Neuro - Cases

Question 1

Winnifred is a 12 year-old female spayed dog that has been acting ‘strangely’ at home for the last few days. Upon examination she does not appear to be aware of the environment. She moves without direction or purpose, and does not appear to interact normally with the person in the room of the environment.

Upon physical examination you note that her conscious proprioception is decreased in all four limbs. Her menance response is absent in both eyes. You note that her facial sensation is decreased bilaterally (she does not move rapidly away from stimulus to the nostrils, but the animal does blink and twitch its facial muscles from the stimulus). All of the other cranial nerve reflexes are present and normal. The rest of her neurologic examination is unremarkable.

Does this animal have neurologic disease?

Answer 1

Most likely yes

The clues are the behavior change, the menace deficits, the facial sensation deficits, and the tetraparesis with normal spinal reflexes.

Question 2

Winnifred is a 12 year-old female spayed dog that has been acting ‘strangely’ at home for the last few days. Upon examination she does not appear to be aware of the environment. She moves without direction or purpose, and does not appear to interact normally with the person in the room of the environment.

Upon physical examination you note that her conscious proprioception is decreased in all four limbs. Her menance response is absent in both eyes. You note that her facial sensation is decreased bilaterally (she does not move rapidly away from stimulus to the nostrils, but the animal does blink and twitch its facial muscles from the stimulus). All other cranial nerve reflexes are present and normal. The rest of her neurologic examination is unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

Answer 2

Intracranial - bilateral supratentorial

Question 3

Winnifred is a 12 year-old female spayed dog that has been acting ‘strangely’ at home for the last few days. Upon examination she does not appear to be aware of the environment. She moves without direction or purpose, and does not appear to interact normally with the person in the room of the environment.

Upon physical examination you note that her conscious proprioception is decreased in all four limbs. Her menance response is absent in both eyes. You note that her facial sensation is decreased bilaterally (she does not move rapidly away from stimulus to the nostrils, but the animal does blink and twitch its facial muscles from the stimulus). All other cranial nerve reflexes are present and normal. The rest of her neurologic examination is unremarkable.

What are the suspected causes?

Answer 3

Tumor, hydrocephalus, cerebrovascular disease, inflammatory brain disease and traumatic injury

Question 4

Winnifred is a 12 year-old female spayed dog that has been acting ‘strangely’ at home for the last few days. Upon examination she does not appear to be aware of the environment. She moves without direction or purpose, and does not appear to interact normally with the person in the room of the environment.

Upon physical examination you note that her conscious proprioception is decreased in all four limbs. Her menance response is absent in both eyes. You note that her facial sensation is decreased bilaterally (she does not move rapidly away from stimulus to the nostrils, but the animal does blink and twitch its facial muscles from the stimulus). All other cranial nerve reflexes are present and normal. The rest of her neurologic examination is unremarkable.

What diagnostic tests would be most helpful?

Answer 4

Routine laboratory assessments, coagulation assessments if clinical signs indicate, blood pressure. If no obvious systemic abnormality is found then advanced imaging (MR) and CSF assessment if the imaging were normal (take from the lumbar region)

Question 5

Bobbard is an 8 year-old male-castrated dog that has been acting ‘strangely’ at home for last week. He appears to not react normally to the environment. He has a head turn and circles to the right. The movements of the thoracic limb are exaggerated.

Bobbard’s concious proprioception is significantly decreased on the left side and mildly decreased on the right side. His menace response is absent in the right eye. His facial sensation is absent on the left (when the nostril is stimulated the animal blinks and twitches its facial muscles, but does not move its head rapidly from the stimulus.) All other cranial nerve reflexes are present and normal. He is painful when his cervical area is palpated. The rest of the neurologic examination was unremarkable.

Does this animal have neurologic disease?

Answer 5

Yes

The clues are the behavior change, the menace deficint, the facial sensation deficit, and the tetraparesis with normal spinal reflexes.

Question 6

Bobbard is an 8 year-old male-castrated dog that has been acting ‘strangely’ at home for last week. He appears to not react normally to the environment. He has a head turn and circles to the right. The movements of the thoracic limb are exaggerated.

Bobbard’s concious proprioception is significantly decreased on the left side and mildly decreased on the right side. His menace response is absent in the right eye. His facial sensation is absent on the left (when the nostril is stimulated the animal blinks and twitches its facial muscles, but does not move its head rapidly from the stimulus.) All other cranial nerve reflexes are present and normal. He is painful when his cervical area is palpated. The rest of the neurologic examination was unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

Answer 6

Intracranial - right supratentorial

Question 7

Bobbard is an 8 year-old male-castrated dog that has been acting ‘strangely’ at home for last week. He appears to not react normally to the environment. He has a head turn and circles to the right. The movements of the thoracic limb are exaggerated.

Bobbard’s concious proprioception is significantly decreased on the left side and mildly decreased on the right side. His menace response is absent in the right eye. His facial sensation is absent on the left (when the nostril is stimulated the animal blinks and twitches its facial muscles, but does not move its head rapidly from the stimulus.) All other cranial nerve reflexes are present and normal. He is painful when his cervical area is palpated. The rest of the neurologic examination was unremarkable.

What are the suspected causes?

Answer 7

Tumor, hydrocephalus, cerebrovascular disease, inflammatory brain disease, traumatic injury, and metabolic diseases

Question 8

Bobbard is an 8 year-old male-castrated dog that has been acting ‘strangely’ at home for last week. He appears to not react normally to the environment. He has a head turn and circles to the right. The movements of the thoracic limb are exaggerated.

Bobbard’s concious proprioception is significantly decreased on the left side and mildly decreased on the right side. His menace response is absent in the right eye. His facial sensation is absent on the left (when the nostril is stimulated the animal blinks and twitches its facial muscles, but does not move its head rapidly from the stimulus.) All other cranial nerve reflexes are present and normal. He is painful when his cervical area is palpated. The rest of the neurologic examination was unremarkable.

What diagnostic tests would be most helpful?

Answer 8

In order of completion: Routine laboratory assessments, coagulation assessments if indicated by clinical signs, blood pressure. If no obvious systemic abnormality found, then advanced imaging (MR) and CSF assessment (if MR is normal)

Question 9

Bobbard is an 8 year-old male-castrated dog that has been acting ‘strangely’ at home for last week. He appears to not react normally to the environment. He has a head turn and circles to the right. The movements of the thoracic limb are exaggerated.

Bobbard’s concious proprioception is significantly decreased on the left side and mildly decreased on the right side. His menace response is absent in the right eye. His facial sensation is absent on the left (when the nostril is stimulated the animal blinks and twitches its facial muscles, but does not move its head rapidly from the stimulus.) All other cranial nerve reflexes are present and normal. He is painful when his cervical area is palpated. The rest of the neurologic examination was unremarkable.

If CSF assessment was indicated in this patient, where would you collect the CSF from?

Answer 9

The lumbar region

Question 10

Geoffrey is a 4 year old male castrated cat that has had an acute onset of inability to stand. Upon examination, he is in lateraly recumbency and unable to stand.

His proprioception is significantly decreased on the left hand side and absent on the right hand side. All of his cranial nerve reflex tests are present and normal. You note that he has positional horizontal nystagmus with the fast phase to the left. Everything else on the neurologic examination is unremarkable.

Does this animal have neurologic disease?

Answer 10

Yes

The clues are the tetraparesis with normal spinal reflexes and the nystagmus

Question 11

Geoffrey is a 4 year old male castrated cat that has had an acute onset of inability to stand. Upon examination, he is in lateraly recumbency and unable to stand.

His proprioception is significantly decreased on the left hand side and absent on the right hand side. All of his cranial nerve reflex tests are present and normal. You note that he has positional horizontal nystagmus with the fast phase to the left. Everything else on the neurologic examination is unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

Answer 11

Intracranial infratentorial (brain stem)

Worse on the right hand side

Question 12

Geoffrey is a 4 year old male castrated cat that has had an acute onset of inability to stand. Upon examination, he is in lateraly recumbency and unable to stand.

