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Neuro > Neuro Exam > Flashcards

Neuro Exam Flashcards

1
Q

Six components of neuro exam

A
  • mentation
  • gait & posture
  • cranial nerves
  • postural reactions
  • segmental reflexes
  • palpation & range of motion
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2
Q

mentation

A
  • alert & appropriate
  • obtunded (dull, lethargic but responsive)
  • stuporous (responsive to noxious stimuli)
  • comatose (not responsive to noxious stimuli)
  • dead
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3
Q

gait

A
  • ambulatory vs. non-ambulatory
  • ataxia
  • paresis or plegia? (mono-, hemi-, para-, tetra-)
  • lameness?
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4
Q

ataxia

A
  • lack of coordination
  • cerebellar, vestibular, proprioceptive
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5
Q

cerebellar ataxia

A

wide-based stance, +/- hypermetria, truncal sway

no CP deficits, no weakness

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6
Q

vestibular ataxia

A

wide-based stance, leaning, listing, “drunken sailor”

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7
Q

proprioceptive ataxia

A

lack of coordination with a lack of awareness and paresis

“spinal ataxia”

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8
Q

posture

A
  • head
    • tilt or turn
    • resting or intention tremors
    • head held low, neck guarding
  • body
    • kyphosis, lordosis, scoliosis
    • torticollis
    • laterally recumbent
  • decerebrate vs. decerebellate vs. Schiff-Sherrington
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9
Q

decerebrate

A
  • cerebrum disconnected
  • comatose
  • rigid extension in all limbs
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10
Q

decerebellate

A
  • acute cerebellar lesions
  • extended TLs, flexed PLs
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11
Q

Schiff-Sherrington

A
  • severe, acute T3-L3 lesions-plegia +/- pain perception
  • not prognostic
  • when placed on side: TLs rigid, HLs weak
  • extensor hypertonia of TLs
  • due to loss of ascending inhibition
  • distinguish from decerebrate and decerebellate posutres (mentation and CNs)
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12
Q

what do decerebrate, decerebellate and Schiff-Sherrington have in common?

A

oposthotonus (star gazing), extended neck and rigid thoracic limbs

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13
Q

menace

A

afferent: CN II
efferent: CN VII

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14
Q

PLR

A

afferent: CN II
efferent: PS CN III

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15
Q

palpebral

A
  • medial canthus:
    • afferent: V (ophth)
    • efferent: VII
  • lateral canthus
    • afferent: V (max)
    • efferent: VII
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16
Q

facial symmetry

A

CN VII

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17
Q

physiologic nystagmus

A

afferent: CN VIII
efferent: CN III, IV, VI

  • MLF
  • strabismus, positional nystagmus
18
Q

gag

A

afferent: CN IX, X
efferent: IX

19
Q

tongue function

A

CN XII

(lesions here are not as common in dogs and cats as horses)

20
Q

postural reactions

A
  • placing/knuckling (CP)
  • hopping
  • hemistanding & hemiwalking
  • wheelbarrow
  • visual & tactile placing
  • extensor postural thrust
21
Q

hemistanding & hemiwalking

A

walk laterally slowly- don’t have musculature to hop medially

should be 1:1 thoracic:pelvic limb steps

22
Q

segmental reflexes: thoracic limb

A
  • withdrawal (reliable)
    • biceps, musculocutaneous n., C6-C8, triceps, radial n., C8-T2
  • biceps & triceps
23
Q

segmental reflexes: pelvic limb

A
  • patellar (reliable)
    • femoral n., L4-L6
  • gastrocnemius
  • cranial tibial
  • withdrawal (reliable)
    • mostly sciatic n.
    • L6-S1
24
Q

segmental reflexes: cutaneous trunci

A
  • lateral thoracic n.
  • C8-T1
  • not a simple reflex
25
Q

segmental reflexes: perineal reflex

A

tail tuck and anal sphincter

26
Q

neurolocalization

A
  • normal vs. abnormal
  • brain vs spine vs LMN vs multifocal
  • 1: brain
  • 2: C1-C5
  • 3: C6-T2
  • 4: T3-L3
  • 5: L4-S3
  • 6: motor unit (LMN)
27
Q

brain and cranial nerves

A
  • forebrain
    • cerebrum: I
    • diencephalon: II
  • cerebellum
  • brainstem
    • midbrain: III-IV
    • pons: V
    • medulla oblongata: VI-XII
28
Q

forebrain lesions-clinical signs

A
  • seizures
  • circling
  • compulsive
  • behavior changes (inapp, getting stuck in corners)
  • blindness, non-ocular (amaurosis)
  • postural reaction deficits
  • gait should be normal (no paresis)
29
Q

idiopathic head tremors

A

“head bobbing”

labs

try feeding PB and will stop

30
Q

cerebellar lesions-clinical signs

A
  • head tilt
  • nystagmus
  • loss of menace
  • intention tremors
  • truncal sway
  • ataxia
  • hypermetria“spastic”
  • DO NOT have: paresis, behavior changes, CP deficits
31
Q
A
32
Q

brainstem lesions-clinical signs

A
  • decreased mentation (ARAS)
    • obtunded to stuporous to comatose
  • CN deficits: III-XII
  • usually some CN VIII involvement
    • check for physiologic nystagmus
  • vestibular or proprioceptive ataxia (if ambulatory)
    • may seem cerebellar depending on lesion
33
Q

vestibular: central vs peripheral

A
  • central
    • CP deficits
    • paresis
    • ataxia
    • hypermetria
    • mentation changes
    • +/- other CN
  • peripheral
    • head tilt
    • nystagmus
    • other CN deficits (VII)
    • ataxia
34
Q

spinal cord lesion

A
  • postural reactions = there is a lesion
  • segmental reflexes = where it is
35
Q

muscle tone

A
  • extended, difficult to flex limb
    • implies UMN lesion
  • normal, resting tone
  • flaccid, unable to support any weight
    • implies LMN involvement
    • consider spinal shock
36
Q

C1-C5

A
  • +/- ambulatory (knuckling, stumbling, “face-planting”
  • tetraparesis
  • ataxia (PL>TL)
  • reflexes: N to increased in all limbs
  • +/- muscle fasiculations
  • +/- pain
37
Q

C6-T2

A
  • +/- ambulatory
    • knuckling, stumbling, “face-planting”
    • “two-engine” gait
  • tetraparesis
  • ataxia
  • reflexes
    • TL: N to decreased
    • PL: N to increased
  • +/- muscle fasiculations
  • +/- pain
38
Q

T3-L3

A
  • +/- ambulatory
  • paraparesis (increased PL tone!)
  • PL ataxia
  • +/- kyphosis
  • reflexes:
    • TL: N
    • PL: N to increased
    • +/- panniculus cut-off
  • +/- pain
39
Q

spinal shock

A
  • T3-L3
  • physiologic or anatomic transection of the spinal cord that results in temporary loss or depression of all or most muscle tone and spinal reflex activity below the level of injury
  • acute injury
  • patellars return within hours in dogs
  • withdrawal reflexes can take days
  • not prognostic
40
Q

L4-S3

A
  • +/- ambulatory
  • PL ataxia
  • +/- pain
  • paraparesis-decreased PL muscle tone
  • reflexes:
    • TL: N
    • PL: decreased to absent
    • +/- panniculus cut off
41
Q

LMN

A
  • +/- ambulatory
  • no ataxia
  • no pain
  • +/- CN weakness (facial, gag)
  • paresis: decreased muscle tone all over
  • reflexes:
    • decreased to absent
    • panniculus may or may not be affected
  • exercise intolerance

Neuro (6 decks)

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