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

Abstract

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.

Comparison of atlantoaxial and lumbosacral cerebrospinal fluid centesis techniques in South American camelids

“…A recent study in horses described transient hyperthermia after AA centesis, regardless of whether or not local analgesia was administered before centesis 21 . Necropsy examination of horses after AA centesis documented occurrence of subarachnoid hemorrhage, edema and hemorrhage of the neck musculature and the cervical epidural soft tissues, and axonal degeneration 13,24 . Because the AA centesis technique is a novel procedure in SAC, reports of adverse effects are currently not available.…”

“…21 Necropsy examination of horses after AA centesis documented occurrence of subarachnoid hemorrhage, edema and hemorrhage of the neck musculature and the cervical epidural soft tissues, and axonal degeneration. 13 , 24 Because the AA centesis technique is a novel procedure in SAC, reports of adverse effects are currently not available. It is plausible that similar complications may occur in SAC, and choosing the AA technique therefore should be governed by clinical circumstances, neuroanatomical localization of disease, operator experience, animal compliance, animal anatomy, and availability of necessary equipment.…”