspected spinal cord lesions.
- Suspected multifocal or diffuse lesions of the CNS.
Advantages
- CSF abnormalities highly significant and of diagnostic and prognostic value.
Disadvantages
- Results of analysis may be unrewarding.
- Need for general anesthesia Anesthesia: general - overview in an already sick animal (cisternal puncture).
- Lumbosacral puncture may be technically difficult to perform.
- Full aseptic precautions required.
- If dramatic drop in CSF pressure created during withdrawal of CSF, this may result in tentorial herniation and convulsions.
- Atlanto-occipital collection contraindicated if signs of brain herniation, eg dilated pupils, are present.
- Lumbosacral collection often contaminated with blood.
Technical problems
- Familiarity with anatomical landmarks - which can vary significantly in appearance depending on horse's body condition (very difficult to identify/palpate in obese animals).
- Lumbosacral collection requires practice.
Alternative techniques
- Recent technique described for collection of CSF from atlanto-occipital site in the standing horse.
- Ultrasounds-guided standing cervical centesis between 1st and 2nd cervical vertebrae also reported.
Time required
Preparation
- General anesthesia if atlanto-occipital collection.
- Skin preparation as for surgical procedure.
Procedure
- 10-20 min after skin preparation.
Decision taking
Criteria for choosing test
- CSF can be collected from the atlanto-occipital site (ideally for suspected brain lesions) or the lumbosacral site (ideally for suspected spinal lesions - CSF tends to flow in a caudal direction).
- Either site is acceptable for multifocal or diffuse lesions.
- Risks of sudden change in CNS pressure resulting in herniation.
- Bleeding disorders are a contraindication to CSF collection due to the risk of iatrogenic hemorrhage.
Risk assessment
- Balance risk of procedure to horse against information likely to be gained.
- Risk to personnel when performing procedure in recumbent/severely ataxic horse.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Depecker M, Bizon-Mercier C & Courouce-Malblanc A (2014) Ultrasound-guided atlanto-occipital puncture for cerebrospinal fluid analysis on the standing horse. Vet Rec 174 (2), 45 PubMed.
- Rease A, Behan A & Bohart G (2012) Ultrasound-guided cervical centesis to obtain cerebrospinal fluid in the standing horse. Vet Radiol Ultrasound 53 (1), 92-95 PubMed.
- Aleman M, Borchers A, Kass P H & Puchalski S M (2007) Ultrasound-assisted collection of cerebrospinal fluid from the lumbosacral space in equids. J Am Vet Medic Ass 230 (3), 378-384 PubMed.
- Schwarz B & Piercy R J (2006) Cerebrospinal fluid collection and its analysis in equine neurological disease. Equine Vet Educ 18 (5), 243-248 VetMedResource.
- Johnson P J & Constantinescu G M (2000) Collection of cerebrospinal fluid in horses. Equine Vet Educ 12 (1), 7-12 VetMedResource.
- Johnson P J & Constantinescu G M (2000) Analysis of cerebrospinal fluid in horses. Equine Vet Educ 12 (1), 13-17 VetMedResource.