Ultrasound‐Guided Atlanto‐Occipital Puncture for Myelography in the Horse

Audigié, Fabrice; Tapprest, Jackie; Didierlaurent, David; Denoix, Jean‐Marie

doi:10.1111/j.1740-8261.2004.04065.x

Cited by 37 publications

(46 citation statements)

References 20 publications

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“…When obtaining a cervical sample from the atlanto‐occipital region, general anesthesia is performed routinely. In addition, the use of ultrasound guidance has been described to verify needle placement into the subarachnoid space at the atlanto‐occipital junction while the patient is under general anesthesia . This use of ultrasound guidance also allows for proper placement of contrast medium into the subarachnoid space for myelography as well as to minimize the risk of needle placement into the subdural space or within the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided Cervical Centesis to Obtain Cerebrospinal Fluid in the Standing Horse

Pease

Behan

Bohart

2011

Vet Radiology Ultrasound

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Horses with intracranial lesions and severe ataxia are not good anesthesia candidates; however, only one method to obtain cerebrospinal fluid (CSF) from the cervical region in a standing horse has been reported. This method is not performed routinely due to the difficulty for sample acquisition. Our hypothesis is that standing cervical centesis can be performed in horses without complication. Ultrasound-guided centesis of the CSF between C1 and C2 in 11 clinically normal horses and two horses with neurologic signs were performed. Horses were sedated and ultrasound was used to identify the subarachnoid space and spinal cord between C1 and C2. With ultrasound guidance, a needle was introduced into the dorsal aspect of the subarachnoid space using a lateral approach. Ten milliliters of CSF was obtained and analyzed. Two normal horses in this study had moderate red blood cell contamination in the CSF (940 and 612 RBC/microl). One horse had 11 RBC/microl and the remaining horses had < 4 RBC/microl. The total procedure time was approximately 2 min. No reaction was observed and no complications were detected up to 48 h after the procedure. Ultrasound-guided centesis between C1 and C2 is a rapid procedure that causes minimal to no reaction in standing, sedated horses used in this study. The use of ultrasound to guide a standing C1-2 centesis of the subarachnoid space provides an additional route to obtain CSF for analysis in the equine patient.

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Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided Cervical Centesis to Obtain Cerebrospinal Fluid in the Standing Horse

Pease

Behan

Bohart

2011

Vet Radiology Ultrasound

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“…For more accuracy, myelography can show the reduction of the dual sac. From a technical viewpoint, the advantage, especially with the use of “standing” myelography, is that general anesthesia is not required [10], and ultrasound guidance minimizes accidental insertion of a needle into the spinal cord [2]. However, even in myelography, variability is present [5].…”

Section: Discussionmentioning

confidence: 99%

Quantitative evaluation of cervical cord compression by computed tomographic myelography in Thoroughbred foals

Yamada

Sato

Hada

et al. 2016

JES

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Five Thoroughbred foals (age, 8–33 weeks; median age, 31 weeks; weight, 122–270 kg; median weight, 249 kg) exhibiting ataxia with suspected cervical myelopathy (n=4) and limb malformation (n=1) were subjected to computed tomographic (CT) myelography. The areas of the subarachnoid space and cervical cord were measured on transverse CT images. The area of the cervical cord was divided by the area of subarachnoid space, and stenosis ratios were quantitatively evaluated and compared on the basis of histopathological examination. The sites with a ratio above 52.8% could have been primary lesion sites in the histopathological examination, although one site with a ratio of 54.1% was not a primary lesion site. Therefore, in this study, a ratio between 52.8–54.1% was suggested to be borderline for physical compression that damages the cervical cord. All the cervical vertebrae could not be scanned in three of the five cases. Therefore, CT myelography is not a suitable method for locating the site of compression, but it should be used for quantitative evaluation of cervical stenosis diagnosed by conventional myelography. In conclusion, the stenosis ratios determined using CT myelography could be applicable for detecting primary lesion sites in the cervical cord.

