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Medicine 1 VCS860 > Introduction to Neurology > Flashcards

Introduction to Neurology Flashcards

1
Q

Upper Motor Neurons

Origin

A

cerebrum or brainstem

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2
Q

Upper motor Neuron

pathway

A

spinal cord to connect the brain to the lower motor neurons

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3
Q

UMN

Function

A

synapse with the lower motor neurons that innervate the muscles

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4
Q

UMN

When Damaged

A

Increased muscle tone (hypertonus)

Exaggerated spinal reflexes (Hyperreflexia)

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5
Q

Lower Motor Neurons

Origin

A

CNS

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6
Q

LMN

Pathway

A

exits the CNS to form the cranial nerves and peripheral nerves

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7
Q

LMN

Function

A

final pathway to innervation and activation of musclular activity

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8
Q

LMN

When Damaged

A

Decreased muscle tone (hypotonus)

Diminished or absent spinal reflexes (areflexia or Hyporeflexia)

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9
Q

Ipsilateral

A

lesion on the same side of the body as the neurological deficit

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10
Q

Contralateral

A

a Lesion on the opposite side of the body as the neurological deficit

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11
Q

Sidedness

A

Function of decussation, or the crossing of nerve fibers over midline from one side of the body to the other

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12
Q

Ascending Tracts of Spinal Cord

A

Responsible for proprioception and various forms of sensory input, including pain

Sensory tracts designated by the prefix “spino-” although the dorsal white column is also sensory

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13
Q

Ascending tracts of Spinal Cord

Proprioception

A

Dorsal white column → contralateral cerebrum

Spinocerebellar Tracts → Ipsilateral cerebellum

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14
Q

Ascending Tracts of Spinal Cord

Spinothalamic tracts

A

involved in pain, temperature, and pressure sensation

Lateral spinothalamic tract → “superficial pain” sensation

Ventral Spinothalamic tract → “Deep pain” sensation

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15
Q

Descending Tracts of Spinal Cord

Corticospinal tracts

A

conscious motor control over skeletal muscles

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16
Q

Descending Tracts of Spinal Cord

Vestibulospinal

A

Controls muscles for posture and balance

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17
Q

Descending Tracts of Spinal Cord

Tectospinal

A

Responisible for responses to startling visual or auditory input

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18
Q

Cranial Nerves

Ipsilateral vs. Contralateral

A

All cranial nerves have ispilateral lesions except for cranial nerve 4 that has contralteral lesions

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19
Q

Descending Tract of Spinal Cord

Reticulospinal

A

Activates respiratory muscles

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20
Q

Descending Tracts of Spinal Cord

Rubrospinal

A

Controls Flexor and Extensor Tone

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21
Q

Pressure applied to the cord

What do you lose when

A

First: proprioception, then conscious motor, followed by superficial pain, and then deep pain

Reticulospinal tract (respiratory muscles) not lost with cervical and throacic spinal cord lesions and would only happen after deep pain is lost

Function regained in opposite direction

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22
Q

Paralysis

A

is the complete loss of function

Also can be referred to by the suffix -plegia

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23
Q

Paresis

A

musclular weakness associated with neurological dysfunction

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24
Q

“tetra-”

A

Affecting all four limbs

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25
Q

“Hemi-”

A

Affecting the front and rear limbs on one side of the body

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26
Q

“Para-”

A

Affecting only the rear limbs

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27
Q

Goals of the initial Evaluation

A

Determine if the patient has neurological disease

Localize the lesion

Create a reasonable list of differential diagnoses

Determine level of therapeutic intervention prior to a diagnosis

Select appropriate diagnostics

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28
Q

The Neurological History

Determine the course of the disease

A

Slowly progressive

Waxing/Waning

Sudden onset and stable

Sudden onset and getting worse

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29
Q

Neurological History

Possible inciting causes

A

Traumatic Events

Pre-existing medical conditions, drug history

Vaccine history, environmental exposures, whether other animals in the house are affected

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30
Q

Neurological History

If we don’t ask we will never uncover any clues

A

listen for clues, discordant answers, vague timelines, assumptions, hearsay

Pursue immediately or “pin it” for follow-up

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31
Q

What is a “time course of disease”?