His proprioception is significantly decreased on the left hand side and absent on the right hand side. All of his cranial nerve reflex tests are present and normal. You note that he has positional horizontal nystagmus with the fast phase to the left. Everything else on the neurologic examination is unremarkable.

What are the suspected causes?

Answer 12

Tumor, hydrocephalus, cerebrovascular disease, inflammatory brain disease, traumatic injury, and metabolic diseases

Question 13

Geoffrey is a 4 year old male castrated cat that has had an acute onset of inability to stand. Upon examination, he is in lateraly recumbency and unable to stand.

His proprioception is significantly decreased on the left hand side and absent on the right hand side. All of his cranial nerve reflex tests are present and normal. You note that he has positional horizontal nystagmus with the fast phase to the left. Everything else on the neurologic examination is unremarkable.

What diagnostic tests would be most helpful?

Answer 13

In order of completion: Routine laboratory assessments, potentially coagulation assessments if clinical signs indicate, blood pressure, advanced imaging, and CSF if the imaging studies are normal

Question 14

Geoffrey is a 4 year old male castrated cat that has had an acute onset of inability to stand. Upon examination, he is in lateraly recumbency and unable to stand.

His proprioception is significantly decreased on the left hand side and absent on the right hand side. All of his cranial nerve reflex tests are present and normal. You note that he has positional horizontal nystagmus with the fast phase to the left. Everything else on the neurologic examination is unremarkable.

If you end up taking CSF in the case, where would you get the sample from?

Answer 14

the lumbar region

Question 15

Veronica is a 9 year old female spayed dog that has been acting ‘this way’ for the last 10 days. You notice that she has a head tilt to the left side and that she is moving her head in swaying movements from side to side.

Veronica has decreased proprioception on the left side and normal proprioception on the right hand side. All cranial nerve reflex tests are present and normal. She has a positional horizontal nystagmus with the fast phase to the right. The remainder of the neurologic examination was unremarkable.

Does this animal have neurologic disease?

Answer 15

Yes

Question 16

Veronica is a 9 year old female spayed dog that has been acting ‘this way’ for the last 10 days. You notice that she has a head tilt to the left side and that she is moving her head in swaying movements from side to side.

Veronica has decreased proprioception on the left side and normal proprioception on the right hand side. All cranial nerve reflex tests are present and normal. She has a positional horizontal nystagmus with the fast phase to the right. The remainder of the neurologic examination was unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

Answer 16

The signs are fairly localizing for a left-sided central vestibular abnormality

Question 17

Veronica is a 9 year old female spayed dog that has been acting ‘this way’ for the last 10 days. You notice that she has a head tilt to the left side and that she is moving her head in swaying movements from side to side.

Veronica has decreased proprioception on the left side and normal proprioception on the right hand side. All cranial nerve reflex tests are present and normal. She has a positional horizontal nystagmus with the fast phase to the right. The remainder of the neurologic examination was unremarkable.

What are the suspected causes?

Answer 17

Tumor, hydrocephalus, inflammatory brain disease, traumatic injury, cerebrovascular disease, and metronidazole toxicity

Question 18

Veronica is a 9 year old female spayed dog that has been acting ‘this way’ for the last 10 days. You notice that she has a head tilt to the left side and that she is moving her head in swaying movements from side to side.

Veronica has decreased proprioception on the left side and normal proprioception on the right hand side. All cranial nerve reflex tests are present and normal. She has a positional horizontal nystagmus with the fast phase to the right. The remainder of the neurologic examination was unremarkable.

What diagnostic tests would be most helpful?

Answer 18

In order of completion: Routine laboratory assessments, coagulation assessments if clinical signs indicate, blood pressure, advanced imaging, and CSF assessment if advanced imaging studies are normal

Question 19

Veronica is a 9 year old female spayed dog that has been acting ‘this way’ for the last 10 days. You notice that she has a head tilt to the left side and that she is moving her head in swaying movements from side to side.

Veronica has decreased proprioception on the left side and normal proprioception on the right hand side. All cranial nerve reflex tests are present and normal. She has a positional horizontal nystagmus with the fast phase to the right. The remainder of the neurologic examination was unremarkable.

If you need to take a CSF sample from this patient, where would you take it from?

Answer 19

the lumbar region

Question 20

Paco is an 8 year old male-castrated cat who has been acting ‘this way’ for the last 10 days. You notice that he has a severe head tilt to the right hand side.

All proprioceptive and cranial nerve reflexes are present and normal. You note that he has spontaneous rotary head tilt and that his head seems to move similarly with each beat of the nystagmus. The rest of the neurologic examination was unremarkable.

Does this animal have neurologic disease?

Answer 20

yes

Question 21

Paco is an 8 year old male-castrated cat who has been acting ‘this way’ for the last 10 days. You notice that he has a severe head tilt to the right hand side.

All proprioceptive and cranial nerve reflexes are present and normal. You note that he has spontaneous rotary head tilt and that his head seems to move similarly with each beat of the nystagmus. The rest of the neurologic examination was unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

Answer 21

Signs could reflect either a central or a peripheral vestibular abnormality

Question 22

Paco is an 8 year old male-castrated cat who has been acting ‘this way’ for the last 10 days. You notice that he has a severe head tilt to the right hand side.

All proprioceptive and cranial nerve reflexes are present and normal. You note that he has spontaneous rotary head tilt and that his head seems to move similarly with each beat of the nystagmus. The rest of the neurologic examination was unremarkable.

What are the suspected causes?

Answer 22

Central vestibular abnormalities: tumor, hydrocephalus, inflammatory brain disease, traumatic injury, and cerebrovascular disease

Peripheral vestibular abnormalities: Middle/inner ear infection, middle/inner ear tumor, traumatic injury, and idiopathic feline vestibular disease

Question 23

Paco is an 8 year old male-castrated cat who has been acting ‘this way’ for the last 10 days. You notice that he has a severe head tilt to the right hand side.

All proprioceptive and cranial nerve reflexes are present and normal. You note that he has spontaneous rotary head tilt and that his head seems to move similarly with each beat of the nystagmus. The rest of the neurologic examination was unremarkable.

What diagnostic tests would be most helpful?

Answer 23

In order of completion: Otoscopic examination, routine laboratory asssessments, coagulation assessments if indicated by clinical signs, blood pressure, advanced imaging (MR), and CSF assessment if imaging studies are normal

Question 24

Paco is an 8 year old male-castrated cat who has been acting ‘this way’ for the last 10 days. You notice that he has a severe head tilt to the right hand side.

All proprioceptive and cranial nerve reflexes are present and normal. You note that he has spontaneous rotary head tilt and that his head seems to move similarly with each beat of the nystagmus. The rest of the neurologic examination was unremarkable.

If you were to evaluate the CSF, where would you get the sample from?

