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The diagnostic utility of cerebrospinal fluid creatine kinase activity in the horse
C Jackson1, A de Lahunta, T Divers
1Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
Insights
Creatine kinase (CK) activity in cerebrospinal fluid (CSF) is unreliable for diagnosing equine neurological diseases. Contamination with epidural fat or dura during sample collection can falsely elevate CSF CK levels.
Area of Science:
- Veterinary Neurology
- Biochemistry
Background:
- Creatine kinase (CK) is an enzyme found in muscle and brain tissue.
- Elevated CK levels in cerebrospinal fluid (CSF) have been investigated as a potential biomarker for neurological disorders in horses.
Purpose of the Study:
- To evaluate the diagnostic utility of creatine kinase (CK) activity in the cerebrospinal fluid (CSF) of horses with neurological conditions.
- To determine if CSF CK activity correlates with other diagnostic parameters and identify factors influencing its levels.
Main Methods:
- CSF samples from 128 horses with various neurological disorders were analyzed for CK activity.
- CSF CK activity was compared with CSF red blood cell count, nucleated cell count, total protein, and serum CK activity.
- The sensitivity and specificity of CSF CK for specific neurological diseases were calculated.
- The impact of potential contaminants (blood, hemolyzed cells, serum, epidural fat, dura) on CSF CK activity was assessed.
Main Results:
- No significant association was found between CSF CK activity and CSF cell counts, total protein, or serum CK.
- CSF CK activity showed higher, but still inadequate, sensitivity and specificity for protozoal myelitis compared to other neurological conditions.
- Contamination with whole blood, hemolyzed red blood cells, or serum did not significantly increase CSF CK.
- Inclusion of epidural fat or dura in CSF samples significantly elevated CK activity in all tested cases.
Conclusions:
- CSF CK activity is an unreliable diagnostic indicator for neurological disease in horses.
- Falsely elevated CSF CK levels can occur due to contamination with epidural fat or dura during CSF collection procedures.
Abstract:
We evaluated creatine kinase (CK) activity in the cerebrospinal fluid (CSF) of 128 horses with various neurological disorders. No association was found between CSF CK activity and CSF red blood cell count, CSF nucleated cell count, CSF total protein concentration, or serum CK activity. The sensitivity and specificity of CSF CK activity as a diagnostic test for protozoal myelitis in horses (61% and 56%, respectively) was higher than for cervical stenotic myelopathy, degenerative myelopathy, or motor neuron disease, but was considered to be inadequate to be of use diagnostically. Contamination of CSF with whole blood, hemolyzed red blood cells, or serum did not substantially contribute to increases in CSF CK activity. Addition of epidural fat or dura to CSF significantly increased CSF CK activity in all cases. We suggest that the use of CSF CK activity as a diagnostic indicator of neurological disease in the horse in unreliable, and that CSF CK activity may be falsely increased by contamination of CSF with epidural fat or dura during CSF collection.