The function, composition and analysis of cerebrospinal fluid in companion animals: part I - function and composition

Cerebrospinal fluid (CSF) is a clear, colourless ultrafiltrate of plasma with low protein content and few cells. The CSF is mainly produced by the choroid plexus, but also by the ependymal lining cells of the brain's ventricular system. CSF flows through the ventricular system and then into the subarachnoid space and it is subsequently absorbed through the subarachnoid villi into the venous system. CSF has several functions in the nervous system. It protects the brain during blood pressure fluctuations, regulates the chemical environment of the central nervous system and it is a vehicle for intracerebral transport. This two-part article reviews CSF function, physiology, analytical techniques and interpretations in disease states of companion animals. This first part will address the function and composition of CSF in companion animals.

Analysis of cerebrospinal fluid from dogs and cats after 24 and 48 hours of storage

OBJECTIVE

To compare differential cell counts and cell characteristics of CSF samples analyzed immediately or after storage for 24 and 48 hours at 4 C with and without the addition of autologous serum.

DESIGN

Prospective study.

ANIMALS

36 dogs and 6 cats.

PROCEDURE

CSF samples were collected from the cerebellomedullary cistern and divided into 250-microliter aliquots. Slides of CSF samples were prepared by use of cytocentrifugation immediately and after 24 and 48 hours of storage with addition of autologous serum (final concentrations, 11 and 29%). Differential cell counts and number of unrecognizable cells were compared among preparations.

RESULTS

Significant differences in the differential cell counts were not detected among samples analyzed before or after storage. Although the number of unrecognizable cells increased with storage time, this did not result in a significant effect on cell distribution or diagnosis. Cells in CSF samples stored with 11% serum more closely resembled cells in fresh samples than did cells in samples stored with 29% serum.

CONCLUSIONS AND CLINICAL RELEVANCE

CSF samples collected at veterinary clinics remote from a diagnostic laboratory or during nonoperational hours may be preserved through the addition of autologous serum. Evaluation of such samples is likely to result in an accurate diagnosis for at least 48 hours after collection.

Cerebrospinal fluid

It is hoped that we have demonstrated that collection, handling, and limited analysis of CSF samples from the dog and cat are relatively simple. No special equipment or handling is required, and the procedures are within the capabilities of any veterinarian interested in performing them. In addition, although this article was not intended to present a detailed discussion on the interpretation of the analysis of CSF, we have demonstrated some very practical interpretations to the various aspects of a routine CSF analysis. When combined with a signalment, complete history, and thorough general physical and neurologic examination, CSF analysis can prove invaluable in the workup of an animal with a neurologic disorder. Relatively simple laboratory procedures can be helpful in differentiating peripheral blood contamination from true intrathecal hemorrhage, in identifying an active inflammatory process, in potentially characterizing an etiologic agent, and, on rare occasions, in identifying primary or metastatic neoplastic disease involving the CNS. In many cases, the above is not directly possible, because the changes observed in our routine analysis are nonspecific. Yet, documenting and following these "nonspecific" alterations are helpful in determining if there is progression or regression of the disease process. In turn, these changes or lack of changes are helpful in identifying if the proper therapy has been instituted and if additional or different therapy is required.

Characterization of matrix metalloproteinase-2 and -9 in cerebrospinal fluid of clinically normal dogs

OBJECTIVE

To characterize matrix metalloproteinase (MMP)-2 and -9 in CSF of clinically normal dogs.

SAMPLE POPULATION

Samples of CSF collected from 23 dogs.

PROCEDURE

Dogs were anesthetized, CSF samples were collected, and dogs were then euthanatized. Each CSF sample was evaluated immediately for RBC count, WBC count, and protein and glucose concentrations, and cytologic examination also was performed. Samples were considered normal when protein concentration was < 25 mg/dL and CSF contained < 6WBCs/microL and < 25 RBCs/microL. Samples were stored at -70 degrees C. Sections of brain tissue were collected and processed for histologic examination. The MMPs were evaluated by use of gelatin zymography and a polyclonal antibody-based sandwich ELISA.

