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Neuro junior > Intro: Neuro exam and neurolocalization > Flashcards

Intro: Neuro exam and neurolocalization Flashcards

1
Q

Objectives (4)

A
  1. List components of neurological exam
  2. List CNs and their function
  3. Recognize neurologic abnormalities
  4. Make neuroanatomic diagnosis (Neurolocalization)
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2
Q

Big picture (6)

A
  1. TPR
  2. PE
  3. HX
  4. Duration and progression
  5. Other concurrent dz: sepsis, heart dz, addison’s/cushing
  6. Medications: steroids, opioids, ace
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3
Q

Indications for exam (7)

A
  1. Seizures, other episodic behavoir
  2. Behavoir changes, circling
  3. Paresis
  4. Ataxia
  5. Pain
  6. Lameness
  7. Trauma
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4
Q

Six components neuro exam (5)

A
  1. Mentation
  2. Gait & posture
  3. Cranial nerves
  4. Segmental reflexes
  5. Palpation and Range of motion (painful stuff last)
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5
Q

Mentation (5)

A
  1. Alert & appropriate
  2. Obtunded - dull, lethargic and responsive
  3. Stuporous
    - inappropriate/not responsive to normal stimuli
    - responsive to noxious stimuli
  4. Comatose
    - Not responsive to noxious stimuli, but alive
  5. Dead
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6
Q

Gait

A

Ambulatory status (quadrapeds can’t be ambulatory X 2)

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7
Q

Ataxia (3)

A

Lack of coordination

  1. Cerebellar:
    - wide-based stance
    - hypermetria
    - truncal sway
  2. Vestibular:
    - wide based stance
    - leaning/listing
    - drunken sailor
  3. Proprioceptive: lack of coordination with a lack of awareness and paresis
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8
Q

Posture: head (3)

A
  1. Tilt, turn
  2. Resting or intention tremors
  3. Head held low, neck guarding
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9
Q

Posture: Body (3)

A
  1. Kyphosis (forward rounding of back), lordosis (inward rounding of back), scoliosis (curved spine)
  2. Torticollis (twisted neck)
  3. Lateraly recumbent
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10
Q

Posture: Decerebrate (2)

A
  1. Comatose

2. Rigid extension in all limbs

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11
Q

Posture: Decerebellate (2)

A
  1. Acute cerebellar lesions

2. Extended TLs, flexed PLs

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12
Q

Posture: Shiff-Sherrington (2)

A
  1. Severe, acute T3-L3 lesions

2. Not prognostic

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13
Q

Cranial Nerves

A 
I: Olfactory
II: Optic
III: Oculomotor
IV: Trochlear
V: Trigeminal
VI: Abducent
VII: Facial
VIII: Vestibulocochlear
IX: Glossopharyngeal
X: Vagus
XI: Accessory
XII: Hypoglossal
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14
Q

Menace (afferent/efferent)

A

Afferent: CN II
Efferent: CN VII

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15
Q

PLR (afferent/efferent)

A

Afferent: CN II
Efferent: PS CN III

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16
Q

Palpebral (afferent/efferent)

A 
Medial canthus
-Afferent: V opth
-Efferent: VII
Lateral Canthus
-Afferent V max
-Efferent: VII
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17
Q

Facial symmetry

A

CN VII

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18
Q

Physiologic Nystagmus

A

Afferent: CN VIII
Efferent: CN III, IV, VI
MLF
Strabismus, positional nystagmus

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19
Q

Gag

A

Afferent: CN IX, X
Efferent: IX

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20
Q

Tongue Function

A

CN XII

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21
Q

Postural reactions (6)

A
  1. Placing/knuckling (CP)
  2. Hopping
  3. Hemistanding & hemiwalking
  4. Wheelbarrow
  5. Visual & Tactile placing
  6. Extensor postural thrust
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22
Q

Placing responses (CPs)

