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Spinal Surgery 1 > Cranial Nerve Examination and Differential Diagnosis > Flashcards

Cranial Nerve Examination and Differential Diagnosis Flashcards

1
Q

What are the four stages evaluation of the cranial nerves can be divided into?

A

1 Assessment of symmetry of the face
2 Eyes (neurophthalmic examination)
3 Facial sensation
4 Gag reflex.

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2
Q

When a reflex is assessed, it will mostly evaluate the brainstem with…?

A

An afferent and efferent pathway

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3
Q

What change is seen in the following with forebrain lesion abnormalities:
A) Mental status?
B) Cranial nerves?

A

A) Altered mentation/change in behaviour
B) Contralateral lack of menace with normal PLR

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4
Q

What change is seen in the following with forebrain lesion abnormalities:
A) Posture/gait
B) Postural reaction?

A

A) Normal gait with poss abnormal posture
B) Contralateral deficits

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5
Q

What change is seen in the following with forebrain lesion abnormalities:
A) Spinal reflexes/muscle tone
B) Sensation
C) Other symptoms possibly seen? (2 - neuro)

A

A) Normal to increased contralaterally
B) Facial and body contralateral absent to decreased
C) Seizures/hemi-neglect syndrome

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6
Q

What change is seen in the following with brainstem lesion abnormalities:
A) Mental status?
B) Cranial nerves?

A

A) Altered
B) 3 - 12

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7
Q

What change is seen in the following with brainstem lesion abnormalities:
A) Posture/gait
B) Postural reaction?

A

A) Tetra/hemi paresis/plegia
B) Affected all 4 limbs/one side

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8
Q

What change is seen in the following with brainstem lesion abnormalities:
A) Spinal reflexes/muscle tone
B) Sensation
C) Other symptoms possibly seen? (not neuro!)

A

A) Normal to increased in all four limbs or ipsilaterally
B) Possible cervical hyperaesthesia
C) Poss cardiac/resp abnormailites

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9
Q

The two cranial nerves involved in the symmetry of the face are ?

A

trigeminal (CN V) and facial (CN VII) nerves.

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10
Q

The trigeminal nerve is sensory for the A) and motor for the B) through its mandibular branch.

A

A) entire face (cutaneous, cornea, nasal septum and oral cavity)
B) masticatory muscles

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11
Q

The facial nerve is innervating the A) of the face and sensory for the

A

A) muscles of the expression
B) rostral part of the palate and tongue.

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12
Q

Testing the palpebral reflex involves which nerves? (2)

A

facial (CN VII) and trigeminal (CN V) nerves.

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13
Q

Afferent nerve of the palpebral reflex?

A

Trigeminal (V)

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14
Q

Efferent nerve of the palpebral reflex?

A

Facial (VII)

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15
Q

The facial nerve has parasympathetic fibres supplying?

A

Lacrimal glands

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16
Q

Dysfunction of the facial nerve parasympathetic fibres can cause what? (2)

A

KCS (dry eye) and xeromycteria (dry nose)

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17
Q

PLR efferent pathway?

A

Oculomotor (III)

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18
Q

PLR afferent pathway?

A

Optic (II)

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19
Q

Aside from a lesion affecting the PLR pathways, the PLR can de decreased or absent in cases of? (3)

A

Iris atrophy
Drugs to dilate pupils
Light source of insufficient intensity.

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20
Q

Which nerves are involved in the menace response?

A

II and VII

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21
Q

How to perform a menace response?

A

The menace response is elicited by waving the hand toward one eye and blindfolding the other, creating a visual threat, the response is involving the awareness of the patient and should elicit the closure of the eyelid.

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22
Q

When is the menace response more reliable in cats?

A

When not blindfolded

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23
Q

Define nystagmus

A

Nystagmus is the involuntary rhythmic oscillation of the eyeball.

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24
Q

The extraocular muscles are controlled by which nerves? (3)

A

oculomotor nerve (CN III), trochlear nerve (CN IV), and abducens nerve (CN VI).