RESULTS

Mean WBC count for CSF samples was < 1 WBC/microL (range, 0 to 3 WBCs/mL). Mean protein concentration was 12 mg/dL (range, 8 to 17 mg/dL). Mean RBC count was 3.65 RBCs/microL (range, 0 to 21 RBCs/microL). All CSF samples generated a clear band on zymography gels that corresponded to the human commercial standard of proenzyme MMP-2. Other major clear bands were not detected on zymography gels. Bands correlating to MMP-9 were not detected in any samples. The ELISA results revealed a mean +/- SD proenzyme MMP-2 concentration of 5.61 +/- 1.92 ng/mL (range, 3.36 to 10.83 ng/mL).

CONCLUSIONS AND CLINICAL RELEVANCE

The proenzyme form of MMP-2 is detectable in CSF of clinically normal dogs, whereas MMP-9 is not detectable. Additional investigation of MMPs in CSF from dogs with various diseases of the nervous system is indicated.

Developmental changes in CSF hypocretin-1 (orexin-A) levels in normal and genetically narcoleptic Doberman pinschers

Loss of hypocretin cells or mutation of hypocretin receptors causes narcolepsy. In canine genetic narcolepsy, produced by a mutation of the Hcrtr2 gene, symptoms develop postnatally with symptom onset at 4 weeks of age and maximal symptom severity by 10-32 weeks of age. Canine narcolepsy can readily be quantified. The large size of the dog cerebrospinal fluid (CSF) cerebellomedullary cistern allows the withdrawal of sufficient volumes of CSF for accurate assay of hypocretin levels, as early as postnatal day 4. We have taken advantage of these features to determine the relation of CSF hypocretin levels to symptom onset and compare hypocretin levels in narcoleptic and normal dogs. We find that by 4 days after birth, Hcrtr2 mutants have significantly higher levels of Hcrt than normal age- and breed-matched dogs. These levels were also significantly higher than those in adult narcoleptic and normal dogs. A reduction followed by an increase in Hcrt levels coincides with symptom onset and increase in the narcoleptics. The Hcrtr2 mutation alters the normal developmental course of hypocretin levels.

The 1H NMR profile of healthy dog cerebrospinal fluid

The availability of data for reference values in cerebrospinal fluid for healthy humans is limited due to obvious practical and ethical issues. The variability of reported values for metabolites in human cerebrospinal fluid is quite large. Dogs present great similarities with humans, including in cases of central nervous system pathologies. The paper presents the first study on healthy dog cerebrospinal fluid metabolomic profile using ¹H NMR spectroscopy. A number of 13 metabolites have been identified and quantified from cerebrospinal fluid collected from a group of 10 mix breed healthy dogs. The biological variability as resulting from the relative standard deviation of the physiological concentrations of the identified metabolites had a mean of 18.20% (range between 9.3% and 44.8%). The reported concentrations for metabolites may be used as normal reference values. The homogeneity of the obtained results and the low biologic variability show that the ¹H NMR analysis of the dog’s cerebrospinal fluid is reliable in designing and interpreting clinical and therapeutic trials in dogs with central nervous system pathologies.

Determination of homovanillic acid, 5-hydroxyindoleacetic acid and pressure in the cerebrospinal fluid of collie dogs following administration of ivermectin