A

Must support patient

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23
Q

Hopping

small/large

A

Small dog: pick up 3 legs hop on one

Large dog: pick up contralateral limb and pivot

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24
Q

Extensor postural thrust

A

Lift from axillae and lower towards ground

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25
Q

Hemistanding & hemiwalking (3)

A
  1. Lift limbs and support some weight first
  2. Walk laterally slowly
  3. Should be 1:1 thoracic:pelvic limb steps
26
Q

Wheelbarrow (2)

A
  1. Lift rear limbs, sheft weight to TLs

2. Slowly push forward

27
Q

Segmental reflexes (4)

A
  1. Thoracic limb
  2. Pelvic limb
  3. Cutaneous trunci
  4. Perineal relfex
28
Q

Thoracic limb (segmental reflexes)

A
  1. Withdrawal
    - biceps
    - Musculocutaneous n.
    - C6-C8
    - Triceps
    - Radial n.
    - C8-T2
  2. Biceps & Triceps
29
Q

Pelvic limb (segmental reflexes)

A
  1. Patellar
    - femoral n
    - L4-L6
  2. Gastrocnemius
  3. Cranial Tibial
  4. Withdrawal
    - mostly sciatic n.
    - L6-S1
30
Q

Cutaneous trunci (segmental reflexes) (2)

A
  1. Lateral thoracic n.

2. C8-T1

31
Q

Perineal reflex (segmental reflexes)

A

Tail tuck, and anal sphincter

32
Q

Severing spinal cord

A

reflex will still be intact

33
Q

Neurolocalization dog segments (6)

A
  1. Brain
  2. C1-C5
  3. C6-T2
  4. T3-L3
  5. L4-S3
  6. Motor Unit
    - lower motor neuron
34
Q

Forebrain lesion (7)

A
  1. Seizures
  2. Circling
  3. Compulsion
  4. Behavior changes: innapropriate, stuck in corners
  5. Blindness: non-ocular (amaurosis)
  6. Postural reaction deficits
  7. GAIT SHOULD BE NORMAL
35
Q

Cerebellar lesion (7)

A
  1. Head Tilt
  2. Nystagmus
  3. Loss of menace
  4. Intention tremors
  5. Truncal sway
  6. Ataxia: hypermetric/spastic
  7. Hypermetria
36
Q

Cerebellar lesion won’t have (3)

A
  1. Paresis
  2. Behavior changes
  3. CP defecits
37
Q

Brainstem lesion (3)

A
  1. Decreased mentation: obtunded to comatose
  2. CN defecits - III-XII
  3. Usually CN VIII involvement
    - CHECK FOR PHYSIOLOGIC NYSTAGMUS
38
Q

Brainstem lesion: Gait

A
  1. Vestibular or proprioceptive ataxia (if ambulatory)

2. may resemble cerebellar lesion

39
Q

Central vestibular animal (6)

A
  1. CP defecits
  2. Paresis
  3. Ataxia
  4. Hypermetria
  5. Mentation changes
  6. +/- other CN
40
Q

Peripheral vestibular animal (4)

A
  1. Head tilt
  2. Nystagmus
  3. Other CN defecits (VII)
  4. Ataxia
41
Q

Managing dizzy dog (2)

A
  1. Try to distinguish between central vs peripheral
  2. rolling and flailing light sedation and re-eval later
    - chlorpromazine or diazepam once
42
Q

Postural rxns tell us

A

a lesion exists

43
Q

Segmental reflexes tell us

A

where the lesion is

44
Q

C1-C5 lesion

A
  1. TL post rxns: dec to absent
  2. TL reflexes: N to inc
  3. PL post rxns: dec to absent
  4. PL reflexes: N to inc
45
Q

C6-T2 lesion

A
  1. TL post rxns: N to dec to absent
  2. TL reflexes: dec to absent
  3. PL post rxns: dec to absent
  4. PL reflexes: N to inc
46
Q

