How to perform stress-free neurological exam Flashcards
Minimising stress in neuro exam
Avoid eye contact
Minimise prolonged handling
Avoid forced restrain
make maximum use of observation in all parts of exam
Signs of forebrain lesion
Mentation and behaviour changes
Seizures
Proprioceptive deficits (contralateral)
Menace deficit, central blindness (contralateral)
Circling (towards lesion), not common
Gait often normal
Can get hemi-neglect syndrome
Signs of brainstem lesion
Proprioceptive or vestibular ataxia
Paresis: tetra or hemi (ipsilateral)
Mentation change: ascending reticular activating system
Cranial nerve deficits: ipsilateral
Circling (vestibular)
Signs of cerebellar lesion
Head tremor - intention tremor
Dysmetria/hypermetria and ataxia
No paresis
Menace deficit (ipsilateral): no blindness
Vestibular/paradoxical vestibular signs
Relatively common cause is Neospora
Where is movement of the limbs generated
Brain
What would UMN signs in front and back legs signify?
Lesion C1-5
What would UMN signs in back legs and LMN in front legs signify?
Lesion C6-T2
Lower moton neuron signs
Paresis or paralysis
Reflexes absent or reduced
Mucsle tone reduced
Muscle atrophy severe, early - neurogenic
Upper motor neuron signs
Paresis or paralysis
Normal or increased reflexes
Normal or increased muscle tone
Muscle atrophy late, mild - disuse
C1-C5 injury
Thoracic limbs: UMN
Pelvic limbs: UMN
C6-T2 lesion
Thoracic limbs: LMN
Pelvic limbs: UMN
T3-L3 lesion
Thoracic limbs: Normal
Pelvic limbs: UMN
L4-S3 lesion
Thoracic limbs: Normal
Pelvic limbs: LMN
Paresis/plegia: C1-C5
‘Floating’ thoracic limb gait
Tetraparesis/plegia
Ataxia all limbs
Postural reaction deficits all limbs
Spinal reflexes normal in all limbs
Neck pain
Horner’s syndrome
Possible urinary retention (UMN bladder)
Paresis/plegia: C6-T2 spine
‘Two engine’ gait - pathognomonic (unless significant pain in both front legs, but not postural reaction deficits)
Tetraparesis/plegia
PR (postural reaction) deficits all limbs
Neck pain
Reduced spinal reflexes/absent F/L’s (front legs), normal H/L’s
Muscle atrophy and reduced tone F/L’s
Horner’s syndrome
Cutaneous trunci may be absent
UMN bladder
Paresis/plegia: T3-L3 spine
Paraparesis/plegia
Ataxia pelvic limbs only
PR deficits pelvic limbs only
Spinal reflexes normal all limbs
Thoracolumbar Pain
Cutaneous trunci reflex interruption
Urinary retention (UMN bladder)
Schiff-Sherrington phenomenon
Paresis/plegia: L4-S3 spine
Paraparesis/plegia > ataxia
PR deficits (pelvic limbs)
Lumbosacral pain
Spinal reflexes ↓/absent pelvic limbs
Muscle atrophy and reduced tone pelvic limbs
Perineal reflex ↓/absent
Tail movements ↓/absent
Urinary incontinence (LMN bladder)
Spinal shock
Reflexes in pelvic limbs are absent even if T3-L3 lesion (so should be normal).
Can mean you incorrectly localise to L4-S3, look for cutaneous trunci cut off.
Spinal shock causes this, it is temporary and doesn’t impact prognosis.
Myelomalacia
PMM (progressive).
Usually occurs in acute, severe thoracolumbar lesions e.g. intravertebral disc extrusion.
Chain of events that leads to necrosis of the spinal cord in both directions.
It is irreversible so usually euthanasia is the only option as it can cause respiratory muscles to stop working.
Cutaneous trunci may creep cranially so monitor daily, LMN in hind limbs, forelimb signs, loss of tone in abdominal muscles etc.
If they cant hold themselves in a sitting position that is a bad sign.
Schiff-sherrington reflex
rigidly extended limbs when lying down, border cells knocked out meaning disinhibition to extensor tone in front legs, but standing everything else works fine.
Doesn’t tell you anything about prognosis.
T3-L3 thoracolumbar lesion.
