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MOD > E3. Neurology > Flashcards

E3. Neurology Flashcards

1
Q

What are the 9 steps/approaches to a patient with neurological dysfunction?

A
  1. Determine case signalment and owners complaint.
  2. Obtain history.
  3. Perform a general physical examination.
  4. Perform a neurological examination and localize lesion/s.
  5. Compile differential diagnosis list.
  6. Collect minimum database.
  7. Do special diagnostic tests.
  8. Establish prognosis with and without treatment.
  9. Initiate therapy if necessary.
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2
Q

True or false for case signalment:

Most neurological diseases affect animals of certain age, breed or sex.

A

True.

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3
Q

What might determination of the onset and progression of neurological signs indicate?

A

Possible etiologies

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4
Q

What might a peracute onset of neurological signs suggest? (Possible etiology)

A

Trauma or disc extrusion.

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5
Q

What might a slow progressive development of neurological signs be more likely to suggest? (Possible etiologies)

A

Degenerative, neoplastic or metabolic changes.

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6
Q

On your general physical examination if you see dysfunction in the nervous system and other organ systems what might this suggest? Give examples.

A

Polysystemic disorders might be present.

Examples are distemper, metabolic problems (hepatic encephalopathy, renal failure), neoplasia.

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7
Q

What can influence the prognosis and treatment of neurological problems? (These could be found on a general physical examination) (general think of summation)

A

Concurrent diseases

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8
Q

What is the purpose of a neurological examination?

A

Localized neurological lesions in animals with neurological dysfunction.

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9
Q

Where are your upper motor neurons (UMN) cell bodies and axons located? (4)

A

Situated in the cerebral cortex and brainstem (cell bodies) and in the brain stem or spinal cord (axons)

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10
Q

Where are your lower motor neurons (LMN) cell bodies and axons located?

A

Cell bodies: brainstem (cranial nerves) or ventral horn of the spinal cord (peripheral nerves).
Axons: runs in the cranial or peripheral nerves and supply muscles and glands of the body.

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11
Q

What is able to control the lower motor neurons?

A

Voluntary control (via UMNs) and can also be controlled by reflex activity in the spinal cord.

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12
Q

Look at the bottom of page 2 in top of page 3

A

.

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13
Q

What type of affected does upper motor neurons have on the lower motor neurons spinal reflexes tested in the neurological examination?

A

It will inhibit.

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14
Q

What happens if you lose your upper motor neurons?

A

Loss of UMNs therefore results in intact or hyperactive spinal reflexes. It also results in paralysis/ pareseis, mild muscle atrophy due to disuse, normal/increased tone in limb muscles, and abnormal reflexes such as the crossed- extensor reflex (see below).

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15
Q

What happens if you lose your lower motor neurons?

A

(1) paresis or paralysis,
(2) hyporeflexia or areflexia,
(3) early and severe muscle atrophy which may result in fibrosis and contracture of affected muscles after several weeks,
(4) loss of muscle tone.

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16
Q

What type of neurons is responsible for carrying conscious proprioception and pain and touch information to the contralateral cerebral cortex?

A

Long tract sensory neurons

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17
Q

What happens if there is a lesion in the long tract sensory nerves? (5)

A

(1) anesthesia or hypoesthesia caudally to the lesion,
(2) normoreflexia,
(3) abnormal positioning of the feet (lack of conscious proprioception),
(4) dysmetria (usually hypermetria - steps are longer and higher than normal, and
(5) ataxia (incoordination - a swaying staggering gait with occasional hypermetria and catching of limbs dd. weakness - stiff stilted gait with short strides, postural tremor, usually collapses or rests after a few strides)

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18
Q

look at page 3

A

.

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19
Q

Lesions between the 6th cervical spinal cord segment (lying within the vertebral canal of vertebra C6) and the 2nd thoracic spinal cord segment (in T2) affect what?

A

Affect the cell bodies of the LMN to the forelimb – radial nerve etc.

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20
Q

Lesions in the C6 to T2 spinal cord segments can cause what?

A

Cause LMN and segmental sensory signs to one front limb (if the lesion is unilateral) or both front limbs (if the lesion is bilateral). In the hind limbs, signs will also be seen but these will be UMN and long tract sensory.

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21
Q

What can a lesion in the spinal cord segment of T3 to L3 cause?

A

Lesions in spinal cord segments T3 to L3 cause UMN and long tract sensory signs in the hind limbs. Lesions caudal to L3 will involve the cell bodies of the nerves of the hind limbs (femoral, sciatic, etc) and this will therefore give rise to LMN and segmental sensory signs in the hind limbs.

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22
Q

Look at page 4

A

.

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23
Q

What can cause hyperreflexia?

A

Loss of upper motor nor on inhibition to extensor spinal neurons. It can also be due to the narration hypersensitivity where partially innervated spinal motor neurons become more sensitive to afferent stimulation.

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24
Q

What can cause cross extensor reflex?

A

There are long spinal reflexes between limbs that are usually suppressed by UMNs. Damage to the UMNs releases this inhibition and flexion of one limb in response to a noxious stimulus is accompanied by extension of the contralateral limb.

