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Neuro examinations Flashcards

1
Q

VITAMIN D for ddx

A

V vascular
I infectious / inflammatory
T trauma / toxic
A anomaly / autoimmune / allergic
M metabolic
I idiopathic
N neoplastic
D degenerative / deficiency

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2
Q

After general physical examination of a neuro patient, based on your findings you may need to move on to… (3) …before your neuro exam.

A
  • orthopaedic
  • ophthalmological
  • dermatological examination

Do the clinical signs indicate a nervous system
lesion?

Which part of NS is affected? (localization)

Differential diagnoses (VITAMIND)?

How severe is the condition, i.e. how urgent is
it?

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3
Q

Plantigrade stance in cats can be caused by:

A

metabolic disease: poorly controlled diabetes (ischiadicus nerve degeneration can cause plantigrade stance these)

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4
Q

Mental status may be described as: (4)

A
  • normal: bright, alert, responds adequately
    to environmental stimuli
  • apathetic-obtunded: drowsy, distracted,
    less responsive to environmental stimuli
  • stupor: not conscious, reactions to external
    stimuli severely reduced, feels pain
  • coma: unconscious, unresponsive to
    external stimuli, including pain
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5
Q

Neuro patient behavior may be described as: (7)

A
  • disoriented
  • circling (large/small circles, direction)
  • compulsive movement: forced movement
  • head pressing
  • vocalizing
  • loss of learned behaviour like suddenly peeing inside
  • aggression
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6
Q

Neuro patient posture may be described as: (6)

A
  • head tilt
  • head turn
  • ventroflexion
  • wide-based stance
  • spinal curvature
  • Schiff-Sherrington posture

Patients with injury to the T2-L2 thoracic spine often display the Schiff-Sherrington syndrome (Figure 47, inset A), typically with normal mentation, forelimbs in extensor rigidity, and hind limbs that are flaccid. The prognosis for these patients is usually grave due to severe spinal cord trauma.

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7
Q

Describe head tilt. (3)

A
  • indicates a vestibular problem (peripheral or central)
  • often in the direction of the lesion (but can also be opposite)
  • paradoxical -head tilted contralateral to the lesion, in certain cerebellar regions
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8
Q

Describe head turn. (4)

A
  • Not the same as head tilt.
  • Often with body turn and circling
  • usually indicates a problem with the forebrain, in the direction of the lesion.
  • may also occur in brainstem lesions
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9
Q

Describe ventroflexion. (5)

A
  • head flexed ventrally down, may touch the sternum
  • neuromuscular weakness
  • metabolic (e.g. hypokalaemia)
  • nutritional (e.g. thiamine/B1 deficiency)
  • serious spinal cord injury in the cervical spine
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10
Q

Describe wide-based stance. (2)

A
  • in case of balance problems
  • especially with ataxia think vestibular system
    (peripheral/central)
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11
Q

Spinal curvature description: (5)

A
  • kyphosis: dorsal curvature of the spine (pictured)
  • lordosis: ventral curvature of the spine
  • scoliosis: lateral deviation of the spine
  • congenital/acquired
  • permanent/intermittent

Reasons:
* pain
* vertebral malformation
* spinal cord parenchymal disease (e.g. syringomyelia)

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12
Q

Describe Schiff-Sherrington posture.

A
  • front limbs overextended, flaccid paralysis of hind limbs
  • mental status normal or apathetic
  • acute severe spinal cord injury in the thoracolumbar region

Patients with injury to the T2-L2 thoracic spine often display the Schiff-Sherrington syndrome, typically with normal mentation, forelimbs in extensor rigidity, and hind limbs that are flaccid. The prognosis for these patients is usually grave due to severe spinal cord trauma.

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13
Q

Describe gait in neuro patients.

A

Very important: Normal gait requires intact function of the forebrain, brainstem, cerebellum, spinal cord,
sensory and motor peripheral nerves, neuromuscular synapse and muscles.