Answer 24

the lumbar region

Question 25

Squidward is an 8 year old male castrated dog that has been **acting this way for the last 7 days** and the owner noticed that he **'looked funny.'** You notice that Squidward has an **asymmetrical facial appearance.** His **menace response is absent on the left side,** however he does appear to **retract the eye during menace testing.** His blinking and palpebral reflex is **absent on the left side,** however he does appear to **retract the eye during palpebral testing.** Squidward does **not appear to move the facial muscle and ear on the right side.** All other cranial reflexes are present and normal. The remainder of the neurologic exam was unremarkable. **Does he have neurologic disease?**

Answer 25

Yes

Question 26

Squidward is an 8 year old male castrated dog that has been **acting this way for the last 7 days** and the owner noticed that he **'looked funny.'** You notice that Squidward has an **asymmetrical facial appearance**. His **menace response is absent on the left side**, however he does **appear to retract the eye during menace testing**. His **blinking and palpebral reflex is absent on the left side**, however he does **appear to retract the eye during palpebral testing.** Squidward does **not appear to move the facial muscle and ear on the right side.** All other cranial reflexes are present and normal. The remainder of the neurologic exam was unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 26

Right facial nerve

Question 27

Squidward is an 8 year old male castrated dog that has been **acting this way for the last 7 days** and the owner noticed that he **'looked funny.'** You notice that Squidward has an **asymmetrical facial appearance.** His **menace response is absent on the left side**, however he does **appear to retract the eye during menace testing.** His **blinking and palpebral reflex is absent on the left side**, however he does **appear to retract the eye during palpebral testing.** Squidward does **not appear to move the facial muscle and ear on the right side.** All other cranial reflexes are present and normal. The remainder of the neurologic exam was unremarkable. **What are the suspected causes?**

Answer 27

Idiopathic facial nerve paralysis, tumor, middle/inner ear inflammation, traumatic injury, and also consider central causes

Question 28

Squidward is an 8 year old male castrated dog that has been **acting this way for the last 7 days** and the owner noticed that he **'looked funny.'** You notice that Squidward has an **asymmetrical facial appearance.** His **menace response is absent on the left side**, however he does **appear to retract the eye during menace testing**. His **blinking and palpebral reflex is absent on the left side**, however he does **appear to retract the eye during palpebral testing**. Squidward does **not appear to move the facial muscle and ear on the right side.** All other cranial reflexes are present and normal. The remainder of the neurologic exam was unremarkable. **What diagnostic tests would be most helpful?**

Answer 28

In order of completion: Routine laboratory assessments, coagulation assessments if clinical signs indicate, blood pressure, advanced imaging (MR), and CSF assessment if MR is normal.

Question 29

Squidward is an 8 year old male castrated dog that has been **acting this way for the last 7 days** and the owner noticed that he **'looked funny.'** You notice that Squidward has an **asymmetrical facial appearance**. His **menace response is absent on the left side**, however he does **appear to retract the eye during menace testing**. His **blinking and palpebral reflex is absent on the left side**, however he does **appear to retract the eye during palpebral testing.** Squidward does **not appear to move the facial muscle and ear on the right side.** All other cranial reflexes are present and normal. The remainder of the neurologic exam was unremarkable. **If you were to take a CSF sample in this patient, where would you take it from?**

Answer 29

the lumbar region

Question 30

Walter is a 6 year old male castrated dog that has been having **intermittent seizure-like episodes.** All reflexes are present and normal. You recognize during your examination that Walter is **experiencing a classic grand mal seizure**. The rest of the neurologic exam is unremarkable. **Does this animal have neurologic disease?**

Answer 30

Yes

Question 31

Walter is a 6 year old male castrated dog that has been having **intermittent seizure-like episodes**. All reflexes are present and normal. You recognize during your examination that Walter is **experiencing a classic grand mal seizure.** The rest of the neurologic exam is unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 31

Neuroanatomically, seizures are most often associated with supratentoral or forebrain abnormalities. While this is the area of the nervous system where the seizure activity originates, the disease that results in a seizure may be present in oter symptoms besides the nervous system.

Question 32

Walter is a 6 year old male castrated dog that has been having **intermittent seizure-like episodes**. All reflexes are present and normal. You recognize during your examination that Walter is experiencing a **classic grand mal seizure.** The rest of the neurologic exam is unremarkable. **What are the suspected causes?**

Answer 32

Structural (intracranial), metabolic (extracranial), or idiopathic

Question 33

Walter is a 6 year old male castrated dog that has been having **intermittent seizure-like episodes.** All reflexes are present and normal. You recognize during your examination that Walter is experiencing a **classic grand mal seizure.** The rest of the neurologic exam is unremarkable. **What diagnostic tests would be the most helpful?**

Answer 33

In order of completion: Routine laboratory assessments, coagulation assessments if indicated by clinical signs, blood pressure, advanced imaging (MR), and CSF assessment if MR is normal (take from lumbar region)

Question 34

Edgar is a 4 year old male castrated cat that you are seeing 3 days after a **seizure-like episode**. You are able to examine him during one of his episodes and notice that he has **dilated pupils**, is **falling to one side**, and **salivating**. These are all signs of a **focal seizure**. All reflexes are pesent and normal. The remainder of the neurologic examination is unremarkable. **Does this animal have neurologic disease?**

Answer 34

yes

Question 35

Edgar is a 4 year old male castrated cat that you are seeing 3 days after a **seizure-like episode**. You are able to examine him during one of his episodes and notice that he has **dilated pupils**, is **falling to one side**, and **salivating**. These are all signs of a **focal seizure**. All reflexes are pesent and normal. The remainder of the neurologic examination is unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 35

Neuroanatomically, seizures are most often associated with supratentoral or forebrain abnormalities. While this is the area of the nervous system where the seizure activity originates, the disease that results in a seizure may be present in oter symptoms besides the nervous system.

Question 36

Edgar is a 4 year old male castrated cat that you are seeing 3 days after a **seizure-like episode**. You are able to examine him during one of his episodes and notice that he has **dilated pupils**, is **falling to one side**, and **salivating**. These are all signs of a **focal seizure**. All reflexes are pesent and normal. The remainder of the neurologic examination is unremarkable. **What are the suspected causes?**

Answer 36

Structural (intracranial), metabolic (extracranial), and idiopathic

Question 37

Edgar is a 4 year old male castrated cat that you are seeing 3 days after a **seizure-like episode**. You are able to examine him during one of his episodes and notice that he has **dilated pupils,** is **falling to one side**, and **salivating**. These are all signs of a **focal seizure**. All reflexes are pesent and normal. The remainder of the neurologic examination is unremarkable. **What diagnostic tests would be most helpful?**

Answer 37

In order of completion: Routine laboratory assessments, coagulation assessments if indicated by clinical signs, blood pressure, advanced imaging (MR), and CSF assessment if MR is normal (take from lumbar region)

Question 38

Allen is a 3 year old male castrated cat that is presenting for a **change in behavior for the past week.** You notice that he is experiencing **intermittent, apparently involuntary movements** that **primarily involve the left thoracic limb**. **Does this animal have neurologic disease?**

Answer 38

It is uncertain

Question 39

Allen is a 3 year old male castrated cat that is presenting for a **change in behavior for the past week.** You notice that he is **experiencing intermittent**, apparently **involuntary movements** that **primarily involve the left thoracic limb**. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 39

Ultimately, the movement is resulting from depolarization of certain muscles or muscle groups. These muscles could be depolarizing spontaneously because of a primary muscle abnormality. Spontaneous nervous system activation could occur, for example, during a seizure, or result from peripheral nerve activation.

Question 40

Allen is a 3 year old male castrated cat that is presenting for a **change in behavior for the past week**. You notice that he is experiencing **intermittent**, apparently **involuntary movements** that **primarily involve the left thoracic limb**. **What are the suspected causes?**

Answer 40

The differential diagnosis would include diseases that could result in spontaneous activation of either nerves (including central and peripheral nerves) or muscle.

Question 41

Allen is a 3 year old male castrated cat that is presenting for a **change in behavior for the past week.** You notice that he is experiencing **intermittent**, apparently **involuntary movements** that **primarily involve the left thoracic limb**. **What diagnostic tests would be the most helpful?**

Answer 41

In order of completion: Routine laboratory assessments To assess for central nervous system: Advanced imaging (MR) and CSF if MR is normal To assess for peripheral nervous system disease: Serum creatinine kinase, possible electromyography and nerve conduction studies, serum anti-ACH antibody titer for myasthenia gravis Based on the tests above potentially nerve or muscle biopsy.