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25
Physiological nystagmus can be elicited how?
moving the head from side to side and up and down.
26
When is pathological nystagmus seen?
At rest
27
However, in some cases no abnormal eye movement is seen at rest but can be observed if the vestibular system is challenged. How could you then look for pathological positional nystagymus?
change the head position or have the patient on its back
28
How to assess facial sensation? (2)
Corneal reflex Nasal stimulation
29
How to perfom the corneal reflex?
a damp cotton bud to touch the sclera of the eye and then evaluating closure of the eyelids and retraction of the globe.
30
Which nerves does the corneal reflex involve? (2)
ophthalmic branch of the trigeminal nerve (CN V) facial nerve (CN VII)
31
In cases of involvement of the ophthalmic branch of the CN V when performing corneal reflex, what may occur? (2)
neuroparalytic keratitis and ulcerative keratitis
32
How to perform nasal stimulation; what are you looking for?
Cover eyes, applying a forceps to the nasal mucosa; observing withdrawal of the head which is cortically mediated
33
Afferent pathway of the nasal stimulation?
Ophthalmic branch of V
34
Why might nasal stimulation be reduced?
Ipsilateral trigeminal lesion contralateral forebrain/cortical lesion as it involves the contralateral cerebral hemisphere.
35
The swallowing or gag reflex can be elicited by
applying gentle pressure on the larynx after opening the mouth.
36
Which nerves are assessed with gag reflex? (3)
IX (glossopharyngeal), X (vagus), hypoglossal (CN XII)
37
Normal response to gag reflex?
The patient will normally close its mouth, swallow, and lick its nose.
38
Dysphagia due to reduced gag reflex can be seen in patient with what types of conditions (2)
neuromuscular conditions brainstem lesions
39
Dysphagia due to lack of gag reflex; increases morbidity how?
Increased aspiration pneumonia
40
The aim of the neurological examination is to
achieve a neuro-anatomical localisation
41
localisations are generally divided into: (3)
Intracranial (prosencephalon, brainstem and cerebellar) Spinal (C1-C5, C6-T2, T3-L3, L4-S2) Neuromuscular system.
42
3 subdivisions of intracranial localisation?
prosencephalon, brainstem cerebellar)
43
The list of differential diagnoses is formulated based on: (4)
Signalment Onset Progression Response to possible therapies tried.
44
what does VITAMIN D stand for for your D/Dx?
Vascular Inflammatory Trauma or Toxic Anomalous Metabolic Idiopathic Neoplastic Degenerative.
45
C1 - C5 spinal cord segment lesions; escribe the abnormalities with: A) Mental status? B) Cranial nerves? C) Posture/gait? (3)
A) Normal B) Normal; possible ipsilateral horners C) Tetraparesis Hemiparesis/hemiplegia Possible torticollis/scoliosis
46
C1 - C5 spinal cord segment lesions; describe the abnormalities with: A) Proprioception? B) Spinal reflex/muscle tone C) Sensation?
A) All 4 limbs affected/ipsilateral side affected B) Normal - increased in all 4 limbs C) Poss cervical hyperaesthesia
47
C1 - C5 spinal cord segment lesions; wat "other" non defined signs may be seen? (4)
Persistent scratching on neck and shoulder Respiratory difficulty Nerve root signature Urinary incontinence
48
What is nerve root signature
Neurogenic lame
49
C6- T2 spinal cord segment lesions; describe the abnormalities with: A) Mental status? B) Cranial nerves? C) Posture/gait?
A) Normal B) Normal; possible ipsilateral horners C) Tetraparesis Hemiparesis/hemiplegia
50
C6- T2 spinal cord segment lesions; describe the abnormalities with: A) Proprioception? B) Spinal reflex/muscle tone C) Sensation? (3)
A) All 4 limbs affected/one side affected B) Decreased in one or both thoracic limb and normal to increased in pelvic limbs C) Possible hyperaesthesia at the level of the lesion Possible reduced to absent sensation caudal to the lesion Cutaneous trunci reflex depressed or absent (unilaterally or bilaterally)
51
C6- T2 spinal cord segment lesions; wat "other" non defined signs may be seen?
Urinary retention
52
T3 - L3 spinal cord segment lesions; describe the abnormalities with: A) Mental status? B) Cranial nerves? C) Posture/gait? (3) Thoracic limbs?
A) Normal B) Normal C) Thoracic limbs unaffected Paraparesis/plegia Kyphosis Schiff-Sherrington posture possible
53
T3- L3 spinal cord segment lesions; describe the abnormalities with: A) Proprioception? B) Spinal reflex/muscle tone C) Sensation? (3)