T3-L3 lesion

A
  1. TL post rxns: N
  2. TL reflexes: N
  3. PL post rxns: dec to absent
  4. PL reflexes: N to inc
47
Q

L4-S3 lesion

A
  1. TL post rxns: N
  2. TL reflexes: N
  3. PL post rxns: N to dec to absent
  4. PL reflexes: N to dec
48
Q

Motor Unit nerve lesion

A
  1. TL post rxns: N to dec
  2. TL reflexes: dec
  3. PL post rxns: N to dec
  4. PL reflexes: dec
49
Q

NMJ lesion

A
  1. TL post rxns: N (may be too weak)
  2. TL reflexes: N
  3. PL post rxns: N (may be too weak)
  4. PL reflexes: N
50
Q

Muscle lesion

A
  1. TL post rxns: N (may be too weak)
  2. TL reflexes: N to dec
  3. PL post rxns: N (may be too weak)
  4. PL reflexes: N to dec
51
Q

Extended, tense muscle implies

A

UMN lesion

52
Q

Flaccid weak muscle tone implies

A
  1. LMN involvement

2. consider spinal shock

53
Q

C1-C5 localization (6)

A
  1. +/- ambulatory: knuckling, stumbling, face planting
  2. Tetraparesis
  3. Ataxia: TL signs more subtle than PL
  4. Reflexes: N to inc all limbs
  5. +/- muscle fasciculations
  6. +/- pain
54
Q

C6-T2 localization (6)

A
  1. +/- ambulatory: knuckling, stumbling, face planting, two engine gait
  2. Tetraparesis
  3. Ataxia
  4. Reflexes
    - TL: N to dec
    - PL: N to inc
  5. +/- Muscle fasiculations
  6. +/- pain
55
Q

Accuracy of cervical neurolocalization (3)

A
  1. Agreement between Neuro exam and MRI was 65.8%
  2. Cranial cervical lesions significantly assoc with incorrect neuro dx
  3. Withdrawal reflex in dogs with cervical disk herniation not reliable
56
Q

T3-L3 localization (6)

A
  1. +/- ambulatory
  2. Paraparesis: inc PL tone
  3. PL ataxia
  4. +/- Kyphosis
  5. Reflexes
    - TL: N
    - PL: N to inc
    - +/- Panniculus cut-off
  6. +/- pain
57
Q

localization T3-L3: Spinal shock (5)

A
  1. physiologic/anatomic transection of spinal cord
    - loss/depression all/most muscle tone below injury
  2. acute injury
  3. patellars return w/in hours in dogs
  4. withdrawels can take days
  5. NOT PROGNOSTIC
58
Q

localization T3-L3: Shiff-Sherrington posture (5)

A
  1. Extensor hypertonia of the TLs
  2. Due to loss of ascending inhibition
  3. Assoc with severe TL lesions: plegia +/- pain perception
  4. Distinguish from decerebrate/decerebellate postures
    - mentation, CNs
  5. NOT PROGNOSTIC
59
Q

L4-S3 localization (5)

A
  1. +/- ambulatory
  2. PL ataxia
  3. +/- pain
  4. Paraperesis: dec PL muscle tone
  5. Reflexes
    - TL: N
    - PL: dec to absent
    - +/= Panniculus cut-off
    - Anal tone?
    - Tail tone?
    - Tail sensation?
60
Q

Motor unit localization: LMN (7)

A
  1. +/- Ambulatory
  2. NO ATAXIA
  3. NO PAIN
  4. +/- CN weakness: facial, gag
  5. Paresis: gen dec muscle tone
  6. Reflexes
    - dec to absent
    - panniculus may/may not be affected
  7. Exercise intolerance
61
Q

Schiff scherrington

A
  1. Usually plegic +/- feeling
  2. usually acute/severe lesion
  3. disk, FCE, fx luxation
  4. If T3-L3 will have intact PL reflexes
  5. Not usually with L4-S3 dz

Neuro junior (14 decks)

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