Question 42

Poe is a 4 month old intact male dog that has **been this way since the dog was able to move.** You notice that he is **uncoordinated with exaggerated movements.** You note that the menace response is **absent in both eyes** but his vision is normal. All other cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **Does this animal have neurologic disease?**

Answer 42

Yes The clues are the exaggerated movements, coupled with the normal conscious proprioceptive assessments. The menace deficit with normal vision is also an important clue

Question 43

Poe is a 4 month old intact male dog that has **been this way since the dog was able to move**. You notice that he is **uncoordinated with exaggerated movements.** You note that the **menace response is absent in both eyes** but his vision is normal. All other cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 43

Intracranial infratentorial unconscious proprioceptive system disorder (including the cerebellum) Consistent with cerebellar system abnormality.

Question 44

Poe is a 4 month old intact male dog that has **been this way since the dog was able to move**. You notice that he is **uncoordinated with exaggerated movements.** You note that the **menace response is absent in both eyes** but his vision is normal. All other cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What are the suspected causes?**

Answer 44

Congenital cerebellar disease, anomalous cerebellar disease, inherited degenerative condition such as storage disease, hydrocephalus, inflammatory brain disease, and traumatic injury

Question 45

Poe is a 4 month old intact male dog that has **been this way since the dog was able to move**. You notice that he is **uncoordinated with exaggerated movements.** You note that the **menace response is absent in both eyes** but his vision is normal. All other cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What diagnostic tests would be most helpful?**

Answer 45

In order of completion: Routine laboratory assessments, coagulation assessments if clinical signs indicate, blood pressure, advanced imaging (MR), and CSF assessment if MR is normal (take from the lumbar region)

Question 46

Edith is a 7 year old female spayed dog that has a history of **progressive pelvic limb dysfunction over the last 3 weeks.** You notice that she has **exaggerated movements of the pelvic limbs.** The **inter-step distance are inconsistent between the left and right resulting in an irregualr footfall pattern.** Occasionally she will **sink lower on one of the pelvic limb when contacting the ground, and then over flex on the immediately following flight phase of the limb.** When looking at Edith from behind you notice that she **does not walk in a straight line and tends to sway from side to side.** You note that **proprioception is decreased on both pelvic limbs,** but the proprioception on the thoracic limbs are normal. The rest of the neurological examination is unremarkable. **Does this animal have neurologic disease?**

Answer 46

yes

Question 47

Edith is a 7 year old female spayed dog that has a **history of progressive pelvic limb dysfunction over the last 3 weeks**. You notice that she has **exaggerated movements of the pelvic limbs**. The **inter-step distance are inconsistent between the left and right resulting in an irregualr footfall pattern**. Occasionally she will **sink lower on one of the pelvic limb when contacting the ground**, and then **over flex on the immediately following flight phase of the limb**. When looking at Edith from behind you notice that **she does not walk in a straight line and tends to sway from side to side.** You note that **proprioception is decreased on both pelvic limbs**, but the proprioception on the thoracic limbs are normal. The rest of the neurological examination is unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 47

Based on the conscious and unconscious proprioceptive deficits in the pelvic limbs and the normal spinal reflexes, the neuroanatomical diagnosis is a **T3-L3** spinal cord abnormality.

Question 48

Edith is a 7 year old female spayed dog that has a **history of progressive pelvic limb dysfunction over the last 3 weeks**. You notice that she has **exaggerated movements of the pelvic limbs**. The **inter-step distance are inconsistent between the left and right resulting in an irregular footfall pattern.** Occasionally she will **sink lower on one of the pelvic limb when contacting the ground**, and **then over flex on the immediately following flight phase of the limb.** When looking at Edith from behind you notice that she **does not walk in a straight line and tends to sway from side to side**. You note that **proprioception is decreased on both pelvic limbs**, but the proprioception on the thoracic limbs are normal. The rest of the neurological examination is unremarkable. **What are the suspected causes?**

Answer 48

Tumor, intervertebral disk disease, inflammatory spinal disease, traumatic injury, spinal vascular disease, and diskospondylitis/osteomyelitis

Question 49

Edith is a 7 year old female spayed dog that has a **history of progressive pelvic limb dysfunction over the last 3 weeks**. You notice that she has **exaggerated movements of the pelvic limbs**. The **inter-step distance are inconsistent between the left and right resulting in an irregular footfall pattern.** Occasionally she will **sink lower on one of the pelvic limb when contacting the ground**, and **then over flex on the immediately following flight phase of the limb**. When looking at Edith from behind you notice that **she does not walk in a straight line and tends to sway from side to side.** You note that **proprioception is decreased on both pelvic limbs,** but the proprioception on the thoracic limbs are normal. The rest of the neurological examination is unremarkable. **What diagnostic tests would be most helpful?**

Answer 49

In order of completion: Routine laboratory assessments, spinal radiographs, advanced imaging (MR), CSF assessment if imaging studies are normal (from the lumbar region)

Question 50

Fred is an 8 month old male dog that is presenting for **progressive problems walking for the past four months.** You notice that the dog has **exaggerated movements of all four limbs. The interstep distance are inconsistent between the left and right, and front and back resulting in an irregular footfall pattern. Ocassionally he will sink lower on one of the pelvic limbs when contacting the ground,** and then **over-flexing on the immediately following flight phase of the limb (some would label this as hypermetria).** When you look at Fred from behind, he **does not travel in a straight line, but rather sways from side to side (some would label this as ataxia).** You notice that **proprioception is mildly decreased on all four limbs.** All cranial nerve reflexes are present and normal. The remainder of the neurological examination is unremarkable. **Does this animal have neurologic disease?**

Answer 50

Yes The clinical signs are suggestive of proprioceptive deficits in all limbs

Question 51

Fred is an 8 month old male dog that is presenting for p**rogressive problems walking for the past four months.** You notice that the dog has **exaggerated movements of all four limbs**. The i**nterstep distance are inconsistent between the left and right, and front and back resulting in an irregular footfall pattern. Ocassionally he will sink lower on one of the pelvic limbs when contacting the ground, and then over-flexing on the immediately following flight phase of the limb (some would label this as hypermetria).** When you look at Fred from behind, he **does not travel in a straight line, but rather sways from side to side (some would label this as ataxia).** You notice that **proprioception is mildly decreased on all four limbs**. All cranial nerve reflexes are present and normal. The remainder of the neurological examination is unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 51

Based on the conscious and unconscious proprioceptive deficits in all of the limbs and the normal spinal reflexes, the neuroanatomical diagnosis is a **C1-C5,** spinal cord abnormality

Question 52

Fred is an 8 month old male dog that is presenting for **progressive problems walking for the past four months**. You notice that the dog has **exaggerated movements of all four limbs**. The i**nterstep distance are inconsistent between the left and right, and front and back resulting in an irregular footfall pattern. Ocassionally he will sink lower on one of the pelvic limbs when contacting the ground, and then over-flexing on the immediately following flight phase of the limb** (some would label this as **hypermetria**). When you look at Fred from behind, **he does not travel in a straight line, but rather sways from side to side** (some would label this as **ataxia**). You notice that **proprioception is mildly decreased on all four limbs. All cranial nerve reflexes are present and normal.** The remainder of the neurological examination is unremarkable. **What are the suspected causes?**

Answer 52

Degenerative condition, congenital condition, anomalous condition, cervical vertebral malformation/malartriculation (Wobbler's syndrome), inflammatory spinal disease, traumatic injury, tumor, and diskospondylitis/osteomyelitis

Question 53

Fred is an 8 month old male dog that is presenting for **progressive problems walking for the past four months.** You notice that the he has **exaggerated movements of all four limbs**. The **interstep distance are inconsistent between the left and right, and front and back resulting in an irregular footfall pattern. Ocassionally he will sink lower on one of the pelvic limbs when contacting the ground, and then over-flexing on the immediately following flight phase of the limb** (some would label this as **hypermetria)**. When you look at Fred from behind, he **does not travel in a straight line, but rather sways from side to side** (some would label this as **ataxia**). You notice that **proprioception is mildly decreased on all four limbs**. All cranial nerve reflexes are present and normal. The remainder of the neurological examination is unremarkable. **What diagnostic tests would be helpful?**

