ISSN 2398-2950      

Cerebrospinal fluid: sampling

ffelis

Synonym(s): CSF tap, cerebromedullary cistern


Introduction

  • Central spinal fluid (CSF) produced by active secretion as well as selective filtration from blood by choroid plexus.
  • It should be clear and transparent (or colorless) and should not clot.
  • CSF normally has a low protein content and contain few cells.
  • Pathology in the CNS is often reflected in the CSF when there is compromise of the blood-brain barrier, the blood-CSF barrier or the CSF's interface with the brain and spinal cord.
  • CNS disease does not consistently cause alterations in the CSF - abnormalities depend on the location and extent of the CNS lesion.
  • General anesthesia is mandatory for CSF collection.

Uses

  • Diagnosis of central nervous system disease and evaluation of therapy.
  • Therapeutic drainage of CSF at high pressure, or blood or exudate.

Advantages

  • Ease of collection.
  • Full fluid analysis can be performed.
  • Enables injection of contrast material for imaging.

Disadvantages

  • Best results obtained during acute phase of disease.
  • Requires general anesthesia.
  • Risk of puncturing brainstem if unskilled.
  • Risk of brain herniation Brain: tentorial hernation, which may be fatal, in cases of acute cerebral trauma due to hemorrhage and edema   →   increased intracranial pressure Intracranial pressure measurement.
  • Similarly, risk of brain herniation in cases of intracranial neoplasia Brain neoplasia.
  • Risk of introducing infection - strict asepsis mandatory.
  • Life-threatening complications.

Contraindications for CSF collection

  • Patient unstable for general anesthesia.
  • Evidence of coagulopathy.
  • Instability or pathology suspected at the site of collection (eg atlanto-axial instability).
  • Severe hydrocephalus Hydrocephalus Hydrocephalus: congenital.
  • Recent head trauma Head: trauma.
  • Imaging evidence of intracranial mass lesion or edema/hemorrhage causing mass effect.
  • Clinical indication of increased intracranial pressure.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Further Reading

Publications

Refereed papers

Other sources of information

  • Walmsley H (2013) Clinical pathology. In: Manual of Canine and Feline Neurology. Platt S R, Olby N J (eds). British Small Animal Veterinary Association, Gloucester, pp 36-58.
  • Rusbridge C (1997) Collection and interpretation of cerebrospinal fluid in cats and dogs. In Practice 19 (6), 322-324, 327-331.

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