A

Progression of clinical signs in a patient as they move further away from their normal

A sudden (peracute) change is described as “lights on/lights off”

Traumatic, vascular, toxicity, Idiopathic cause

Progressive deterioration in a patient’s neurological staus is typically caused by infectious disease, immune-mediated disease, neoplasia, and degenerative conditions, although the speed of decline would be different for each of these

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32
Q

Mental Status

A

under the control of the cerebrum and ascending reticular activating system (located in midbrain)

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33
Q

Mental status

Alert

A

This implies a normal state of consciousness

“normal” varies due to different behavioural responses to situations

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34
Q

Mental Status

Inappropriate

A

all-inclusive term for abnormal mental function that firs somewhere between normla and stupor/coma

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35
Q

Mental Status

Inappropriate

Depressed

A

Quiet and unwilling to perform normally but responds to environmental stimuli

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36
Q

Mental status

Inappropriate

Obtunded

A

Dull and relatively nonresponsive but conscious

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37
Q

Mental Status

Inappropriate

Demented

A

Unrecoverable loss of higher brain functions

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38
Q

Mental Status

Inappropriate

Delerious

A

Temporary disturbance of higher brain functions characterized by inappropriate responses or behaviours

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39
Q

Mental Status

Stuporus

A

unconscious in the resence of normal environmental stimuli, but can be roused with more intense stimuli

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40
Q

Mental Status

Comatose

A

Unconscious regardless of the intensity of the stimulus applied

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41
Q

Gait Abnormalities

A

Observe the patient walking around the exam room on their own or leash walked at different speeds

This helps to identify and define abnormalities noted by the client

42
Q

Gait Abnormalities

Ataxia

A

Sensory, cerebellar, vestibular

43
Q

Gait abnormalities

Hypermetria (dysmetria)

A

Cerebellum, or cerebellar pathways

44
Q

Gait abnormalities

Circling

A

cerebellar, cerebral, vestibular

45
Q

Ataxia

A
  • Loss of muscular coordination:
    • Instability when walking
    • fall or swaying from side-to-side
    • Crossing limbs when walking
  • Sensory
    • peripheral nerves, spinal cord, brianstem, cerebral
    • Visual cues can help with compensation
  • Vestibular
    • peripheral or central vestibular
    • Central vestibular disease may have components of sensory and vestibular ataxia
  • Cerebellar ataxia
    • can be present without loss of motor function
46
Q

Proprioception

A

Perception or awareness of the position and movement of the body

Orientation in relation to gravity

Orientation of a joint (to prevent hyperflexion of hyperextension) or body parts in relation to each other

Proprioceptive deficits involve disruption of the sensory pathway from peripheral nerve, through spinal cord, brainstem, midbrain and to central recognition of perception

An animal can be ataxia (cerebellar or peripheral vestibular) and still have proprioception, although the ability to place may be affected

47
Q

Different Types of Circles

“Big Circles”

A

Characteristic of cerebral disease

Generally circle in the direction of where the mass is located

The patient will overstep with the throacic limb contralateral of the mass

On occasion dogs may circle in the direction opposite to the side of the mass (confuzes localization)

Localization: Cerebrum

48
Q

Different Types of Circles

“Small Circles”

A

Small circles are associated with disease of the vestibular system or cerebellum

Other findings - head tilt in the direction of the circling, nystagmus, cranial nerve 7 deficits, multiple cranial nerve deficits and limb deficits

Localization: Vestibular or Cerebellum

49
Q

Head tilt

A

Abnormal posture of the head in which one ear is held ventral (lower) that the opposite ear

The nose continues to point straight ahead

Most often caused by disease of the vestibular or cerebellar systems

The tilt (down) is generally towards the lesion

In pradoxical vestibular syndrome, the head tilt is in hte direction opposite the lesion (sometimes seen with disease of the cerebellum)

50
Q

Head Turn

A

Abnormal posture in which the plane of the ears remians parallel to the ground

The nose id deviated towards the caudal aspect of the body

Most often associated with CEREBREAL lesions

Head turn is usually toward the side of the lesion

Circling may also be associated with the head turn

In some patients with caudal brainstem lesions a component of head turn and head tilt can be seen

51
Q

Conscious Proprioception

Technique

A

Place the paw where the footfall would land with the dorsal surface of the paw on the ground

Supprot the pet’s weight

52
Q

Conscious Proprioception

A

Severe pain may produce pseudo-deficits

Brusque or excessive movement → additional pain/pressure and proprioceptors may be fired, making subtle abnormalities difficult to identify

53
Q

Hopping

A

Technique:

slightly lift the leg opposite to the one being examined

Use this hold to push the dog toward the limb to be examined

As the paw goes toward midline, the patient will hop the limb laterally to maintain balance

Pivot point are the paired limbs not examined

Paper Slide test

Can do in cats

54
Q

Wheelbarrowing

A

Performed by lifting the pelvic limbs off the ground and walking the patient forward

THe head can be elevated (eyes covered) to remove visual cues and detect subtle deficits

Cat’s don’t like this test

55
Q

Hemiwalking

A

Performed by lifting the limbs (fore and rear) on one side of the body and pushing the dog towards the other limbs

The limbs will correct to keep the patient form losing balance and falling

Cat’s dont like this test

56
Q

Extensor Postural Reaction

A

Performed by holding the patient vertically and bringing them down to land on the pelvic limbs

The patient will natureally step back so that they can then land on their front feet

