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Neurology > Abnormal Neurologic Examination > Flashcards

Abnormal Neurologic Examination Flashcards

1
Q

Demented

A
  • Inappropriate response to a normal stimuli
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2
Q

Disoriented

A
  • Lost in space
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3
Q

Depressed

A
  • Behaviorally seems dull
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4
Q

Obtunded

A
  • Severe depression and dullness
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5
Q

Stuporous

A
  • Only responds to deep pain
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6
Q

Comatose

A
  • Nonresponsive and does not respond to deep pain
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7
Q

Describe decerebrate rigidity

A
  • Opisthotonos
  • Extensor rigidity of all limbs
  • Stupor or coma***
  • +/- respiratory problems
  • +/- heart rate and blood pressure problems
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8
Q

Where does decerebrate rigidity localize to?

A
  • Midbrain** (thalamus and pons)
  • Midbrain controls reticular activating system
  • Alarm of wakeup for the cortex
  • Cerebrum doesn’t get any input from the rest of the body
  • Controls blood pressure, breathing, etc.
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9
Q

What can happen with breathing during decerebrate rigidity?

A
  • Hyperventilation
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10
Q

Decerebellate rigidity appearance

A
  • Opisthotonus
  • Extensor rigidity of thoracic limbs +/- pelvic limbs
  • Aware of the environment**
  • Other cerebellar signs like intention tremors
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11
Q

Where does decerebellate rigidity localize?

A
  • Cerebellum
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12
Q

What is the primary way to differentiate decerebrate and decerebellate?

A
  • Decerebellate are aware of the environment, and decerebrate are not
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13
Q

Schiff Sherrington appearance

A
  • Extensor rigidity of thoracic limbs

- NO opsithotonus

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14
Q

WHat causes Schiff Sherrington?

A
  • Lack of inhibition to the extensors of thoracic limbs (border cells)
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15
Q

Where is the lesion usually with Schiff Sherrington?

A
  • T3-L3 lesion

- UMN paraplegia

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16
Q

Can you use Schiff Sherrington as a prognostic indicator?

A
  • NO
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17
Q

Head turn description

A
  • Nose is deviated to one side or the other
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18
Q

Localization of lesion with head turn

A
  • Supratentorial lesion
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19
Q

Where is the lesion most of the time with a head turn?

A
  • Towards the side of the head turn
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20
Q

Head tilt description

A
  • Head is tilted without deviation of the nose
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21
Q

Localization of head tilt

A
  • Cerebellar or vestibular
  • Usually towards the size of the lesion
  • Paradoxical head tilt is away from the side of the lesion
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22
Q

Describe paradoxical head tilt

A
  • Away from the side of the lesion
  • Caudal cerebellar peduncle
  • Flocculonodular lobe of the cerebellum
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23
Q

Cerebellar lesion features

A
  • Head tilt (paradoxical)
  • Nystagmus/ocular tremors
  • Falling/wide-based stance
  • Hypermetrix ataxia
  • Circling
  • Intention tremors
  • Menace deficit (ipsilateral) but visual
  • Rebound phenomenon
  • Decerebellate rigidity
  • Elevated 3rd eyelid, pupillary dilation, enlarged palpebral fissure
  • Increased urination
  • NO CP deficits or paresis
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24
Q

Should a dog with a cerebellar lesion have CP deficits?

A
  • NO
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25
Q

Appearance of eyes with cerebellar lesions?

A
  • Elevated 3rd eyelid
  • Pupillary dilation
  • Enlarged palpebral fissure
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26
Q

Menace with cerebellum

  • present/absent?
  • What side?
  • Are they visual or not?
A
  • Menace deficit (ipsilateral) but visual
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27
Q

Vestibular lesion features

A
  • Head tilt
  • Nystagmus
  • Falling/wide-based stance/rolling
  • Ataxia
  • Circling
  • Head tremors and eyelid contraction secondary to nystagmus
  • Positional strabismus
  • +/- CP deficits or paresis (>ipsilateral)
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28
Q

Where does a positional strabismus generally localize?

