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CSF & Serum Lactate Levels in Canine CNS Disease

Erin Y. Akin, DVM, DACVIM (Neurology), Bush Veterinary Neurology Service, Woodstock, Georgia

Neurology

|November/December 2021

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In the Literature

Fitz FR, Reese M. Association between cerebrospinal fluid lactate concentration and central nervous system disease in dogs. Vet Clin Pathol. 2020;49(4):583-589.


FROM THE PAGE …

CSF is collected via cisterna magna or lumbar puncture with the patient under general anesthesia and can be used to help evaluate CNS disorders and associated clinical signs (eg, seizures, inflammatory disease).1 CSF normally contains a small number of cells and a small amount of protein.2 Variations in composition are often nonspecific for a given disease process, and CSF analysis should be interpreted along with other diagnostic tests and physical and neurologic examinations. Lactate, creatine kinase, glial fibrillary acidic protein, and other biomarkers have been investigated in recent studies to identify more specific and sensitive markers in canine CSF.3

Measuring serum or CSF lactate levels is typically simple, inexpensive, and quickly performed in the clinic. One study in human medicine showed that increased CSF lactate levels were associated with some CNS disorders, including epilepsy, inflammatory disease, and neoplasia.4 A study established a reference range for CSF lactate levels in dogs but failed to find a consistent correlation between CSF and plasma lactate levels.5 

This study investigated the possible association between lactate levels in CSF and presence of CNS disease in 49 dogs. It also evaluated a possible correlation between concurrent lactate levels in CSF and venous blood.

Dogs were classified as having normal CSF (total nucleated cell count [TNCC] ≤5/µL, protein ≤25 mg/dL) or abnormal CSF (TNCC >5/µL, protein >25 mg/dL). Dogs with abnormal CSF were further divided into groups with TNCC >100/µL and TNCC <100/µL. Independent of TNCC, the abnormal CSF group was also divided into dogs with seizure activity, neoplastic diseases, and inflammatory diseases. 

Dogs with abnormal CSF had significantly higher CSF and blood lactate levels as compared with the normal CSF group. No significant differences in CSF or blood lactate levels were noted between dogs with abnormal CSF and higher or lower TNCC counts. No differences were found among dogs with seizure activity, neoplastic disease, or inflammatory disease. All dogs in the study had a median CSF lactate level higher than that of peripheral venous blood, but no direct correlation could be identified.

The authors concluded that CSF and blood lactate levels are useful biomarkers for CNS disease. Although CSF lactate levels are not specific for individual diseases, measurement may allow treatment to be initiated before complete CSF results are received.


… TO YOUR PATIENTS

Key pearls to put into practice:

1

Measuring CSF lactate levels may allow early initiation of treatment for presumptive CNS disease before complete CSF results are received; however, this approach should be used with, not in place of, a full neurodiagnostic investigation.

2

CSF tap and analysis are often performed in conjunction with advanced imaging (eg, MRI, CT), so referral may be necessary.

3

Further studies in veterinary medicine are needed to investigate the use of CSF lactate as a biomarker for CNS diseases.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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