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Critical Risks of CSF Collection in Dogs: Insights from 11 Major Complications

JVIM 2025

Cecilia-Gabriella Danciu, Alana McCarthy, Abbe Crawford

Background
Cerebrospinal fluid (CSF) collection is a common diagnostic procedure in veterinary neurology, typically regarded as safe. However, severe complications such as brain herniation or death, though rarely reported, may occur, particularly in cases with elevated intracranial pressure (ICP). This study aimed to identify the frequency and nature of major complications following CSF collection in dogs over a 26-year period at a single referral center.

Methods
A retrospective review of medical records from 1998 to 2024 was conducted to identify dogs that experienced major complications after CSF collection. A major complication was defined as any event requiring immediate therapeutic intervention, resulting in prolonged hospitalization, permanent neurological deficits, or death. MRI and other diagnostics were reviewed for clinical and imaging characteristics associated with adverse outcomes.

Results
Out of 7,545 CSF collections, 11 dogs (0.15%) experienced major complications. Common findings included abnormal mentation (8/11), effacement of cerebral sulci (7/9), and ventricular dilatation (5/9) on MRI. CSF analysis aided in diagnosing conditions such as meningoencephalitis of unknown origin (MUO), lymphoma, and cryptococcosis. Eight dogs were euthanized or died due to failure to recover spontaneous ventilation, cardiopulmonary arrest, or neurological decline. Two dogs survived with permanent deficits, and one diagnosis was inconclusive.

Limitations
The retrospective design limited control over diagnostic consistency. In some cases, deterioration may have resulted from disease progression rather than the CSF collection itself. Lack of post-complication imaging or necropsy in several cases precluded definitive attribution. The small sample size also limits generalizability.

Conclusions
Although the overall rate of major complications was low, mortality among affected dogs was high. MRI signs suggestive of increased ICP, particularly cortical swelling, were common in affected dogs. Clinicians should carefully weigh risks and benefits of CSF collection in neurologically compromised dogs, especially when MRI abnormalities are present. Prospective multicenter studies are warranted to better define high-risk features.

Magnetic resonance images of the brain of two dogs that had a major complication secondary to CSF collection (A–C: Dog 4, D: Dog 11). (A) Transverse T2-weighted (T2W), (B) T2W fluid attenuated inversion recovery (FLAIR) and (C) T1-weighted post-contrast images at the level of the optic chiasm of Dog 4. There are multifocal, ill-defined intra-axial lesions (white arrows) in the gray and white matter which appear T2W and T2W-FLAIR hyperintense, with focal contrast enhancement (yellow arrow). Additionally, there is generalized effacement of the cerebral sulci. (D) T2W sagittal view of the brain of Dog 11 shows generalized dilatation of the ventricular system (yellow asterisks). The interthalamic adhesion is reduced in size (white asterisk), and there is evidence of flow artifact in the mesencephalic aqueduct (orange arrowhead). There is moderate, poorly demarcated intramedullary T2W hyperintensity in the rostral aspect of the cervical spinal cord (white arrowhead). All changes are described relative to normal gray matter.

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