A
  • vestibular lesion
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29
Q

Type of ataxia with cerebellar lesion?

A
  • Hypermetric ataxia
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30
Q

What is rebound phenomenon?

A
  • Elevate the head put out of orientation, they fall down

- Normally the dog should just put their head down normally

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31
Q

What are the two locations for vestibular lesions?

A
  • Central (supratentorial or infratentorial)

- Peripheral (inner ear)

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32
Q

What are four ways to differentiate a central vestibular lesion from a peripheral lesion?

A
  • Vertical nystagmus*
  • Changing nystagmus*
  • CN deficits other than 7 or 8**
  • CP deficits
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33
Q

What CN deficits can you see with a peripheral vestibular lesion?

A
  • CN 7 and 8
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34
Q

Case:

Right head tilt
Vertical nystagmus
Right hemiparesis

A
  • Right sided central vestibular
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35
Q

Case:

Left head tilt
Vertical nystagmus
Right hemiparesis

A
  • Right sided central vestibular/cerebellar with paradoxical head tilt
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36
Q

If you have contradicting left and right central vestibular signs what should you go with?

A
  • Go with the side of the paresis

- Remember you can have a paradoxical head tilt

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37
Q

Type of circling with cerebellar and infratentorial vestibular lesion?

A
  • Usually tight circles
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38
Q

Type of circling with supratentorial vestibular lesion?

A
  • Usually bigger circles
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39
Q

Direction of circles in general?

A
  • TOWARDS the side of the lesion
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40
Q

Kyphosis

A
  • Dorsal curvature of the spine
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41
Q

Scoliosis

A
  • Lateral curvature of the spine
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42
Q

Dfdx for scoliosis

A
  • Painful or denervated on one side
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43
Q

Dfdx for ventral neck flexion

A
  • neck pain
  • Myopathy/neuropathy
  • Myasthenia gravis
  • Thiamine deficiency
  • Hyperthyroidism
  • Organophosphate toxicity
  • Ethylene glycol toxicity
  • Electrolyte abnormalities
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44
Q

Which electrolyte abnormalities associated with ventral neck flexion?

A
  • K
  • Na
  • Ca
  • Phosphate
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45
Q

Abnormal gaits associated with neurologic disease (also orthopedic disease!)

A
  • Lameness
  • Ataxia
  • Dysmetria - hypermetria
  • Increased step distance
  • Decreased step distance
  • Paresis
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46
Q

What is the nerve root signature?

Appearance and significance

A
  • Intermittent packing of the limb and crying

- Should rule out a nerve root tumor

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47
Q

Ataxia definition

A
  • Lack of an axis

- Failure of muscle coordination

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48
Q

Three types of ataxia

A
  1. Vestibular ataxia
  2. Cerebellar ataxia
  3. Proprioceptive/sensory ataxia
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49
Q

Vestibular ataxia appearance

A
  • Falling/leaning
50
Q

Cerebellar ataxia appearance

A
  • Hypermetria

- Disease of cerebellum or spinocerebellar tracts of the spinal cord

51
Q

Proprioceptive/sensory ataxia appearance

A
  • Wide-based, crossing over, swaying; dz in CP pathway
52
Q

Where is the lesion with cerebellar ataxia?

A
  • CEREBELLUM or spinocerebellar pathways (spinal cord)
53
Q

Definition of step distance

A
  • Distance between the 2 thoracic limbs or 2 pelvic limbs when both are on the floor
54
Q

What does increased step distance indicate?

A
  • UMN lesion
55
Q

What does decreased step distance indicate?

A
  • LMN lesion or pain
56
Q

Describe the two parts of the 2 engine gait

A
  • Decreased step distance in the front (LMN)

- Increased step distance in the pelvic limb (UMN)

57
Q

Where does a 2 engine gait localize?