Answer 53

In order of completion: Routine laboratory assessments, spinal radiographs, advanced imaging (MR), and CSF assessment if imaging reveals nothing (take from lumbar areas)

Question 54

Roswald is a 4 year old male castrated dog that is presenting for **progressive problems walking for 4 days.** You notice that he is **dragging his pelvic limbs.** He also **intermittently does not support his own weight in these limbs and will sink closer to the ground upon weight bearing.** You note that he has **significantly decreased proprioception in both pelvic limbs**, but normal proprioception in both thoracic limbs. His cranial nerve reflexes are present and normal. You also note that he has a **painful reaction upon palpation of the thoraco-lumbar junction.** The remainder of the neurologic examination was unremarkable. **Does he have neurologic disease?**

Answer 54

Yes The clinical signs are suggestive of proprioceptive deficits in the pelvic limbs

Question 55

Roswald is a 4 year old male castrated dog that is presenting for **progressive problems walking for 4 days**. You notice that he is **dragging his pelvic limbs**. He also **intermittently does not support his own weight in these limbs and will sink closer to the ground upon weight bearing.** You note that he has **significantly decreased proprioception in both pelvic limbs**, but normal proprioception in both thoracic limbs. His cranial nerve reflexes are present and normal. You also note that he has a **painful reaction upon palpation of the thoraco-lumbar junction.** The remainder of the neurologic examination was unremarkable. **What is the neuroantatomical diagnosis (where is the lesion)?**

Answer 55

Based on the conscious and unconscious proprioceptive deficits in the pelvic limbs and the normal spinal reflexes, the neuroanatomical diagnosis is a **T3-L3** spinal cord abnormality

Question 56

Roswald is a 4 year old male castrated dog that is presenting for **progressive problems walking for 4 days**. You notice that he is **dragging his pelvic limbs**. He also **intermittently does not support his own weight in these limbs and will sink closer to the ground upon weight bearing.** You note that he has **significantly decreased proprioception in both pelvic limbs**, but normal proprioception in both thoracic limbs. His cranial nerve reflexes are present and normal. You also note that he has a **painful reaction upon palpation of the thoraco-lumbar junction**. The remainder of the neurologic examination was unremarkable. **What are the suspected causes?**

Answer 56

Intervertebral disk disease, inflammatory spinal disease, traumatic injury, tumor, and diskospondylitis/osteomyelitis

Question 57

Roswald is a 4 year old male castrated dog that is **presenting for progressive problems walking for 4 days**. You notice that he is **dragging his pelvic limbs**. He also **intermittently does not support his own weight in these limbs and will sink closer to the ground upon weight bearing.** You note that he has **significantly decreased proprioception in both pelvic limbs**, but normal proprioception in both thoracic limbs. His cranial nerve reflexes are present and normal. You also note that he has a **painful reaction upon palpation of the thoraco-lumbar junction**. The remainder of the neurologic examination was unremarkable. **What diagnosstic tests would be most helpful?**

Answer 57

In order of completion: Routine laboratory assessments, spinal radiographs, advanced imaging (MR), and CSF assessment if imaging shows nothing (take from lumbar area)

Question 58

Kirk is an 8 year old male castrated dog that is presenting for **progressive problems walking for 3 months**. You notice that he has his **head in a downward posture**. **His thoracic limbs appear to have somewhat short steps, while the pelvic limbs have more irregular steps.** You note that he has **mildly decreased proprioception in all four limbs.** He also has **decreased thoracic withdrawal reflexes on both sides**. The cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **Does this animal have neurologic disease?**

Answer 58

Yes The clinical signs are suggestive of proprioceptive deficits in all of the limbs

Question 59

Kirk is an 8 year old male castrated dog that is **presenting for progressive problems walking for 3 months.** You notice that he has his **head in a downward posture. His thoracic limbs appear to have somewhat short steps, while the pelvic limbs have more irregular steps.** You note that he has **mildly decreased proprioception in all four limbs**. He also has **decreased thoracic withdrawal reflexes on both sides.** The cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 59

Based on the conscious and unconscious proprioceptvee deficits in all of the limbs and the normal spinal reflexes in the pelvic limb with decreased reflexes in the thoracic limbs, the neuroanatomical diagnosis is a **C6-T2** spinal cord abnormality. The gait is also characteristic of an abnormality in this region of the spinal cord

Question 60

Kirk is an 8 year old male castrated dog that is presenting for **progressive problems walking for 3 months**. You notice that he has his **head in a downward posture**. His t**horacic limbs appear to have somewhat short steps, while the pelvic limbs have more irregular steps.** You note that he has **mildly decreased proprioception in all four limbs**. He also has **decreased thoracic withdrawal reflexes on both sides.** The cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What are the suspected causes?**

Answer 60

Cervical vertebral malformation/malarticulation (Wobbler's syndrome), inflammatory spinal disease, traumatic injury, tumor, and diskospondylitis/osteomyelitis

Question 61

Kirk is an 8 year old male castrated dog that is presenting for **progressive problems walking for 3 months.** You notice that he has his **head in a downward posture**. His **thoracic limbs appear to have somewhat short steps, while the pelvic limbs have more irregular steps**. You note that he has **mildly decreased proprioception in all four limbs.** He also has **decreased thoracic withdrawal reflexes on both sides.** The cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What diagnostic tests would be helpful?**

Answer 61

In order of completion: Routine laboratory assessments, spiral radiographs, advanced imaging (MR), and CSF assessment if imaging is normal (collect from lumbar region)

Question 62

Paula is an 8 year old female spayed dog that is presenting for being **acutely unable to stand**. You notice that she is in a **laterally recumbent position and in fact unable to stand.** You note that she has **severely decreased/absent proprioception in all four limbs**. All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **Does Paula have neurologic disease?**

Answer 62

Yes The clinical signs are suggestive of proprioceptive deficits in all limbs

Question 63

Paula is an 8 year old female spayed dog that is presenting for being **acutely unable to stand**. You notice that she is in a **laterally recumbent position and in fact unable to stand.** You note that she has **severely decreased/absent proprioception in all four limbs**. All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 63

Based on the conscious and unconscious proprioceptive deficits in all of the limbs and the normal spinal reflexes, the neuroanatomical diagnosis is a **C1-C5** spinal cord abnormality

Question 64

Paula is an 8 year old female spayed dog that is presenting for being **acutely unable to stand**. You notice that she is in a **laterally recumbent position and in fact unable to stand.** You note that she has **severely decreased/absent proprioception in all four limbs.** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What are the suspected causes?**

Answer 64

Intervertebral disk disease, inflammatory spinal disease, traumatic injury, tumor, diskospondylitis/osteomyelitis, and spinal cord vascular disease

Question 65

Paula is an 8 year old female spayed dog that is presenting for being **acutely unable to stand.** You notice that she is in a **laterally recumbent position and in fact unable to stand.** You note that she has **severely decreased/absent proprioception in all four limbs**. All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What diagnostic tests would be helpful?**

Answer 65

In order of completion: Routine laboratory assessments, spinal radiographs, advanced imaging, and CSF assessment if imaging studies are normal (take from lumbar area).