Described as:
* lameness, ataxia, paresis
* which limbs are affected
* ambulatory/nonambulatory

If necessary, support the body to assess the gait!
Examination outdoors or indoors on a non-slippery surface/carpet!

Lameness is the reduced ability to bear body weight. Ataxia is uncoordinated gait (sensory deficit).
Paresis is a loss of ability to support the weight or an inability to generate gait. (motor deficit).

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14
Q

Lameness is?
Nerve root sign is?

A

the reduced ability to bear body weight to the limb due to pain or limited mobility, a short step on the
affected limb and a long step on the normal opposite limb.

  • “nerve root signature” referring to possible compression or inflammation of the nerve root lateral to the spine that may present as severe lameness. Thus, making your combined ortho and neuro exams very important.
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15
Q

Ataxia is…?
Origin? (3)

A

uncoordinated gait (sensory deficit).

Ataxia can originate from only 3 places:
1. spinal ataxia (e.g. sensory ataxia)
2. vestibular ataxia
3. cerebellar ataxia

hypometria: shorter step
hypermetria: longer step
dysmetria: a combination of hypo- and hypermetria, unable to control distance, force and speed of limb movement.

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16
Q

ataxia affecting all 4 limbs can be localized to?

A

C1-C5

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17
Q

common cause of congenital cerebellar ataxia in cats

A

panleukopenia infection in utero

Head “pecking” in these cats is referred to as intention tremor.

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18
Q

Paresis is…?
Plegia is…?

A

Paresis is a loss of ability to support the weight or an inability to generate gait (motor deficit). Paresis is essentially partial paralysis, some voluntary movement still present, deep pain sensation present.

Plegia: paralysis, no voluntary movement, deep
pain sensation present or not.
* monoparesis: one limb
* paraparesis: both hind limbs (knuckling typical)
* tetraparesis: four limbs (you may see “stronger” hindlegs and worse front legs but they are all still affected)
* hemiparesis: limbs on one side

Only front legs paresis is rare.

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19
Q

Postural reactions indicate

A

ability to sense body’s position and movements.

  • motion-sensitive proprioceptors located in joints, tendons, muscles and the inner ear.
  • information collected at the receptors is transmitted to the cerebral cortex, where it is permanently perceived.
  • they need the whole NS functioning.
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20
Q

Why do we test postural reactions? (4)

A
  • Helps to detect subtle dysfunction and asymmetry!
  • Tests the animal’s awareness of each limb/body position and ability to move the limb.
  • Sensitive but low specificity test for localisation.
  • NB Orthopaedic disease can affect proprioception!
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21
Q

Name 5 postural reaction tests.

A
  • paw replacement
  • hopping (hold 1 paw up and push dog lateral, free paw should hop)
  • extensor postural thrust
  • wheelbarrowing (with neck extension)
  • visual and tactile placing reaction

These are the main ones but there are more.

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22
Q

What is the extensor postural thrust reflex?

A

This reflex evaluates postural reactions and extensor tone by checking the animal’s ability to bear weight on its limbs when lowered to the ground. Its to assess the functionality of the descending motor pathways and proprioception.

The examiner holds the animal upright (supporting it under the thorax).

The animal is then lowered toward the ground in a vertical position, so its hindlimbs make contact first.

A normal response is extension of the hindlimbs, followed by a slight forward stepping motion to adjust posture and maintain balance.

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23
Q

Describe the segmental distribution of the spinal cord.

A

The Spinal cord widens in the caudal part of
the cervical region and the lumbar regions:
the cervical and lumbar intumescences. This is where the nerves to the limbs originate.

The spinal cord has a segmental distribution. The spinal segment is the part of the spinal cord from which one pair of spinal nerves originate. A segment does not always correspond to a single vertebra.