Twelve adult Collie dogs were studied to determine the effects of ivermectin on neurotransmitter metabolites released from the brain into the cerebrospinal fluid (CSF) and on CSF pressure. Ten of the 12 Collies were given ivermectin orally at a concentration of 200 micrograms/kg body weight. Three of these 10 Collies showed clinical signs of ivermectin-induced toxicosis which progressed into a state of unresponsive recumbency in 2 dogs. Cerebrospinal fluid pressures and neurotransmitter metabolite concentrations in cisterna magna CSF were analysed 49 to 50 hours after administration of ivermectin in 6 of the 10 treated dogs, and in the 2 untreated control Collies. Cerebrospinal fluid pressures were within normal limits in all dogs. However, compared to the CSF concentrations in the 2 untreated and 3 non-reactive Collies, the 2 ivermectin-reactive Collies still in recumbency had elevated CSF concentrations of homovanillic acid (HVA), a metabolite of dopamine, and 5-hydroxyindoleacetic acid (5-HIAA), a metabolite of serotonin. These findings suggest an association between altered neurotransmission and severe ivermectin-induced neurological abnormalities. No evidence of elevated intracranial pressure was found.

Tumor necrosis factor-α and interleukin-6 concentrations in cerebrospinal fluid of dogs after seizures

BACKGROUND

Idiopathic and acquired epilepsy are common in dogs. Up to 30% of these dogs are refractory to pharmacological treatment. Accumulating experimental evidence indicates that brain immune response and presence of inflammatory mediators decrease the threshold for individual seizures and contribute to epileptogenesis.

HYPOTHESIS

Dogs with seizures have higher cerebrospinal interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations compared to dogs with no seizures.

METHODS

A prospective double blinded study; cerebrospinal fluid (CSF) and serum IL-6, TNF-α and total protein (TP) concentrations were measured by a blinded investigator for the study group and CSF IL-6 and TNF-α levels and TP concentrations were measured in the control group (CG).

ANIMALS

Dogs presented with seizures that had enough CSF collected to allow analysis were included in the study group. Twelve apparently healthy, quarantined, stray dogs served as control (CG).

RESULTS

Cerebrospinal fluid TNF-α and IL-6 concentrations were significantly higher (P = .011, P = .039) in dogs with seizures (0 ± 70.66, 0.65 ± 10.93 pg/mL) compared to the CG (0 ± 19, 0.73 ± 0.55 pg/mL). When assessing cytokine concentrations of specifically the idiopathic epilepsy (IE) dogs compared to the CG, only TNF-α concentrations (8.66 ± 62, 0 ± 19 pg/mL) were significantly higher (P = .01). CSF TP concentrations were not significantly higher in the study dogs compared to the CG.

CONCLUSIONS AND CLINICAL IMPORTANCE

Higher TNF-α and IL-6 concentration in the CSF of dogs with naturally occurring seizures. The higher supports the hypothesis that inflammatory processes through certain mediators play a role in the pathogenesis of seizures in dogs.

Cytological, immunocytochemical and biochemical cerebrospinal fluid investigations in selected central nervous system disorders of dogs

Cerebrospinal fluid (CSF) obtained from 20 clinically healthy dogs and from 15 dogs affected by neurological disorders were examined for total and differential cell counts, immunocytochemistry for canine distemper virus antigen, total protein concentration and electrophoretic separation, and glucose and enzyme determination. Dogs affected by canine distemper showed an increase in macrophages, presence of specific inclusion bodies, and an increase in total protein concentration and gamma-globulin fraction. In bacterial meningoencephalomyelitis pleocytosis, increase of total proteins with special regard to high molecular weight proteins, elevated levels of lactate dehydrogenase (LDH), alterations of LDH isoenzyme profile, and decrease in glucose levels were detected; inflammatory disorders were more often characterized by an increase in LDH level, while in non-inflammatory disorders (hydrocephalus and spinal cord neoplasia) no variation in LDH levels was detected. Analysis of CSF in dogs appears relatively easy to perform and may help in establishing the condition of the blood-brain barrier as well as in the diagnosis of neurological disorders.