Question 66

Margie is a 2 year old female spayed dog that is presenting for being found **acutely unable to stand**. You notice that she in fact is **unable to stand and support weight on the pelvic limbs.** You note that the **proprioception in the pelvic limbs are severely decreased/absent**. The **patellar and withdrawal reflexes in both pelvic limbs are absent**. You also note that the **deep pain sensation is absent in the pelvic limbs**. All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **Does this animal have neurologic disease?**

Answer 66

Yes The clinical signs are suggestive of severe proprioceptive deficits in the pelvic limbs

Question 67

Margie is a 2 year old female spayed dog that is presenting for being found **acutely unable to stand**. You notice that she in fact is **unable to stand and support weight on the pelvic limbs.** You note that the **proprioception in the pelvic limbs are severely decreased/absent.** The **patellar and withdrawal reflexes in both pelvic limbs are absent**. You also note that the **deep pain sensation is absent in the pelvic limbs.** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 67

Based on the conscious and unconscious proprioceptive deficits in the pelvic limbs and the normal spinal reflexes, the neuroanatomical diagnosis is a **L4-S3** spinal cord abnormality.

Question 68

Margie is a 2 year old female spayed dog that is presenting for being found **acutely unable to stand**. You notice that she in fact is **unable to stand and support weight on the pelvic limbs.** You note that the **proprioception in the pelvic limbs are severely decreased/absent.** The **patellar and withdrawal reflexes in both pelvic limbs are absent.** You also note that the **deep pain sensation is absent in the pelvic limbs.** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What are the suspected causes?**

Answer 68

Intervertebral disk disease, spinal cord vascular disease, inflammatory spinal disease, traumatic injury, tumor, and diskospondylitis/osteomyelitis

Question 69

Margie is a 2 year old female spayed dog that is presenting for being found **acutely unable to stand**. You notice that she in fact is **unable to stand and support weight on the pelvic limbs.** You note that the **proprioception in the pelvic limbs are severely decreased/absent.** The **patellar and withdrawal reflexes in both pelvic limbs are absent.** You also note that the **deep pain sensation is absent in the pelvic limbs.** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What diagnostic tests would be most helpful?**

Answer 69

In order of completion: Routine laboratory assessments, spinal radiographs, advanced imaging (MR), and CSF assessment if imaging studies are normal (sample from lumbar region)

Question 70

Bertha is a 6 year old female spayed dog that is presenting for **acute onset of clinical signs that have persisted for 3 weeks**. You notice that she has her **head in a downward posture**. **Proprioception is decreased on all four limbs.** You note that she has **severe cervical pain**. All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **Does this animal have neurologic disease?**

Answer 70

Yes Based on the pain and proprioceptive deficits in the limbs

Question 71

Bertha is a 6 year old female spayed dog that is presenting for **acute onset of clinical signs that have persisted for 3 weeks**. You notice that she has her **head in a downward posture.** **Proprioception is decreased on all four limbs.** You note that she has **severe cervical pain**. All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 71

Based on the conscious and unconscious proprioceptive deficits in all of the limbs and the normal spinal reflexes in the pelvic limb with decreased reflexes in the thoracic limbs, the neuroanatomical diagnosis is a **C1-T5** spinal cord abnormality

Question 72

Bertha is a 6 year old female spayed dog that is presenting for **acute onset of clinical signs that have persisted for 3 weeks**. You notice that she has her **head in a downward posture.** **Proprioception is decreased on all four limbs**. You note that she has **severe cervical pain**. All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What are the suspected causes?**

Answer 72

Intervertebral disk disease, inflammatory spinal disease, traumatic injury, tumor, and diskospondylitis/osteomyelitis

Question 73

Bertha is a 6 year old female spayed dog that is presenting for **acute onset of clinical signs that have persisted for 3 weeks**. You notice that she has her **head in a downward posture**. **Proprioception is decreased on all four limbs.** You note that she has **severe cervical pain**. All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What diagnostic tests would be most helpful?**

Answer 73

In order of completion: Routine laboratory assessments, spinal radiographs, advanced imaging (MR), and CSF assessment if imaging studies are normal (sample from lumbar region)

Question 74

Willard is a 3 year old male castrated dog that is presenting for **walking 'funny' for 2 weeks.** You notice that his **gait in the pelvic limbs is more short-stepped**, and this **progressively worsens with continued movement**. During the movement, the Willard forms a **kyphotic posture in the lumbar region,** and the **thoracic limb inter-step distance becomes shorter.** **With consistent movement, the dog will simultaneously advance both pelvic limbs.** His **mouth has an open appearance** and **salivation is obvious.** You note that the **palpebral reflex is mildly decreased in both eyes**. The rest of the cranial nerve reflexes are present and normal. The remainder of the neurologic examination was unremarkable. **Does Willard have neurologic disease?**

Answer 74

Probably yes

Question 75

Willard is a 3 year old male castrated dog that is presenting for **walking 'funny' for 2 weeks**. You notice that his **gait in the pelvic limbs is more short-stepped,** and this **progressively worsens with continued movement**. During the movement, the Willard forms a **kyphotic posture in the lumbar region**, and the **thoracic limb inter-step distance becomes shorter.** With **consistent movement, the dog will simultaneously advance both pelvic limbs.** His **mouth has an open appearance and salivation is obvious**. You note that the **palpebral reflex is mildly decreased in both eyes**. The rest of the cranial nerve reflexes are present and normal. The remainder of the neurologic examination was unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 75

The shorter inter-step distance can be a sign of either pain in or around the limbs, or of peripheral nerve, muscle, or neuromuscular junction dysfunction. If a musculoskeletal assessment does not find an obious cause for diffuse limb pain, then this gait is most characteristic of **LMN dysfunction**

Question 76

Willard is a 3 year old male castrated dog that is presenting for **walking 'funny' for 2 weeks**. You notice that his **gait in the pelvic limbs is more short-stepped**, and this **progressively worsens with continued movement**. During the movement, the Willard forms a **kyphotic posture in the lumbar region**, and the t**horacic limb inter-step distance becomes shorter**. With **consistent movement, the dog will simultaneously advance both pelvic limbs**. His **mouth has an open appearance and salivation is obvious.** You note that the p**alpebral reflex is mildly decreased in both eyes.** The rest of the cranial nerve reflexes are present and normal. The remainder of the neurologic examination was unremarkable. **What are the suspected causes?**

Answer 76

Degenerative neuropathies/myopathies, acquired neuropathies/myopathies, traumatic injury, inflammatory nerve diseases, toxic nerve diseases, and myasthenia gravis

Question 77

Willard is a 3 year old male castrated dog that is presenting for **walking 'funny' for 2 weeks**. You notice that his **gait in the pelvic limbs is more short-stepped**, and this **progressively worsens with continued movement**. During the movement, the Willard forms a **kyphotic posture in the lumbar region**, and the **thoracic limb inter-step distance becomes shorter**. With consistent movement, the dog **will simultaneously advance both pelvic limbs.** His **mouth has an open appearance and salivation is obvious.** You note that the **palpebral reflex is mildly decreased in both eyes.** The rest of the cranial nerve reflexes are present and normal. The remainder of the neurologic examination was unremarkable. **What diagnostic tests would be helpful?**

Answer 77

In order of completion: Routine laboratory assessments, Serum creatine kinase, tensillon response test, possibly electromyography and nerve conduction studies, Serum anti-ACH antibody titer for myasthenia gravis, based on these tests potentially nerve or muscle biopsy

Question 78

Richard is a 7 month old male castrateed dog that is presenting for **progressive inability to walk normally over the last 3 days.** You notice that his **gait in the pelvic limbs is more short-stepped**, and this **progressively worsens with continued movement**. During the movement, he forms a **kyphotic posture in the lumbar region**. With **consistent movement, Richard will simultaneously advance both pelvic limbs (bunny hop).** **Proprioception is decreased in all four limbs.** You note that the **palpebral reflex is decreased in both eyes.** The remainder of the cranial nerve reflexes are present and normal. Willard also has **decreased withdrawal reflexes in all four limbs** and his **patellar relfexes are absent in both pelvic limbs.** The remainder of the neurological examination is unremarkable. **Does Richard have neurologic disease?**