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25
Q

What can cause Schiff-Sherrington phenomenon?

A

Following damage (usually severe) to the spinal cord (T3 to L3) the forelimbs may become rigidly extended with marked increase in extensor tone. Voluntary movement is still present although markedly reduced by the hypertonia. Ascending spinal cord tracts in the spinal cord from L1 to L5 inhibit extensor muscles of the thoracic limbs. Transection of these pathways removes the inhibition and results in extension of the thoracic limbs.

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26
Q

What are the six things that must be done in sequence and neurological examination?

A
  1. Observation of mental status, posture and gait.
  2. Palpation of muscular and skeletal systems.
  3. Evaluation of postural reactions.
  4. Evaluation of cranial nerves.
  5. Evaluation of spinal nerves.
  6. Evaluation of sensation.
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27
Q

What are the four different states you could see in an animal when assessing its mental status?

A
  1. Normal, alert and somewhat apprehensive when examined.
  2. Depression: lack of responsiveness to normal stimulation. (Remember that some animals are naturally withdrawn.)
  3. Stupor: present when the animal is severely depressed but can be aroused with painful stimuli.
  4. Coma: Occurs when the animal is severely depressed and can’t be aroused by stimuli.
28
Q

What are abnormalities in the mental status related to? (Think about parts of the brain)

A

Brainstem or the thalamocortex.

29
Q

What is the best way to evaluate the animals mental status?

A

Through its history. The evaluator might not know what’s normal for the animal.

30
Q

Look at page 6 paragraph 2

A

.

31
Q

What complaints might you see from an owner with an animal that has a change in its mental status?

A

The owner may complain the animal is less playful, sleeping more, quieter or lethargic.

32
Q

What is the thalamocortex the site for?

A

It is the site of intelligence and goal directed behaviors.

33
Q

What signs might you see if there is a lesion in the thalamocortex?

A

Compulsive circling, had depressing, decreased or absence of awareness of what is going on around the animal.

34
Q

Look at page 6 posture

A

.

35
Q

How do animals orientate their body parts normally when at rest and walking? Where might abnormalities in this system affect?

A

By integrating sensory information gained through sight and from the balance receptors (vestibular system) and conscious and unconscious proprioception (see gait below).

Abnormalities may affect the head, body or both.

36
Q

Define Ataxia. What is it indicated by?(page 6 gait info)

A

Lack of coordination. Indicated by a lack of awareness of limb position.

37
Q

What are the 3 forms of ataxia?

A

1) Sensory (conscious proprioception)
2) Cerebellar (unconscious proprioception)
3) Vestibular

38
Q

Which type of ataxia is being described? Here animals fall, circle or roll towards the affected side. Head tilt and nystagmus (see later) are usually also present.
A. Sensory (conscious proprioception)
B. Vestibular
C. Cerebellar (unconscious proprioception)
D. None of the above

A

B. Vestibular

39
Q

Which type of ataxia is being described? This is seen with spinal cord lesions and lesions in the motor cortex. It is characterized by crossing-over of the affected limbs and scuffing of the toes while walking. Usually there are also proprioceptive positioning deficits (see later).
A. Sensory (conscious proprioception)
B. Vestibular
C. Cerebellar (unconscious proprioception)
D. None of the above

A

A. Sensory (conscious proprioception)

40
Q

Which type of ataxia is being described? This is seen with cerebellar lesions or spinal cord lesions effect spinocerebellar tracts. It is characterized by limbs being positioned peripheral to the center of gravity (broad based stance), dysmetria (exaggerated advancement of the limbs) - either hypermetria (overreaching) or hypometria (under- reaching). Tremor and intention tremor is usually also present in dogs with cerebellar disease.
A. Sensory (conscious proprioception)
B. Vestibular
C. Cerebellar (unconscious proprioception)
D. None of the above

A

C. Cerebellar (unconscious proprioception)

41
Q

What is the point of doing a palpation during your neurological exam?

A

Palpation of the muscular and skeletal systems may reveal lesions in these systems which might be confused with neurological problems (eg. pelvic limb weakness - bilateral patella luxation, hip dysplasia).
Muscle mass and tone are severely decreased with LMN lesions while UMN lesions only results in mild loss of muscle mass and hypertonia, especially extensor, may be present.

42
Q

Which is worse for muscle mass loss, LMN or UMN? (pg 7 palp)

A

LMN
* Muscle mass and tone are severely decreased with LMN lesions while UMN lesions only results in mild loss of muscle mass and hypertonia, especially extensor, may be present.

43
Q

What is needed for a successful completion of the postural reactions of the neurological exam?

A

The nervous system must be functional at every level.

44
Q

Name the levels tested by the postural reactions portion of the neurological exam? (10)(pg7 post react.)

A

Sensory receptors, sensory nerves, spinal cord, cortex, thalamus, cerebellum, vestibular system, motor nerves, end plates and muscles.

45
Q

What is the postural reactions portion of the neurological exam good for finding out?

A

If the animal has a normal gait and posture.