Gradient of arginine vasopressin concentration but not angiotensin II concentration between cerebrospinal fluid of anterior 3rd ventricle and cisterna magna in dogs

Dogs were chronically implanted with two devices for cerebrospinal fluid (CSF) sampling from (a) the anterior part of the 3rd ventricle and (b) the cisterna magna. In conscious dogs arginine vasopressin (AVP) concentration of CSF samples collected at different occasions were 2-3 times higher in the CSF of the 3rd ventricle as compared to the AVP concentration of the cisterna magna. Inhalation anesthesia stimulated AVP release into the CSF at both sites by a factor of about 2, the gradient between 3rd ventricle and cisterna magna CSF of 2-3 remained for AVP in simultaneously collected samples. In contrast, angiotensin II-like immunoreactivity of CSF was not significantly different at both sites, neither in the conscious dogs nor during anesthesia. It is concluded that the main amount of AVP enters the CSF at the 3rd ventricular level.

Characterisation of transthyretin and retinol-binding protein in plasma and cerebrospinal fluid of dogs

The aim of this study was to investigate differences in concentrations of vitamin A, transthyretin (TTR) and retinol-binding protein (RBP) between plasma and cerebrospinal fluid (CSF) in dogs. RBP was detected using ELISA, and both RBP and TTR by Western blot analysis after separation on SDS-PAGE. Vitamin A was determined by high performance liquid chromatography. RBP and TTR as well as vitamin A were detected in all samples but at substantially lower concentrations in CSF compared to plasma. RBP in dog plasma showed a similar molecular mass to that of humans, whereas canine TTR had a lower molecular mass. Comparison between plasma and CSF showed that both RBP and TTR were of lower molecular mass in CSF. In CSF, RBP and retinol were present at 10-100-fold lower concentrations compared to plasma. Retinyl esters were present only in minute amounts in 5/17 samples. In conclusion, the CSF of dogs compared to humans is significantly different in terms of both quality and quantity of transport proteins for vitamin A.

The presence of atrial natriuretic peptide in canine cerebrospinal fluid and its possible origin in the brain

The presence of atrial natriuretic peptide (ANP) in canine cerebrospinal fluid (CSF) was clearly demonstrated and an attempt was made to determine its origin as either the brain or the atrium. The concentration of ANP in canine CSF was 0.78 +/- 0.37 pmol/l (n = 31) and showed no evident correlation with that in plasma (r = 0.12). Physiological doses of human alpha-ANP (alpha-hANP) were continuously infused intravenously into nine dogs, and ANP concentrations in CSF and plasma were examined six to eight times within a 120-min period following this. The ANP level in CSF was not influenced by the systemic administration of alpha-hANP up to 180 min. Only one low molecular weight peak corresponding to alpha-hANP could be obtained from the CSF samples, while both low and high molecular weight peaks were observed for plasma ANP by gel permeation chromatography. In the atrial and hypothalamic tissue extracts the same kinds of peaks were also evident. These results prove the presence of ANP in canine CSF and that it does not come from blood that has seeped across the blood-CSF barriers, but suggest that it may originate from the brain.

Testing for Bartonella ssp. DNA in cerebrospinal fluid of dogs with inflammatory central nervous system disease

BACKGROUND

Neurobartonellosis occurs in people. The role these organisms might play in inflammatory brain disease of dogs is unclear.

HYPOTHESIS/OBJECTIVES

That Bartonella spp. DNA would be amplified more commonly from the CSF of dogs with inflammatory disease compared to those with noninflammatory disease. To report the prevalence of Bartonella spp. in dogs with and without inflammatory CNS disease with a commercially available PCR assay.

ANIMALS

Cerebrospinal fluid (CSF) samples from 172 dogs from either Washington State University or Colorado State University.

METHODS

Retrospective study. A search was performed of all medical records from dogs with CSF samples submitted to CSU's Center for Companion Animal Studies or Veterinary Diagnostic Laboratory from CSU or WSU for Toxoplasma or Neospora PCR assay. Increased CSF nucleated cell counts and an adequate volume of CSF must have been present to evaluate Bartonella spp. by PCR assay.