A
  • C6-T2

- LMN in the front and UMN in the hind

58
Q

Paresis Description

A
  • Weakness at gait
59
Q

What causes paresis?

A
  • partial loss of voluntary movement
  • Deficiency in the generation of gait
  • Deficiency in the ability to support weight
60
Q

Clinical manifestations of paresis

A
  • Slow or shuffling gait
  • Dragging/ knuckling of the dorsum of the paw
  • Collapse/falling
  • Exercise intolerance/fatigability
  • unable to support weight
  • Other: difficulty rising
  • inability to jump/climb stairs
  • Unable to maintain squatting position to urinate or defecate
  • Increased ROM - stiff/stilted gait
  • Bunny hopping
61
Q

What is this the definition for?

Weakness in both pelvic limbs

A
  • Paraparesis
62
Q

What is this the definition for?

Weakness in all four limbs

A
  • Tetraparesis
63
Q

What is this the definition for?

Weakness in the thoracic and pelvic limbs on one side

A
  • Hemiparesis
64
Q

What is this the definition for?

Weakness in one limb

A
  • Monoparesis
65
Q

How should you classify paresis further?

A
  • Ambulatory or non-ambulatory
66
Q

What is this the definition for?

No voluntary motor

A
  • Plegia
67
Q

Sitting position that suggests CP deficits in both pelvic limbs

A
  • Sit on their caudal thigh muscles like people
68
Q

What is central cord syndrome?

A
  • CP deficits in the thoracic limbs more severely
69
Q

What does central cord syndrome suggest?

A
  • More disease in the central core of the spinal cord
70
Q

Where are the thoracic tracts relative to the pelvic tracts in the spinal cord?

A
  • The pelvic tracts are more lateral
71
Q

What is happening with reflexes and muscle tone during a clonic event?

A
  • Hypertonia and hyperreflexia
72
Q

To review again with UMN lesions:

  • Reflexes?
  • Muscle tone?
  • Atrophy type and progression?
A
  • Reflexes are hyperreflexic or normoreflexic
  • Hypertonia/stiff to normal tone
  • Disuse atrophy - slow and less severe
73
Q

To review again with LMN lesions:

  • Reflexes?
  • Muscle tone?
  • Atrophy type and progression?
A
  • Hyporeflexia/areflexia
  • Hypotonia/flaccid
  • Neurogenic atrophy (acute and severe)
74
Q

If you find a cut-off on a cutaneous reflex, where is the lesion?

A
  • Lesion is 1-2 spinal cord segments cranial to the cutoff
75
Q

What if cutaneous trunci reflex is absent on one side regardless of where you pinch?

A
  • Efferent problem on that side (C8-T1 spinal cord segments and nerve roots, lateral thoracic nerve, or cutaneous trunci)
  • More likely peripheral nerve or C8-T1 because there’s where cutaneous trunci afferent nerves go
76
Q

Vertebral body associated with the last rib?

A
  • T13
77
Q

WHat spinous process is perpendicular to the last rib?

A
  • L2
78
Q

Brachial plexus avulsion appearance

A
  • Efferent or lateral thoracic nerve on the left side
  • Dog can’t extend the elbow
  • Left thoracic limb can’t extend elbow or bear weight
79
Q

Neuro exam findings associated with optic nerve deficit?

A
  • Menace deficit (and avisual)
  • Absent/decreased PLR
  • Mydriasis
80
Q

Neuro exam findings associated with oculomotor nerve deficit?

A
  • Ptosis (droopy upper eyelid)
  • Ventrolateral resting strabismus
  • Mydriasis from parasympathetic CN3 dysfunction
81
Q

Sympathetic dysfunction signs (i.e. Horner’s syndrome)

A
  • elevated third eyelid
  • Ptosis
  • Miosis
  • Enopthalmosis
82
Q

What is the most common singular sign of Horner’s in SA?