Cats will definitely participate in this test

57
Q

Tabletop Placing

A

Performed by holding the patient and bringing their feet to the table top, individually or in pairs

Avoid “deceleration reaching”

Covering the eyes is important to remove the visual cues

One of the better tests for cats

58
Q

If proprioceptive deficit is identified, determine if UMN or LMN lesion

Upper Motor Neuron Lesion

A

increased muscle tone (hypertonus) and normal to exaggerated reflexes

59
Q

If proprioceptive deficit is identified, determine if UMN or LMN lesion

Lower Motor Neuron Lesion

A

Flaccid muscle tone and diminished to absent reflexes

60
Q

Spinal Reflex Scale

A

Absent - 0

Hyporeflexia (diminished) - 1+

Normal response - 2+

Hyperreflexia (exaggerated) - 3+

Hyperreflexia with Clonus - 4+

Lesion is classified as an UMN lesion (2, 3, 4+) or a LMN lesion (0, 1+)

Reflexes will never classify the limb as normal

61
Q

Quadriceps (Patellar) Reflex

A

Most reliable reflex to interpret in dogs and cats

Evaluates the L4-L6 spinal cord segment and the femoral nerve

If patient is tense, reflex can be difficult to elicit

THe expected response is extension of the stifle

62
Q

Cranial Tibial Reflex

A

Evaluates the L6-L7 spinal cord segment and the peroneal branch of hte sciatic nerve

THe proximal aspect of the muscle belly is percussed

The expected response is flexion of the hock

63
Q

Gastrocnemius Reflex

A

Evaluates the L7-S1 spinal cord segment and the tibial brach of the sciatic nerve

Two Techniques: Percuss the insertion of the tendon and look for extension of the hock; flex the hock to tense the tendon prior to percussion of the distal tendon and look for contraction of the gastrocnemius muscle

64
Q

Flexor (withdrawal) responses

A

Evaluates the sensory component, reflex arc, and motor component

Often dependent on the force applied and the nature of hte patient

THe interpretation of this reflex is questionable at best

A flextion response requires no input from above and should be lost with LMN lesion and present with an UMN lesions

This does not require higher input and is often misinterpreted as the central recognition of pain

65
Q

Biceps Reflex

A

Evaluates the C6-C8 spinal cord segment and the musculocutaneous nerve

Technique: Index finger is wrapped around the distal insertion of the biceps tendon; elbow pulled slightly caudally to stretch the tendon; The finger is tapped with the pleximeter and the examinier watches for contraction of the biceps muscle

66
Q

Triceps Relfex

A

Evaluates teh C7-T1 spinal cord segment and the radial nerve

Technique:

Hold the forearm and pull the elbow slightly caudally and rotate the elbow outwardly to stretch the triceps tendon

The tendon is then percussed and the examiner looks for contraction of the triceps

The index finger can also wrap around the triceps tendon to tension it further and the finger tapped with the pleximeter

ALTERNATE method: tap the triceps tendon or muscle belly and look for extension of the elbow, although paradoxically this will sometimes elicit flexion of the elbow

67
Q

Extensor Carpi Radialis Reflex

A

Evaluates the C7-T1 spinal cord segment and the radial nerve

Technique: Percuss the proximal musle belly of the extensor carpi radialis muscle

Extension of the carpus, limb is supported passively to elicit this reflex

68
Q

Babinski Reflex

A

Has no real bearing on the exam

Normally absent in the neurologically intact patient

Plantar or Palmer surface of the paw is stroked in a proximal to distal direction

Normal →> nothing or slight flexion of hte foot

UMN lesion → Extension of hte Foot and splaying of the toes

69
Q

Pain Sensation

A

Important prognostic information

Superficial pain elicitied by pinching the skin overlying or in between the toes

Deep pain evaluated by applying pressure to bone or joints

Need ot see a central response

Withdrawal of the limb alone does not indicate the presence of deep pain

Loss of deep pain is a grave prognostic finding

70
Q

Crossed Extensor Reflex

A

Can be elicited in a patient wiht an UMN lesion

Normal in very young animals

While performing the withdrawal reflex, as one limb is flexed, the other limb extends

71
Q

Cutaneous Trunci Reflex

A

Evaluates sensory pathway to skin overlying the dorsum

Extends form C8-L4 spinal cord segments

Skin Pinch → cutaneous trunci muscle contract

ABSENT reflex: Lesion is somewhere within 2 vertebrae cranial or caudal of where the reflex disappears

This will not be lost with all spinal cord injuries

72
Q

Cranial Nerve 1

A

Olfactory

73
Q

Cranial nerve 2

A

Optic

74
Q

Cranial Nerve 3

A

Oculomotor

75
Q

Cranial nerve 4

A

Trochlear

76
Q

Cranial Nerve 5

A

Trigeminal

77
Q

Cranial Nerve 6

A

Abducens

78
Q

Cranial Nerve 7

A

Facial

79
Q

Cranial Nerve 8

A

vestibulocochlear (s)

