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Neurology > Neuro exam of the SA > Flashcards

Neuro exam of the SA Flashcards

1
Q

What are the 3 possible locations that a lesion affecting neurological function can be found?

A
  1. Brain (forebrain, midbrain, cerebellum) 2. Spinal cord (C1-5, C6- T2, T3- L3, L4-Cd) 3. Neuromuscular junction
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2
Q

What should be done before a neuro exam?

A

A thorough PE to rule out orthopedic/musculoskeletal issues

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3
Q

What is the aim of a neuro exam?

A
  1. Neurological normal or abnormal? 2. Location
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4
Q

What are the 8 parts of the neuro-exam?

A
  1. Mentation 2. Posture 3. Gait 4. Postural reactions 5. Spinal reflexes 6. Cranial nerves 7. Palpation 8. Nociception

Leave palpation and nociception last as they are the most noxious

General observation to handling

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5
Q

How is mentation assessed?

A
  1. Level of consciousness (alert–>coma) 2. Quality of consciousness (appropriate or inappropriate?)
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6
Q

How is posture accessed?

A

-Posture of HEAD (tilt or turn present?) -Posture of LIMBS (wide/narrow based stance, any decreased weight bearing?) -Posture of BODY (decerebrate, decerebellate, Schiff-Scherrington?)

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7
Q

What issues could these postures point to? a) Head tilt b) Head turn

A

a) Vestibular disease
b) Forebrain disease (head turn towards side of lesion)

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8
Q

What issues could these postures point to? c) Wide based stance d) Narrow based stance e) Decreased weight bearing

A

c) Proprioceptive loss?
d) Weakness?
e) Evidence of pain?

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9
Q

What issues could these posture point to?

f) Decerebrate

A

f) Dog is unconcious and both fore and hind limbs are stiff and stretched out
- Decreased conciousness, opisthotonus (hyperextension of body) + extensor rigidity of all four legs
- This positioning indicates a rostral brainstem lesion or any brain lesion that results in compression of the brainstem,

(can be seen with significant intracranial hypertension + herniation)

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10
Q

What issues could this posture point to?

g) Decerebellate

A

g) Dog is concious but fore himbs are stiff and went its nose is pushed up the dog sits down
- Extensor rigidity of the front limbs, opisthotonus, and the presence of flexed hindlimbs and the coxofemoral joint with normal tone

Associated with cerebellar disease.

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11
Q

What issues could this posture point to?

h) Schiff-Scherrington

A

Dog has an issue in spine (T3-L3 spinal lesions)

  • Exhibit hypertonic front limbs and flaccid paresis of the hindlimbs.
  • Normal consciousness + cranial nerve exam so long as hypovolemia and concurrent brain trauma not present.
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12
Q

How is Gait accessed?

A
  • Requires integration of proprioceptive and motor systems, and can be difficult to assess since looking at a lot of things at once
  • Is gait normal or abnormal?
  • What limbs are affected? (Ataxia, paresis, paralysis, etc?)
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13
Q

What is Paresis? (the two types?)

A

Decreased voluntary movement

  1. Lower motor P (Cell body in SC, axon in peripheral)
  2. Upper motor P (Central)
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14
Q

What is used to differentiate between UMN or LMN paresis?

A

Severity but also postural reacions, spinal reflexes, muscle tone

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15
Q

What is the presentation of UMN paresis?

A
  • See a decreased ability to START voluntary movement; muscle tone is normal to increased in limbs caudal to the lesion, and spinal reflexes are normal to increased in limbs caudal to the lesion
  • Stride length is normal to increase and may see spasticity
  • May or may not see ataxia (sensory related)- swaying gait + knuckling
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16
Q

What is the presentation of LMN paresis?

A
  • Muscle tone is decreased in limbs with a reflex arc containing the lesion
  • Spinal reflexes are decreased to absent in limbs with a reflex arc containing the lesion
  • Stride length is normal to decreased, stiff, will see ‘bunny-hopping’, may or may not see collapse, may or may not see ataxia (sensory- knuckling)

-Lose sense of limbs and slapping limbs

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17
Q

What does ataxia mean?

A

Without order

18
Q

What are the 3 types of ataxia?

A
  1. Sensory (proprioceptive)
  2. Cerebellar
  3. Vestibular
19
Q

What is Sensory ataxia?

A

-Loss of sense of limb/body position

CS:

  • Will see a wide-based stance
  • Increased stride length,
  • Swaying/floating gait, and knuckling
  • Often there is an associated paresis
20
Q

What is Cerebellar ataxia?

A

-Disorder of the RATE and RANGE of movement;

-CS:
Hypermetria
Intention tremors - head bob, high step gait
Postural tremors

Cerebellum is to smooth out movement

21
Q

What is vestibular ataxia?