46
Q

Where do postural reaction deficits typically occur?

A
  • Ipsilateral to unilateral peripheral nerve
  • Spinal cord
  • Most brain stem lesions
  • Cerebrocortical lesions
  • Thalamic lesions
47
Q

What does Cerebrocortical and thalamic lesions result in?

A

Contralateral deficits

48
Q

What are the 6 different postural tests you can do? (page 7 – 8 for how to perform each test)

A
  1. Proprioceptive positioning (paw placement)
  2. Hopping
  3. Placing
  4. Wheelbarrowing
  5. Extensor postural thrust
  6. Hemi-walking
49
Q

What are the cranial nerves then you test in the cranial nerve function portion of the neurological examination? (Page 8-10 shows how to test each nerve)

A 
I – olfactory
II – optic
III – oculomotor
IV – trochlear
V – trigeminal 
VI – abducens
VIII – vestibulocochlear
IX – glossopharyngeal
X – Vagus
XI – accessory
XII – hypoglossal

*hint: to remember nerves/#’s, remember this pneumonic: oh, oh, oh, to touch and feel virgin girls vagina and hips. ( I remembered something from the anatomy tutor, yay!)

50
Q

What are the 8 reflex tests you can do to test the spinal reflexes in an animal during the neurological examination?

A
  1. Perineal reflex
  2. Patellar reflex
  3. Cranial tibialis reflex
  4. Flexor withdrawal reflex
  5. Extensor carpi radialis reflex
  6. Biceps reflex
  7. Triceps reflex
  8. Gastrocnemius reflex
51
Q

Of the eight spinal reflex test which are the most reliable? (4)

A
  1. Patellar reflex
  2. Cranial tibialis reflex
  3. Flexor withdrawal reflex
  4. Extensor carpi radialis reflex
52
Q

What does the perineal reflex test test? How is it done?

A
  • This tests the integrity of the pudendal nerve.
  • Pinching of the skin in the perineal region should result in contraction of the anus, lifting of the vulva and dropping of the tail.
53
Q

How is the patellar reflex tests performed, and when should you see (Normal and abnormal)?

A

Following a sharp tap on the straight patellar tendon there should be contraction of the quadriceps muscle and extension of the stifle joint. Subsequently the stifle joint returns to its normal position although slight oscillations may be observed. In some cases, UMN lesions and when muscle tone is increased, there may be very obvious oscillations, clonus. The efferent and afferent pathways of this reflex are in the femoral nerve.

54
Q

What is the cranial tibialis reflex test responsible for testing? How is it done?

A

This reflex tests the integrity of the sciatic nerve.

The belly of the cranial tibialis muscle is given a sharp tap and the hock should flex.

55
Q

Look at page 11 and 12 for Flexor withdrawal reflex and Extensor carpi radialis reflex.

A

.

56
Q

What nerve causes the detrusor muscle to relax allowing the bladder to fill up with urine? What system stimulates this action?

A

sympathetic stimulation (via the hypogastric nerves L1-4/5) of the detrusor muscle causes it to relax.

57
Q

Look at page 13-14 bladder information

A

.

58
Q

What are the three evaluations of sensation?

A
  1. Pain sensation
  2. Panniculus reflex
  3. Hyperesthesia
59
Q

Look at page 14 for evaluation of sensation

A

.O

60
Q

Name the areas a neurological examination should allow a veterinary to localize a lesion(s) to?

A

The neuromuscular system (peripheral nerve, neuromuscular junction or muscle), one of four regions of the spinal cord (C1-6, C6-T2, T2-L3, L3-S3) or the brain.

61
Q

If there is a lesion within the muscles what would you expect to see?

A

Generalized weakness during locomotion, poor strength in the flexor withdrawal reflex, normal paw placement and reflexes.

62
Q

If there is a lesion in the peripheral nerves what would you expect to see?

A

Usually all four limbs are affected. You will see areflexia, hypotonia, rapid atrophy, lack of sensation.

63
Q

What you see if there was a lesion at L3 and went caudally?

A

LMN signs in the pelvic limbs; lower motor neuron bladder. Lesions caudal to L7 usually cause only minimal pelvic limb dysfunction (S1 has a small contribution to the pelvic limbs) but fecal and urinary incontinence may be present due to loss of bladder and anal sphincter innervation. Lesions in the caudal spinal cord segments cause only tail dysfunction.

64
Q

What would you see if there was a lesion at T2-L3?

A

brain and thoracic limb function will be normal; UMN signs in the pelvic limbs; UMN bladder. Further localization of the lesion can be made using the panniculus reflex and palpation for hyperesthesia.

65
Q

What would you see if there is a lesion in C1-C6?

A

UMN signs in both the thoracic and pelvic limbs; UMN bladder. Also with brain lesions but additional signs will usually be seen (see below under Brain).

66
Q

What would you see if there was a lesion in the brain?

A

Unilateral or bilateral UMN signs in the limbs (tetra/hemi – paresis/plegia); seizures; changes in behavior; cranial nerve deficits, decreased consciousness; cerebellar signs; vestibular signs.

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