Answer 78

It is uncertain

Question 79

Richard is a 7 month old male castrateed dog that is presenting for **progressive inability to walk normally over the last 3 days**. You notice that his **gait in the pelvic limbs is more short-stepped, and this progressively worsens with continued movement**. During the movement, he forms a **kyphotic posture in the lumbar region**. With **consistent movement, Richard will simultaneously advance both pelvic limbs (bunny hop).** **Proprioception is decreased in all four limbs**. You note that the **palpebral reflex is decreased in both eyes**. The remainder of the **cranial nerve reflexes are present and normal**. Willard also has **decreased withdrawal reflexes in all four limbs and his patellar relfexes are absent in both pelvic limbs**. The remainder of the neurological examination is unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 79

Based on the conscious proprioceptive deficits in all limbs with decreased spinal reflexes, these signs are most consistent with the **diffuse LMN presentation**

Question 80

Richard is a 7 month old male castrateed dog that is presenting for **progressive inability to walk normally over the last 3 days**. You notice that **his gait in the pelvic limbs is more short-stepped, and this progressively worsens with continued movement.** During the movement, he forms a **kyphotic posture in the lumbar region**. With **consistent movement, Richard will simultaneously advance both pelvic limbs (bunny hop).** **Proprioception is decreased in all four limbs**. You note that the **palpebral reflex is decreased in both eyes.** The remainder of the cranial nerve reflexes are present and normal. Willard also has **decreased withdrawal reflexes in all four limbs and his patellar relfexes are absent in both pelvic limbs.** The remainder of the neurological examination is unremarkable. **What are the suspected causes?**

Answer 80

Degenerative neuropathies/myopathies, Acquired neuropathies/myopathies, Tick paralysis, Polyradiculoneuritis, Botulism, Traumatic injury, Inflammatory nerve diseases, Toxic nerve diseases, Myasthenia gravis

Question 81

Richard is a 7 month old male castrateed dog that is presenting for **progressive inability to walk normally over the last 3 days**. You notice that his **gait in the pelvic limbs is more short-stepped, and this progressively worsens with continued movement.** During the movement, he forms a **kyphotic posture in the lumbar region**. With **consistent movement, Richard will simultaneously advance both pelvic limbs (bunny hop).** **Proprioception is decreased in all four limbs**. You note that the **palpebral reflex is decreased in both eyes**. The remainder of the cranial nerve reflexes are present and normal. Willard also has **decreased withdrawal reflexes in all four limbs and his patellar relfexes are absent in both pelvic limbs**. The remainder of the neurological examination is unremarkable. **What diagnostic tests would be helpful?**

Answer 81

In order of completion: Routine laboratory assessments, Serum creatine kinase, possibly electromyography and nerve conduction studies, Serum anti-ACH antibody titer for myasthenia gravis, based on these tests potentially nerve or muscle biopsy

Question 82

Dorothy is a 7 month old female dog that is presenting for **progressive inability to walk normally over the last 7 days.** Her **gait in the pelvic limbs is more short-stepped**, and this **progressively worsens with continued movement**. During the movement, **she tends to “crab” i.e. the pelvic limbs advance to one side of the dog.** Her cranial nerve reflex tests are all present and normal. The remainder of the neurologic examination is unremarkable. **Does this dog have neurologic disease?**

Answer 82

Uncertain

Question 83

Dorothy is a 7 month old female dog that is presenting for **progressive inability to walk normally over the last 7 days.** Her **gait in the pelvic limbs is more short-stepped**, and this **progressively worsens with continued movement.** During the movement, **she tends to “crab” i.e. the pelvic limbs advance to one side of the dog.** Her cranial nerve reflex tests are all present and normal. The remainder of the neurologic examination is unremarkable. **What is the neuroanatomic diagnosis (where is the lesion)?**

Answer 83

The shorter inter-step distance can be a sign of either pain in or around the limbs, or of peripheral nerve, muscle, or neuromuscular junction dysfunction. If a musculoskeletal assessment does not find an obvious cause for diffuse limb pain, then this gait is most characteristic of **“LMN” dysfunction.**

Question 84

Dorothy is a 7 month old female dog that is presenting for **progressive inability to walk normally over the last 7 days**. Her **gait in the pelvic limbs is more short-stepped**, and this **progressively worsens with continued movemen**t. During the movement, **she tends to “crab” i.e. the pelvic limbs advance to one side of the dog.** Her cranial nerve reflex tests are all present and normal. The remainder of the neurologic examination is unremarkable. **What are the suspected causes?**

Answer 84

Degenerative neuropathies/myopathies, acquired neuropathies/myopathies, traumatic injury, inflammatory nerve diseases, toxic nerve diseases, and myasthenia gravis

Question 85

Dorothy is a 7 month old female dog that is presenting for **progressive inability to walk normally over the last 7 days**. Her **gait in the pelvic limbs is more short-stepped**, and this **progressively worsens with continued movement**. During the movement, **she tends to “crab” i.e. the pelvic limbs advance to one side of the dog**. Her cranial nerve reflex tests are all present and normal. The remainder of the neurologic examination is unremarkable. **What diagnostic tests would be helpful?**

Answer 85

In order of completion: Routine laboratory assessments, Serum creatine kinase, tensillon response test, possibly electromyography and nerve conduction studies, Serum anti-ACH antibody titer for myasthenia gravis, based on these tests potentially nerve or muscle biopsy

Question 86

Spork is a 6 year old female spayed cat that is presenting for **walking funny for 3 weeks**. You note that she walks with an **over-flexed posture in the pelvic limbs**. During the f**light phase of the gait, cycle Spork does not flex the hock joints appropriately resulting in the stifle having to flex more than normal.** Her **proprioception was decreased in both pelvic limbs**. You also note that **her withdrawal reflexes are decreased in both pelvic limbs**, but the patellar reflexes are normal. All cranial nerve reflexes are present and normal. The remainder of her neurological examination was unremarkable. **Does Spork have neurologic disease?**

Answer 86

Yes

Question 87

Spork is a 6 year old female spayed cat that is presenting for **walking funny for 3 weeks**. You note that she **walks with an over-flexed posture in the pelvic limbs**. **During the flight phase of the gait, cycle Spork does not flex the hock joints appropriately resulting in the stifle having to flex more than normal.** Her **proprioception was decreased in both pelvic limbs**. You also note that her **withdrawal reflexes are decreased in both pelvic limbs, but the patellar reflexes are normal.** All cranial nerve reflexes are present and normal. The remainder of her neurological examination was unremarkable. **What is the neuroanatomical diagnosis?**

Answer 87

The clinical signs are suggestive of **bilateral nerve dysfunction**

Question 88

Spork is a 6 year old female spayed cat that is presenting for **walking funny for 3 weeks**. You note that she walks with an **over-flexed posture in the pelvic limbs**. During the **flight phase of the gait, cycle Spork does not flex the hock joints appropriately resulting in the stifle having to flex more than normal.** Her **proprioception was decreased in both pelvic limbs**. You also note that her **withdrawal reflexes are decreased in both pelvic limbs, but the patellar reflexes are normal**. All cranial nerve reflexes are present and normal. The remainder of her neurological examination was unremarkable. **What are the suspected causes?**

Answer 88

Peripheral nerve diseases - Degenerative neuropathies/myopathies, acquired neuropathies/myopathies, traumatic injury, inflammatory nerve diseases, and toxic nerve diseases Spinal cord abnormalities - Lumbosacral disease, instability, degeneration, invertebral disk disease, inflammatory spinal disease, traumatic injury, tumor, and disk spondylitis/osteomyelitis