80
Q

Cranial Nerve 9

A

Glossopharyngeal (m,s)

81
Q

Cranial Nerve 10

A

Vagus

82
Q

Cranial Nerve 11

A

Accessory

83
Q

Cranial Nerve 12

A

Hypoglossal

84
Q

Evaluation of the cranial nerves

A

Lesion localization within the brain and for sidedness

Each response has both a sensory and motor component

Combine results to isplate which nerve are affected

Cerebrum facilitiates action of cranial nerves

85
Q

Pupillary light Reflex

A

Sensory Pathway: CN2 (optic)

Motor Pathway: Parasympathetic nerve as a component of the oculomotor nerve (CN3)

Perform in dark room with a very bright light

PLR can be absent due to disease of the cornea, iris, lens, anterior or posterior chamber, retina, optic nerve, midbrain, and oculomotor nerve pathway

Evaluate direct and consensual responses to localize the lesion

86
Q

Mydriasis

A

Dilated pupils

Pathologic mydriasis

Parasympathetic denervation CN3, dysautonomia, intraocular disease, Herniation = fixed and dilated or midrange

Iris Atrophy

Fear (especially in cats)

87
Q

Miosis

A

Constricted pupils

Causes: Uveitis, corneal pain, organophosphate or carbamate poisoining, sympathetic denervation, FeLV infections, Severe cerebrocortical disease = miotic and nonresponsive

88
Q

Anisocoria

A

Defined by pupils of different sizes

Important to identify which of the two is abnormal for localization purposes

89
Q

Papilledema

A

Swelling of the optic nerve head seen during retinal examination

Relevance: suggestive of high intracranial pressure

Causes: brain tumor, inflammatory disease, Trauma

90
Q

Horner’s Syndrome

A

Characteristics: Miosis, ptosis (droopy upper eyelid); enophthalmos (sunken globe); Elevate 3rd eyelid (or prolapsed)

Damage to sympathetic innervation to the eye

Post-ganglionic and pre-ganglionic lesions

“Ganglionic” refers to cranial cervical ganglion

91
Q

Horner’s Syndrome Differentiation

Pre-ganglionic: 1st or 2nd neuron

A

“Denervation hypersensitivity”

The iris is sitll innervated (lacks higher input)

Tonic level of norepinephrine prevents denervation hypersensitivity

Dilute phenylephrine on the eye → nothing happens

92
Q

Horner’s Syndrome Differentiation

Post-ganglionic

A

Damage of last neuron form the CCG of the eye

No final nerve to prevent denervation hypersensitivity

Dilute Phenylephrine → pupil dilates

93
Q

Nystagmus

A

Involuntary rapid movement of hte eyes

94
Q

Nystagmus

Physiologic

A

normal response to rotation of hte head

eye repetitively moves slowly away from direction of rotation and rapidly in direction of rotation

95
Q

Nystagmus

Pathologic

A

Present at rest or if placed in an abnormal position

Slow phase is typically toward the lesion and fast phase is away from the lesion

Can be horizontal, rotary, or vertical

96
Q

Physiologic Nystagmus

Sensory Component

A

Vestibular component of CN 8

97
Q

Physiologic Nystagmus

Motor Component

A

Cranial nerves 3, 4, and 6

98
Q

Menace Response

A

Senory pathway: CN2

Motor Pathway: CN 7

When threatened or presented with something that suddenly appears close to the eyes/face, the patient will bling

If create a breeze with the hand → sensory pathway of hte cornea (CN5) can be elicited

Generally easy to evaluate

Patients with cerebral disease may have an intact CN2 and CN7 and still not have a menace response

99
Q

Palpebral Reflex

A

Sensory Component: CN5

Motor Component: CN7

Technique: gently touch the medial and lateral canthus of the eye and look for a blink

100
Q

Facial Sensory Reflex

A

Sensory: CN5

Motor: CN7

Technique: stroke whiskers, side of face, pinch skin

Retraction of side of face or lip

101
Q

Corneal Relfex and Retractor Bulbi Reflex

A

Sensory: CN5

Motor: CN7, CN6

Technique:

Evaluate at the same time

Blow on the cornea or gently touch it with sterile cotton swab

Corneal reflex → blink

Retractor bulbi reflex → Retraction of the globe

102
Q

Gag Reflex

A

Evaluates both motor and sensory components of the glossopharyngeal nerve and vagus nerve (CN 9 and 10)

Technique: touch lateral aspects of pharynx, patient should vigorously move the tongue, pharynx, and head in an attempt to remove the finger

This is not performed on rabid or aggressive animlas EVER

Medicine 1 VCS860 (13 decks)

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