A

-Unilateral: see falling/leaning/circling to one side and a head tilt

  • Bilateral: wide excursions of the head, may or may not see head tilt (since bilateral may cancel out the tilt)
  • crouched posture may be present

-With both, will see abnormal nystagmus (eye side to side) or strabismus (misalignment with eyes)

Vestibular system - central (in brain) and peripheral (inner ear)

22
Q

How is posture assessed?

A

Requires integration of proprioceptive + motor systems
Long pathway - non-specific

  • Paw positioning
  • Hopping
  • Wheelbarrowing
  • Hemi-walking
  • Placing (on a table)
  • Extensor postural thrust - lifting up cats and replacing on table
23
Q

How are spinal reflexes assessed?

A
  • Tendon reflexes
  • Flexor (withdrawal) reflexes
24
Q

What are some of the tendon reflexes they use and what section of the spine do they assess?

A
  • Biceps: Musculocutaneous nerve, C6-8
  • Triceps: Radial nerve, C7-T2
  • Patellar: femoral nerve, L4-6
  • Gastrocnemius: sciatic nerve, L6-S2
25
Q

What are some flexor (withdrawal) reflexes used and what section of the spine do they assess?

A

Thoracic limb Multiple nn (C6-T2)

Pelvic limb Sciatic n (L6-S2)

26
Q

What are some other spinal reflexes used to localize a lesion?

A
  • Perineal reflex (pudendal, S1-3)
  • Cutaneous trunci reflex (C8-T1) - see contraction
27
Q

Name some different reasons for decreased to absent reflexes in an animal

A
  • Lesion within the reflex arc
  • Physical limitation of movement (joint fibrosis, muscle contracture)
  • Excitement/fear
  • “Spinal shock”
28
Q

Name some different reasons for exaggerated reflexes in an animal:

A
  • Lesion to UMN pathways cranial to the spinal cord segments tested
  • Excitement/fear
  • Pseudo-hyperreflexia (loss of antagonism)
29
Q

How is the optic nerve assessed?

A
  1. Vision
  2. Menace response
  3. Pupillary light reflex
  4. Fundic exam

II –> Forebrain

30
Q

What is the menace response arc?

A

CN II to forebrain to cerebellum to brainstem to CN VII (Facial)

Hand to the eye and causes the eye to blink

31
Q

What is the pupillary light reflex arc?

A

CN II (Optic) to brainstem to CN III (Oculomotor); direct and indirect (consensual), so left pupil will constrict when light is shone into the right and vice versa

32
Q

How is the oculomotor nerve assessed?

A

Pupillary light reflex; CNII to brainstem to CNIII (parasympathetic)

33
Q

What nerves are involved in Horner’s Syndrome?

A
  • Oculomotor
  • Trochlear
  • Abducent

-Sympathetic nerves - denervation of orbit - miosis (small pupil), ptosis (drooping eyelid), Enophthalmus (protruding 3rd eyelid)

Motor to extraocular muscles

Strabismus (eye position), Nystagmus (eye movement)
VIII (Vestibulocochlear) to Central Vestibular to CN III, IV, VI

34
Q

How is the trigeminal nerve assessed?

A
  1. Facial sensation
  2. Palpebral reflex (V—> Brainstem –> VII)
  3. Corneal reflex (V–> Brainstem —> VI)
  4. Signs of dysfunction of muscles of mastication (Decreased motor - atrophy, inability to close jaw bilaterly)
35
Q

How is the facial nerve assessed?

A
  1. Signs of dysfunction of muscles of facial expression - facial paresis/asymmetry
  2. Palpebral reflex (V (Trigeminal) to Brainstem to VII (Facial))
  3. Menace response (II to forebrain to cerebellum to brainstem to VII)
  4. Lacrimal production (decreased production)
36
Q

How is the Vestibulocochlear nerve accessed?

A
  • Cochear: Auditory
  • Vestibular:

Signs of dysfunction: ataxia, head tilt, strabismus, nystagmus

37
Q

How is the Glossopharyngeal and Vagus nerve accessed?

A
  • Sensory and motor to pharynx
  • Gag reflex - IX and X —> Brainstem —> IX + X
38
Q

How is the Hypoglossal nerve accessed?

A
  • Motor to tongue
  • Signs of dysfunction: Paresis/Paralysis of tongue (dysphagia), atrophy/asymmetry of tongue, seen as deviation of tongue
39
Q

How is palpation useful in a neurological exam?

A

Light palpation is useful for feeling for swelling or atrophy, and deep palpation is useful for assessing pain

40
Q

What is nociception?

A

Conscious perception of pain - receptors in cerebrum

‘Superficial’ - Skin and ‘Deep’ - Bone (periosteum)

41
Q

Is limb withdrawal indicative of pain perception? (reflex arc still intact)

A

NO

42
Q

What different presentations are there for pain?

A

Focal, Multifocal and diffuse

Neurology (13 decks)

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