Question 89

Spork is a 6 year old female spayed cat that is presenting for **walking funny for 3 weeks**. You note that she **walks with an over-flexed posture in the pelvic limbs**. During the **flight phase of the gait, cycle Spork does not flex the hock joints appropriately resulting in the stifle having to flex more than normal.** Her **proprioception was decreased in both pelvic limbs.** You also note that her **withdrawal reflexes are decreased in both pelvic limbs, but the patellar reflexes are normal.** All cranial nerve reflexes are present and normal. The remainder of her neurological examination was unremarkable. **What diagnostic tests would be helpful?**

Answer 89

In order of completion: Routine laboratory assessments For spinal cord disease - Advanced imaging (MR) and CSF assessment For peripheral nerve disease: Serum creatine kinase, possibly electromyography and nerve conduction studies Based on the above tests - potentially nerve and muscle biopsy

Question 90

Manny is a 5 year old male castrated dog that is presentig for **limb dysfunction over the past 6 weeks.** You notice that he **over-flexes at the right tarsal joint with weight bearing**. His **toes are retracted caudally.** You **palpate the region of the gastrocnemius tendon and note that is is enlarged, firm, and painful.** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination was unremarkable. **Does this animal have neurologic disease?**

Answer 90

No

Question 91

Manny is a 5 year old male castrated dog that is presenting for **limb dysfunction over the past 6 weeks**. You notice that he **over-flexes at the right tarsal joint with weight bearing**. His toes are **retracted caudally.** You palpate the region of the **gastrocnemius tendon and note that is is enlarged, firm, and painful.** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination was unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 91

The clinical signs are suggestive of musculokeletal abnormality of the gastrocnemius tendon or mechanical supporting structures that result in tarsal extension. The normal proprioception and withdrawal reflex also support a non-neurologic cause for this abnormality

Question 92

Manny is a 5 year old male castrated dog that is **presenting for limb dysfunction over the past 6 weeks.** You notice that he **over-flexes at the right tarsal joint with weight bearing**. His **toes are retracted caudally.** You palpate the region of the **gastrocnemius tendon and note that is is enlarged, firm, and painful.** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination was unremarkable. **What are the suspected causes?**

Answer 92

Gastrocnemius tendon rupture, gastrocnemius muscle disease, and Calcaneal fracture

Question 93

Manny is a 5 year old male castrated dog that is **presenting for limb dysfunction over the past 6 weeks**. You notice that he **over-flexes at the right tarsal joint with weight bearing.** His **toes are retracted caudally.** You palpate the region of the **gastrocnemius tendon and note that is is enlarged, firm, and painful.** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination was unremarkable. **What diagnostic tests would be most helpful?**

Answer 93

Routine laboratory assessments, palpation of the gastrocnemius muscle region, ultrasound of the gastrocnemius muscle/tendon, and radiographs of the calcaneal/tarsal region

Question 94

Mitchum is a 6 year old male castrated dog that is presenting for **limb dysfunction for 8 weeks.** You notice that he has **unusual movement of the left thoracic limb**. The **limb is externally rotated at the shoulder** and the **limb moves in a circumducted motion when advancing.** All cranial nerve reflexes are normal and present. The rest of the neurologic examination was unremarkable. **Does Mitchum have a neurologic disease?**

Answer 94

No

Question 95

Mitchum is a 6 year old male castrated dog that is presenting for **limb dysfunction for 8 weeks.** You notice that he has **unusual movement of the left thoracic limb**. The **limb is externally rotated at the shoulder** and the **limb moves in a circumducted motion when advancing.** All cranial nerve reflexes are normal and present. The rest of the neurologic examination was unremarkable. **What is the neuroanatomical diagnosis (where is the lesion)?**

Answer 95

The clinical signs are suggestive of musculoskeletal abnormality. The gait characteristics are those of an infraspinatus muscle/tendon contraction.

Question 96

Mitchum is a 6 year old male castrated dog that is presenting for **limb dysfunction for 8 weeks**. You notice that he has **unusual movement of the left thoracic limb**. The **limb is externally rotated at the shoulder** and the **limb moves in a circumducted motion when advancing.** All cranial nerve reflexes are normal and present. The rest of the neurologic examination was unremarkable. **What is the suspected cause?**

Answer 96

Infraspinatus muscle/tendon contracture

Question 97

Mitchum is a 6 year old male castrated dog that is presenting for **limb dysfunction for 8 weeks**. You notice that he has **unusual movement of the left thoracic limb**. The **limb is externally rotated at the shoulder** and the **limb moves in a circumducted motion when advancing.** All cranial nerve reflexes are normal and present. The rest of the neurologic examination was unremarkable. **What diagnostic tests would be helpful?**

Answer 97

In order of completion: Routine laboratory assessments and musculoskeletal examination

Question 98

Moon Pie is a 1 year old female dog that is presenting for **limb dysfunction for 8 weeks.** You notice that she is **simultaneously advancing both pelvic limbs (bunny hopping).** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **Does Moon Pie have neurologic disease?**

Answer 98

No

Question 99

Moon Pie is a 1 year old female dog that is presenting for **limb dysfunction for 8 weeks.** You notice that she is **simultaneously advancing both pelvic limbs (bunny hopping).** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What is the neuroanatomical diagnosis?**

Answer 99

most likely musculoskeletal

Question 100

Moon Pie is a 1 year old female dog that is presenting for **limb dysfunction for 8 weeks**. You notice that she is **simultaneously advancing both pelvic limbs (bunny hopping).** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What is the suspected cause?**

Answer 100

Bilateral hip dysplasia

Question 101

Moon Pie is a 1 year old female dog that is presenting for **limb dysfunction for 8 weeks.** You notice that she is **simultaneously advancing both pelvic limbs (bunny hopping).** All cranial nerve reflexes are present and normal. The remainder of the neurologic examination is unremarkable. **What diagnostic tests would be most helpful?**

Answer 101

In order of completion: Routine laboratory assessments, musculoskeletal examination, radiographs of clinically affected regions

Question 102

Hot dog is a 6 year old male castrated dog that is presenting for **limb dysfunction for 8 weeks.** You notice that he has **unusual movement of the pelvic limb.** Immediately **past the apex of the flight phase of the gait cycle, his foot is rapidly moved (jerked) medially.** The **stifle may be internally rotated and the hock slightly more externally rotated.** All of the cranial reflexes are present and normal. The neurologic examination was unremarkable. **Does Hot Dog have a neurologic disease?**

Answer 102

No

Question 103

Hot dog is a 6 year old male castrated dog that is presenting for **limb dysfunction for 8 weeks.** You notice that he has **unusual movement of the pelvic limb**. Immediately **past the apex of the flight phase of the gait cycle, his foot is rapidly moved (jerked) medially**. The **stifle may be internally rotated and the hock slightly more externally rotated.** All of the cranial reflexes are present and normal. The neurologic examination was unremarkable. **What is the neuroanatomical diagnosis?**

Answer 103

The clinical signs are suggestive of musculoskeletal abnormality. The gait characteristics are those of a fibrotic myopathy

Question 104

Hot dog is a 6 year old male castrated dog that is presenting for **limb dysfunction for 8 weeks**. You notice that he has **unusual movement of the pelvic limb**. Immediately **past the apex of the flight phase of the gait cycle, his foot is rapidly moved (jerked) medially**. The **stifle may be internally rotated and the hock slightly more externally rotated.** All of the cranial reflexes are present and normal. The neurologic examination was unremarkable. **What is the suspected cause?**

Answer 104

Fibrotic myopathy

Question 105

Hot dog is a 6 year old male castrated dog that is presenting for **limb dysfunction for 8 weeks**. You notice that he has **unusual movement of the pelvic limb**. Immediately **past the apex of the flight phase of the gait cycle, his foot is rapidly moved (jerked) medially**. The **stifle may be internally rotated and the hock slightly more externally rotated.** All of the cranial reflexes are present and normal. The neurologic examination was unremarkable. **What diagnostic tests would be helpful?**

Answer 105

In order of completion: Routine laboratory assessments and musculoskeletal examination