A
  • MIosis
83
Q

In a large animal, what is the most common single sign of Horner’s?

A
  • Ptosis
84
Q

Describe the pathway for sympathetic innervation that is often disrupted with Horner’s syndrome? (1st, 2nd, and 3rd order cell body locations)

A
  • 3rd order cell body: cranial cervical ganglion (goes through inner ear to brain and eye)
  • 2nd order cell body (pre-ganglionic): T1-2 spinal cord segments (runs cranially as vagosympathetic trunk)
  • 1st order cell body: hypothalamus (hypothalamus to brainstem to cervical spinal cord to T1-T2)
85
Q

1st order neuron for sympathetic innervation to the eye route

A
  • Hypothalamus –> down brain stem –> down spinal cord
86
Q

2nd order neuron for sympathetic innervation to the eye route

A
  • T1-T2 spinal cord segments - -> travels cranially with vagosympathetic trunk to the neck
87
Q

3rd order neuron for sympathetic innervation to the eye route

A
  • Cranial cervical ganglion –> through the tympano-occipital fissure into the inner ear –> travels into the ventral floor of the brain –> exit skull through orbital fissure
88
Q

Five things that have sympathetic innervation within the eye and what happens when they lose innervation?

A
  1. Dilator muscles of the pupil (miosis)
  2. Periorbital smooth muscles (enophthalmos)
  3. Third eyelid (elevated)
  4. Eyelid/Muller’s muscle (ptosis)
  5. Blood vessels within and around the eyes
89
Q

What is the word for this definition?

  • Unequal pupil size
A
  • Anisocoria
90
Q

What are causes of miosis (constricted pupil)?

A
  • Increased parasympathetic tone (pilocarpine or severe cerebrocortical disease)
  • Decreased sympathetic (Horner’s syndrome)
  • Primary ocular (corneal ulcer and uveitis)
  • Spastic pupil syndrome - FeLV/FIV
91
Q

What are causes of mydriasis (dilated pupil)?

A
  • Decreased parasympathetic (atropine, CN3 dysfunction)
  • Increased sympathetic (phenylephrine)
  • Primary ocular (blindness, glaucoma, iris atrophy)
  • Cerebellar disease (mydriasis)*
92
Q

Trochlear nerve dysfunction examination findings

  • which eye is impacted?
A
  • CONTRALATERAL* ventromedial resting strabismus
  • Superior oblique pulls eye medially normally, so without it, the eye rolls laterally
  • Y of the retinal vessels is tilted in the fundus in dogs
  • In cats, the pupils are tilted
93
Q

Type of strabismus in a cat with CN IV dysfunction

A
  • Ventromedial strabismus

- Vertical pupils

94
Q

Type of strabismus in a horse with CN IV dysfunction

A
  • Ventrolateral strabismus

- Horizontal pupils

95
Q

If you have a cat with ventromedial strabismus in the left eye, where is the lesion?

A
  • Right CN IV
96
Q

Abducent nerve dysfunction examination findings

A
  • Ventromedial or medial resting strabismus because you lose the lateral rectus
97
Q

Which cranial nerves cause resting strabismus?

A
  • 3, 4, and 6
98
Q

Which CN causes positional strabismus?

A
  • CN VIII
99
Q

Where are the issues potentially with decreased facial sensation (reflex and response)?

A
  • CN V
  • CN VII
  • Contralateral cortex
100
Q

What should you think of with a severe atrophy of the temporalis muscle?

A
  • mandibular branch of CN V dysfunction

- Mostly due to a nerve sheath tumor

101
Q

Where is the dysfunction with a dropped jaw?

A
  • BILATERAL*** Mandibular branch dysfunction (CN5)
102
Q

Which CN is associated with neurotropic keratitis?

A
  • CN5
103
Q

Why does CN5 dysfunction lead to neurotropic keratitis (2 primary reasons)?