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“…9,10 While it is demonstrated that the AO puncture can be performed under ultrasound guidance, it is rarely if ever necessary, and this approach has not been shown to have any particular advantages.…”

Section: Csf Collectionmentioning

confidence: 99%

“…Assuming a normal hemogram, 1 WBC/mm 3 for every 700 RBCs in the CSF is subtracted from the total CSF wbc . From this, if a CSF sample has a RBC count of 7000 and 100 WBC/µl, then 10 WBCs could 40 Section I / Foundations of Clinical Neurology 10 0-7 0-7 Erythrocytes (cells/ml) Less than 50 Less than 50 Total protein (mg/dl) 10-120 10 10-120 10 Immunoglobulin G (mg/dl) 8 3.0-8.0 3.0-10.5 Albumin quotient 8 1.0-2.1 0.9-2.4 Glucose (mg/dl) 10 30-70% of plasma value 30-70% of plasma value Lactic acid (mg/dl) 1.92 ϩ 0.12 2.3 ϩ 0.21 Sodium (mEq/L) 10 140-150 140-150 Potassium (mEq/L) 10 2.5-3.5 2.5-3.5 Chloride (mEq/L) 10 95-123 95-123 Calcium (mg/dl) 10 2.5-6.0 2.5-6.0 Phosphorus (mg/dl) 10 0.5-1.5 0.5-1.5 Urea nitrogen (mg/dl) 10 5-20 5-20 Creatine kinase (IU) 10 0-8 0-8 Lactate dehydrogenase (IU) 10 0-8 0-8 Aspartate transferase 15-50 15-50 (Sigma-Frankel units) 10 be accounted for by the added blood. 17 The CSF prior to blood contamination would then have a corrected, or "true" WBC count of 90 cells/µl.…”

Section: Compositionmentioning

confidence: 99%

Cerebrospinal Fluid and the Blood–Brain Barrier

Furr

Andrews

2007

Equine Neurology

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33Cerebrospinal fluid (CSF) is a clear, colorless fluid that fills the brain ventricular system, central canal of the spinal cord, and subarachnoid space. It penetrates and bathes all central nervous system (CNS) tissue and is contiguous with the CNS extracellular fluid. 1 The CSF is an ultrafiltrate of plasma, with all the constituents of plasma but with differing concentrations and relative proportions. FORMATIONThe CSF is produced as an ultrafiltrate of plasma and is actively secreted by ependymal cells and choroid plexus. While the majority of CSF is produced by the choroid plexus in the lateral ventricles, approximately 30-40% of CSF may be produced by the ependymal lining of the ventricles, the leptomeninges, and brain and spinal cord blood vessels. 1 Production is directly proportional to the transport of sodium via a Na-K ATPase in the brush border of the choroidal epithelium and is independent of vascular hydrostatic pressure. The CSF is formed at a constant rate, which in humans ranges from 0.32 to 0.37 ml/min. 2,3 The rate varies with species and has been estimated to be 0.2-0.5 ml/min/g of choroid plexus tissue. 4 The rate of formation of CSF in the horse has not been determined.The rate of CSF production can be altered by a variety of compounds. Carbonic anhydrase and Na-K ATPase inhibitors and hyperosmolality decrease production rate, while cholera toxin and adrenergic stimulation increase CSF production rate. 4 Osmotic agents and hypertonic solutions such as mannitol and dimethyl sulfoxide, when given intravenously, decrease CSF production in other species, but the effects of these compounds on the production of CSF in the horse have not been investigated.Following formation, CSF flows into the third and fourth ventricles, over the cerebral hemispheres, then exits caudally through foramina in the fourth ventricle to enter the subarachnoid space. Pulsation of blood in the choroid plexus forces the CSF in a cranial to caudal flow, and CSF is absorbed by collections of arachnoid villi in the dural sinuses or the cerebral veins. When CSF pressure exceeds venous pressure, these villi act as a one-way ball valve forcing CSF flow to the venous sinus.The CSF functions to protect the brain from trauma and to maintain a consistent extracellular environment for the CNS. The CSF provides physical support (i.e., buoyancy) and cushioning of the CNS as a result of its specific gravity (1.004-1.006) and fluid pressure, which effectively reduces the weight of the brain 30-fold. 4 It also serves as a physiologic medium to transport a variety of compounds (neurotransmitters) and to regulate the chemical environment of the CNS ("sink-action"). Because the CSF bathes the entire CNS, diseases of the brain and spinal cord may result in changes in its composition, which can be used as a diagnostic aid. BLOOD-BRAIN BARRIERThe blood-brain barrier (BBB) and blood-CSF barrier separate brain interstitial fluid and CSF from the general circulation, respectively. These structures were once thought to be the same, but extensive r...

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Ultrasound‐Guided Atlanto‐Occipital Puncture for Myelography in the Horse

Cited by 37 publications

References 20 publications

Ultrasound‐guided Cervical Centesis to Obtain Cerebrospinal Fluid in the Standing Horse

Ultrasound‐guided Cervical Centesis to Obtain Cerebrospinal Fluid in the Standing Horse

Quantitative evaluation of cervical cord compression by computed tomographic myelography in Thoroughbred foals

Cerebrospinal Fluid and the Blood–Brain Barrier

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