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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
Hemistanding & hemiwalking (3)
1. Lift limbs and support some weight first 2. Walk laterally slowly 3. Should be 1:1 thoracic:pelvic limb steps
26
Wheelbarrow (2)
1. Lift rear limbs, sheft weight to TLs | 2. Slowly push forward
27
Segmental reflexes (4)
1. Thoracic limb 2. Pelvic limb 3. Cutaneous trunci 4. Perineal relfex
28
Thoracic limb (segmental reflexes)
1. Withdrawal - biceps - Musculocutaneous n. - C6-C8 - Triceps - Radial n. - C8-T2 2. Biceps & Triceps
29
Pelvic limb (segmental reflexes)
1. Patellar - femoral n - L4-L6 2. Gastrocnemius 3. Cranial Tibial 4. Withdrawal - mostly sciatic n. - L6-S1
30
Cutaneous trunci (segmental reflexes) (2)
1. Lateral thoracic n. | 2. C8-T1
31
Perineal reflex (segmental reflexes)
Tail tuck, and anal sphincter
32
Severing spinal cord
reflex will still be intact
33
Neurolocalization dog segments (6)
1. Brain 2. C1-C5 3. C6-T2 4. T3-L3 5. L4-S3 6. Motor Unit - lower motor neuron
34
Forebrain lesion (7)
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
Cerebellar lesion (7)
1. Head Tilt 2. Nystagmus 3. Loss of menace 4. Intention tremors 5. Truncal sway 6. Ataxia: hypermetric/spastic 7. Hypermetria
36
Cerebellar lesion won't have (3)
1. Paresis 2. Behavior changes 3. CP defecits
37
Brainstem lesion (3)
1. Decreased mentation: obtunded to comatose 2. CN defecits - III-XII 3. Usually CN VIII involvement - CHECK FOR PHYSIOLOGIC NYSTAGMUS
38
Brainstem lesion: Gait
1. Vestibular or proprioceptive ataxia (if ambulatory) | 2. may resemble cerebellar lesion
39
Central vestibular animal (6)
1. CP defecits 2. Paresis 3. Ataxia 4. Hypermetria 5. Mentation changes 6. +/- other CN
40
Peripheral vestibular animal (4)
1. Head tilt 2. Nystagmus 3. Other CN defecits (VII) 4. Ataxia
41
Managing dizzy dog (2)
1. Try to distinguish between central vs peripheral 2. rolling and flailing light sedation and re-eval later - chlorpromazine or diazepam once
42
Postural rxns tell us
a lesion exists
43
Segmental reflexes tell us
where the lesion is
44
C1-C5 lesion
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
C6-T2 lesion
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
T3-L3 lesion
1. TL post rxns: N 2. TL reflexes: N 3. PL post rxns: dec to absent 4. PL reflexes: N to inc
47
L4-S3 lesion
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
Motor Unit nerve lesion
1. TL post rxns: N to dec 2. TL reflexes: dec 3. PL post rxns: N to dec 4. PL reflexes: dec
49
NMJ lesion
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
Muscle lesion
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
Extended, tense muscle implies
UMN lesion
52
Flaccid weak muscle tone implies
1. LMN involvement | 2. consider spinal shock
53
C1-C5 localization (6)
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
C6-T2 localization (6)
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
Accuracy of cervical neurolocalization (3)
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
T3-L3 localization (6)
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
localization T3-L3: Spinal shock (5)
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
localization T3-L3: Shiff-Sherrington posture (5)
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
L4-S3 localization (5)
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
Motor unit localization: LMN (7)
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
Schiff scherrington
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

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