Subarachnoid hemorrhage and axonal degeneration after C1-C2 cervical centesis in 2 horses.
Authors: Luethy Daniela, Colmer Sarah, Jodzio Dayna, Bender Susan, Porter Erin, Hemmen Zena, Fultz Lisa, Craft William, Walker Randall, Johnson Amy, Holbrook Todd
Journal: Journal of veterinary internal medicine
Summary
Ultrasound-guided cervical centesis at the C1-C2 junction has become increasingly popular for collecting cerebrospinal fluid from standing horses, offering obvious advantages over traditional cisterna magna puncture, yet this case report documents two horses that developed serious complications—subarachnoid haemorrhage and subsequent axonal degeneration in the cranial cervical spinal cord—within days of the procedure, ultimately requiring euthanasia despite clear CSF samples with no obvious blood contamination on cytological examination. Post-mortem findings revealed that whilst one horse had pre-existing equine degenerative myeloencephalopathy contributing to its initial presentation, both animals displayed haemorrhage directly at or adjacent to the centesis needle tract with associated Wallerian degeneration affecting spinal cord axons. Although this complication appears uncommon, the cases highlight that even technically sound procedures—where fluid collection appears successful and uncomplicated—carry risk of devastating cervical spinal trauma that may not be immediately apparent clinically. Equine professionals employing C1-C2 centesis should maintain heightened vigilance for post-procedure neurological deterioration, progressive neck pain, or recumbency beyond the typical mild swelling and transient stiffness occasionally reported, and consider whether diagnostic yield justifies this potential risk in individual patients. As cervical centesis gains traction in clinical practice, further investigation into needle trajectory, insertion angle and depth control may help refine technique and reduce iatrogenic spinal cord injury.
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Practical Takeaways
- •Monitor horses closely for progressive neurologic signs, neck stiffness, regional swelling, and fever for days after C1-C2 centesis, as these may indicate serious complications beyond anecdotal post-procedure soreness
- •Be aware that absence of blood in CSF samples does not exclude hemorrhagic complications at the centesis site, as hemorrhage can occur in the subarachnoid space without contaminating collected fluid
- •Consider the risk-benefit profile of C1-C2 centesis carefully and discuss potential complications with owners, particularly as the technique becomes more widely adopted
Key Findings
- •Two horses developed subarachnoid hemorrhage and Wallerian axonal degeneration at the C1-C2 centesis site within days of routine ultrasound-guided cervical centesis
- •Initial CSF analysis showed no blood contamination in either case despite post-mortem evidence of hemorrhage
- •Both horses required euthanasia due to progressive neurologic deficits associated with the hemorrhagic complication
- •Hemorrhage with associated axonal degeneration appears rare but represents a potentially serious complication of C1-C2 centesis that warrants clinical consideration