A) One or both pelvic limbs affected B) Normal in the thoracic limbs and normal to increased in the pelvic limbs C) Possible hyperaesthesia at the level of the lesion Possible reduced to absent sensation caudal to the lesion Cutaneous trunci reflex depressed or absent (unilateral or bilateral)
54
T3- L3 spinal cord segment lesions; what "other" non defined signs may be seen?
Urinary incontinence
55
L4 -S2 spinal cord segment lesions; describe the abnormalities with: A) Mental status? B) Cranial nerves? C) Posture/gait? (1) Thoracic limbs?
A) Normal B) Norm C) Thoracic limbs unaffected, paraparesis/plegia
56
L4 - S2 spinal cord segment lesions; describe the abnormalities with: A) Proprioception? B) Spinal reflex/muscle tone C) Sensation? (3)
A) One or both pelvic limbs affected Decreased muscle tone B) Unaffected in thoracic limbs Decreased in the pelvic limbs C) Possible hyperaesthesia at the level of the lesion Possible reduced to absent sensation caudal to the lesion
57
L4 - S2 spinal cord segment lesions; what "other" non defined signs may be seen? (5)
Urinary and faecal incontinence Nerve root signature Lameness No perineal tone and sensation Tail paresis-paralysis Decreased sensation of tail
58
A lesion in which spinal cord segments may cause ipsilateral Horner’s syndrome?
C1- C5 C6-T2
59
If spinal reflexes are decreased in the thoracic limbs and increased in the pelvic limbs, which spinal cord segment is affected?
C6 - T2
60
Which spinal cord segment is affected in an animal with pareparesis and decreased spinal reflexes in the pelvis limbs?
L4 - S2
61
In an animal presenting in Schiff-Sherrington posture, which spinal cord segment is affected?
T3 - L3
62
Neuromuscular lesions; what abnormalities are seen with: A) Mental status B) Cranial nerves C) Posture/gait
A) Normal B) Poss deficits of 7, 9, 10 C) Flaccid tetraparesis/plegia
63
Neuromuscular lesions; what abnormalities are seen with: A) Proprioception B) Spinal reflexes/muscle tone C) Sensation
A) Deficits on affected limbs B) Decreased to absent in affect limbs C) Decreased to absent nociception and sensation
64
What non neuro signs might be seen with neuro muscular lesions?
Self mutilation
65
D/Dx that are neuroVascular (3)
Hemorrhagic myelopathy Ischemic myelopathy / fibrocartilaginous embolism Acute non compressive nucleus pulposus extrusion
66
D/Dx that are Inflammatory and Infectious (6)
Discospondylitis Spinal empyema Bacterial meningo-myelitis Neospora / Toxoplasma / Crytococcus myelitis Feline coronavirus meningo-myelitis (FIP) distemper meningomyelitis
67
D/Dx that are Inflammatory and non-Infectious (3)
Meningomyelitis Meningoencephalitis of unknown origin Steroid-responsive meningitis-arteritis
68
D/Dx that is due to Trauma (4)
Spinal trauma (vertebral fracture -luxation) Traumatic disc extrusion Spinal cord contusion Brachial and lumbar plexus avulsions
69
D/Dx that are neuro Toxic (2)
Tetanus Botulism
70
D/Dx that are anomalous? (9)
Atlantoaxial instability and subluxation Arachnoid cysts/pseudo-cysts Constrictive myelopathy and associated articular facet dysplasia Chiari-like malformations and syringomyelia / hydromyelia Dermoid sinus Spina bifida/meningomyelocoele Vertebral malformation and associated kyphosis / scoliosis / lordosis Globoid leukodystrophy Mucopolysaccharidosis type 1/ VI
71
D/Dx that are Metabolic (nutritional) (2)
Hypervitaminosis A Nutritional secondary hyperparathyroidism
72
D/Dx that are Idiopathic (4)
Idiopathic facial neuropathy Idiopathic trigeminal neuropathy Idiopathic vestibular syndrome Idiopathic epilepsy
73
D/Dx that are Neoplastic (7)
Spinal meningiomas Peripheral nerve sheath tumours Spinal lymphoma Vertebral body tumour Vertebral plasma cell tumour Spinal ependymomas Neuroepithelioma
74
D/Dx that are Degenerative (5)
Degenerative myelopathy Afghan Hound myelopathy Motor neuron disease in German Shepherds Hereditary ataxia Rottweiler leukoencephalomyelopathy
75
D/Dx that are Structural / Compressive Degenerative Disorders (9)
Calcinosis circumscripta Cervical spondylomyelopathy (disc associated wobbler syndrome or osseous associated wobbler syndrome) Constrictive myelopathy Foraminal Stenosis Intervertebral disc degeneration and extrusion (Hansen type I) or protrusion (Hansen type II) Degenerative lumbosacral stenosis Osteochondromatosis Spondylosis deformans Spinal synovial cysts

Spinal Surgery 1 (10 decks)

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