RESULTS

Inflammatory CNS disease was confirmed in 65 dogs, none of which were positive for Bartonella spp. DNA. Of the other 107 dogs, one was positive for B. henselae DNA. The CSF from this dog contained red blood cells.

CONCLUSIONS AND CLINICAL IMPORTANCE

Failure to amplify Bartonella spp. DNA from the CSF of the dogs with inflammatory disease suggests the organism was not involved in the etiology of the disease, the organism was in the CNS tissues but not in the CSF, or the organism was present but in quantities undetectable by this PCR assay. The combination of PCR and culture is the most sensitive way to detect Bartonella spp. and the use of that technique should be considered in future studies.

The Effect of 7.2% Hypertonic Saline Solution on the Duration of Sodium Gradient between the Cerebrospinal Fluid and the Venous Circulation in the Dog

To determine the duration of water movement from cerebrospinal fluid (CSF) into venous blood by the infusion of 7.2% hypertonic saline solution (HSS), the sodium gradient between venous blood and CSF were examined. Venous sodium concentrations remained higher than that in CSF for duration of 60 min following HSS infusion. By 90 min, the CSF sodium concentration reached the equilibrium with venous sodium concentration. Those data suggests that the duration of time during which water moved from CSF into capillaries in brain by the gradient of sodium concentration was less than 90 min.

Effect of centrally administered opioid receptor agonists on CSF and plasma oxytocin concentrations in dogs

OBJECTIVE

To measure oxytocin concentrations in blood and CSF following central administration of opioid agonists in dogs.

ANIMALS

5 male dogs.

PROCEDURE

In a crossover design, CSF and blood were collected immediately before and 15 and 30 minutes after cisternal administration of D-Ala2, MePhe4, Gly-ol-enkephalin (DAMGO, a mu-receptor agonist); D-Pen, pCl-Phe4, D-Pen5-enkephalin (a delta-receptor agonist); U50488H (a kappa-receptor agonist); morphine; and saline (0.9% NaCl) solution.

RESULTS

Plasma oxytocin concentration was significantly increased 15 minutes after administration of DAMGO and 30 minutes after administration of U50488H, compared with concentrations obtained after administration of saline solution. Concentration of oxytocin in CSF was significantly decreased 30 minutes after administration of U50488H, compared with concentration after administration of saline solution.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that in male dogs, activation of centrally located mu and kappa receptors elicits an overall excitatory effect on neurons that regulate peripheral release of oxytocin, whereas activation of centrally located kappa receptors elicits an overall inhibitory effect on neurons that regulate central release. These results are in contrast to those reported for other species, in which opioids have a pronounced inhibitory effect on release of oxytocin from the neurohypophysis.

The clinical, cerebrospinal fluid, and histopathologic effects of epidural ketorolac in dogs

OBJECTIVE

To evaluate the clinical, cerebrospinal fluid (CSF), and histopathologic effects of epidural ketorolac.

STUDY DESIGN

Blinded, randomized, placebo controlled study.

ANIMALS

Twenty-two adult mixed breed dogs with 16 treatment and 6 control dogs, weighing 14.4 to 29.8 kg.

METHODS

Dogs were anesthetized and epidural catheters were placed at the lumbosacral space. Catheter placement was evaluated fluoroscopically. Ketorolac (0.4 mg/kg) or placebo (5% ethanol) was administered epidurally over a 52-hour period, with 5 injections given at 12-hour intervals. At 1, 2, 4, or 8 hours after the first and last injection of ketorolac, dogs were anesthetized and CSF was obtained. Control dogs had CSF sampled 1 hour after the first and last ethanol injection. Neurologic function and pain responses were evaluated before and during the study. Selected dogs were then killed and necropsies performed.