A
  • Lack of eyeball and eyelid sensation due to ophthalmic and maxillary dysfunction –> reduce blinking –> corneal drying
  • Lack of proper corneal nutrition due to ophthalmic branch dysfunction –> corneal necrosis
104
Q

CN 7 clinical signs

A
  • Facial nerve paralysis (acute

- Also hemifacial spasm (peracute or chronic)

105
Q

Causes of facial paralysis (and two most common)?

A
  • Idiopathic*** (must rule out other causes)
  • Inner/middle ear disease*
  • Hypothyroidism (always recommend a T4)
  • Trauma
  • Neoplasia - brainstem level of in the nerve peripherally
  • Polyneuropathy
106
Q

What are two causes of hemifacial spasm?

A
  1. Irritated CN7 (initially)

2. result of chronic CN7 paralysis (fibrosis of muscles)

107
Q

In a horizontal nystagmus, where is the slow phase of the nystagmus away from/towards the lesion/

A
  • TOWARDS the lesion

- Fast phase is FLEEING the lesion

108
Q

Again, where does a positional strabismus with no resting strabismus localize?

A
  • CN 8 vestibular dysfunction** (central or peripheral)
  • MLF (medial longitudinal fasciculus)
  • CN 3 (oculomotor)
  • CN 4 (trochlear)
  • CN 6 (abducent nerve)
109
Q

peripheral causes of vestibular disease

A
  • Ear infection
  • Foreign body
  • Polyp
  • Trauma/hemorrhage
  • Tumor
  • Hypothyroidism
  • Drugs - aminoglycosides, furosemide, ear cleaning agents (make sure inner ear is intact)
  • Congenital
  • Idiopathic (geriatric vestibular disease)
110
Q

Central causes of vestibular disease

A
  • Tumor
  • Encephalitis or meningitis (either infectious from CDV, RMSF, FIP or auto-immune/non-infectious)
  • Hydrocephalus
  • Trauma or hemorrhage
  • Cerebral vascular accidents
  • Drugs (metronidazole)
  • Thiamine deficiency
111
Q

What is the dose of metronidazole that can cause a central vestibular lesion?

A
  • more than 50 mg/kg/day
112
Q

Who gets idiopathic geriatric vestibular disease?

A
  • Older dogs lol
113
Q

Clinical signs of idiopathic geriatric vestibular disease

A
  • Acute onset of PERIPHERAL vestibular signs
  • Mild head tilt to severe imbalance/rolling
  • Usually unilateral signs
114
Q

Treatment of idiopathic geriatric vestibular disease

A
  • No treatments
  • Supportive care
  • May decide to keep them in a comfortable environment
  • Can put them on valium or trazodone
  • Antihistamines like benadryl or meclizine
115
Q

How long can it take for dogs to recover with idiopathic geriatric vestibular disease?

A
  • Improve rapidly, but can take 2-3 weeks for complete recovery
  • Usually ambulatory within 1 week
116
Q

Residual signs of idiopathic geriatric vestibular disease?

A
  • Can have a residual head tilt

- Can be relapsing

117
Q

Diagnosis of idiopathic geriatric vestibular disease

A
  • Diagnosis of ruling out other causes of peripheral vestibular disease
  • Doing good blood work (hypothyroid)
  • otoscopic exam
  • Drug history
118
Q

Idiopathic vestibular disease in cats - how common? what age?

A
  • Happen in cats but at any age and is more rare
119
Q

Which CNs could be affected with poor gag or swallow?

A
  • CN 9

- CN 10

120
Q

CN dysfunction associated with megaesophagus potentially -

A
  • CN 10
  • May see dilation of the throat area
  • Pretty uncommon to see
121
Q

Hypoglossal nerve dysfunction signs

  • Ipsilateral or contralateral to lesions?
A
  • See a shriveling of the tongue
  • Often falls towards the weaker side but as you get more chronic it goes toe the stronger side
  • Ipsilateral

Neurology (14 decks)

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