RESULTS

None of the dogs exhibited any clinical or neurologic abnormalities during the study. No statistical difference was noted in pain response or CSF analysis between treatment and control dogs. Gross necropsy revealed gastrointestinal ulceration of varying degrees in all treatment dogs. Histopathologic analysis of the spinal cord and meninges revealed minimal focal leptomeningeal phlebitis in 2 of 8 treatment dogs and minor subdural inflammation in 1 control dog. No changes to the neural structures were noted in any dogs.

CONCLUSIONS

Epidural administration of ketorolac did not cause clinical signs, alteration in CSF values, or pathologic changes to the spinal cord when used for short duration. Gastrointestinal ulceration was common when ketorolac was administered epidurally at 0.4 mg/kg every 12 hours for 5 treatments.

CLINICAL RELEVANCE

This study documented the neurologic safety of epidural ketorolac in dogs before an efficacy trial can be performed. Gastrointestinal ulceration may limit use to short duration or a single injection.

A simplified technique for chronic cerebrospinal fluid collection in the awake dog

A modified design for a guide tube to facilitate collection of cerebrospinal fluid from the lateral ventricle of awake dogs was developed. The modifications allowed for rapid, inexpensive and secure implantation. The tested guide tubes remained in place and patent for 20 weeks.

3-Methoxy-4-hydroxy-phenylglycol sulfate (MOPEG-SO4) in ventricular and cisternal cerebrospinal fluid of dogs

Cerebrospinal fluid was collected from the lateral ventricles and cisternal space from beagle dogs under light pentobarbital anesthesia. Homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenylglyco-sulfate (MOPEG-SO4) levels in the liquor taken from these two regions were evaluated, and the ventricular-cisternal ratio (V/C) was calculated for each monoamine metabolite. A marked similarity in the V/C ratio of 6:1 for 5-HIAA and 5:1 for MOPEG-SO4, as compared to a much higher V/C ratio of 18:1 for HVA, perhaps reflects the more diffuse distribution of norepinephrine and serotonin, precursor amines, as compared to dopamine in the CNS and also emphasizes the probable existence of an active transport mechanism for the removal of MOPEG-SO4, as has been well documented for 5-HIAA and HVA.

Cerebrospinal fluid pressure as a function of body position in dogs

Cerebrospinal fluid (CSF) pressure has been measured as a function of body position in dogs under pentobarbital anaesthesia. CSF pressure was higher than superior sagittal sinus pressure by an almost constant 6 cm of water, regardless of position, if 30 min were allowed for the system to reach equilibrium. The sinus pressure was found to depend on simple hydrostatic theory when the sinus was at or below the level of the heart. When the sinus was above the heart, the collapsing nature of the jugular veins prevented the sinus pressure from dropping as low as a simple hydrostatic theory would predict.

Effects of stylet-in versus stylet-out collection of cerebrospinal fluid from the cisterna magna on contamination of samples, sample quality, and collection time

OBJECTIVE

To evaluate safety of stylet-in and stylet-out techniques for collection of CSF from the cisterna magna and to assess whether there were differences between techniques with regard to contamination of samples, sample quality, and efficiency of collection.

ANIMALS

10 adult purpose-bred research Beagles.

PROCEDURES

A prospective crossover study was conducted. Preanesthetic physical and neurologic examinations and hematologic analyses were performed. Dogs were anesthetized, and collection of CSF samples from the cisterna magna by use of a stylet-in or stylet-out technique was performed. Two weeks later, samples were collected with the other sample collection technique. Samples of CSF were processed within 1 hour after collection.

RESULTS

Cellular debris was detected in higher numbers in stylet-in samples, although this did not affect sample quality. The stylet-out technique was performed more rapidly. No adverse effects were detected for either technique.

CONCLUSIONS AND CLINICAL RELEVANCE

Both techniques could be safely performed in healthy anesthetized dogs. The stylet-out technique was performed more rapidly and yielded a sample with less cellular debris. Both techniques can be used in clinical practice to yield CSF samples with good diagnostic quality.