Functionally, the spinal cord is divided into four regions, see image:

  1. cranial cervical (C1-C5)
  2. cervicothoracic intumescence (C6-Th2)
  3. thoracolumbar (Th3-L3)
  4. lumbosacral intumesence (L4-S3)
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24
Q

(C6-Th2)

A

cervicothoracic intumescence

25
(L4-S3)
lumbosacral intumescence
26
How should you test Spinal reflexes?
* Assess Segmentally: assess the spinal cord segments in the intumescence, that correspond to the stimulated nerve! * Most reliable spinal reflexes are the: flexor reflex (FL/HL) and patellar reflex (HL). * These can be used to distinguish which segment of the spinal cord is affected and whether it is a UMN or LMN type dysfunction. * If the reflex is hyperreflexic, its UMN; if its hyporeflexic or absent, its LMN. ## Footnote Scale: -2, -1, 0, +1, +2
27
Front limb spinal reflexes.
extensor carpi radialis & flexor
28
Hind limb spinal reflexes.
tibialis cranialis, patellar & flexor
29
Which Hind limb spinal reflex tells you about peroneal nerve function?
tibialis cranialis
30
Which Hind limb spinal reflex tells you about femoral nerve function?
both patellar and flexor
31
tetraparesis with either * normal/increased reflexes in the front limbs * normal/increased reflexes in the hind limbs localizes to?
C1-C5
32
tetraparesis with either * decreased/absent reflexes in the front limbs * normal/increased reflexes in the hind limbs localizes to?
C6-Th2
33
paraparesis with * normal/increased reflexes in the hind limbs localizes to?
Th3-L3
34
paraparesis with * decreased/absent reflexes in the hind limbs localizes to?
L4-S3
35
The concept of the UMN and the LMN.
* The UMN and LMN are nerve cell systems. * A normal gait requires cooperation between UMN and LMN. * Spinal reflexes can be used to distinguish whether the dysfunction is UMN or LMN type. * UMN-neurons in the brain that control the body's motor activity * LMN-neurons directly innervate muscles. * UMN stimulates and inhibits LMN! UMN are the boss, LMN are the workers.
36
Describe Upper motor neurons (UMN).
* are located in the CNS * cell bodies are located in the cerebral cortex, brainstem * axons run through the white matter of the brain and spinal cord and are associated with LMNs * UMN is responsible for initiating and maintaining movements * maintains the tone of the extensor muscles to support the body against gravity * UMN inhibits and stimulates LMN * NB Dysfunction of the UMN, suppressive effect disappears and spinal reflexes are normal or increased!
37
Describe Lower motor neurons (LMN).
* connects the CNS to the innervated muscle * cell bodies are located in the ventral horn of the spinal cord (intumescence region) * axons run from the CNS along the ventral nerve roots, join the spinal nerve, the peripheral nerve and connect to the muscle * induces muscle contraction to maintain body position, support weight and generate movement * LMN dysfunction causes decreased or absent spinal reflexes! ## Footnote LMN dysfunction causes decreased or absent spinal reflexes!
38
UMN vs LMN paresis signs related to posture gait motor function spinal reflexes muscle tone passive limb extension/flexion muscle atrophy
39
Lesion localization depending on whether you have UMN or LMN deficit signs in FL or HL. e.g. if FL show LMN deficit & HL show UMN deficit, where is your lesion localized to? To C6-Th2! Try these next: If FL show normal reflexes & HL show UMN deficit, where is your lesion localized to? If FL show normal reflexes & HL show LMN deficit, where is your lesion localized to? If FL show LMN deficit & HL show LMN deficit, where is your lesion localized to?
If FL show normal reflexes & HL show UMN deficit, where is your lesion localized to? To Th3-L3! If FL show normal reflexes & HL show LMN deficit, where is your lesion localized to? To L4-S3! If FL show LMN deficit & HL show LMN deficit, where is your lesion localized to? To the peripheral nervous system!
40
If you have a patient with monoparesis and has decreased/absent spinal reflexes? Or a tetraparetic patient has generally decreased/absent spinal reflexes? Where might the problem lie?
Think about a peripheral nervous system problem!
41
Describe the Peripheral nervous system.
Made up of: * 12 pairs of cranial nerves, most of them originate from the brainstem (exceptions are CN I and CN II) * 36 pairs of spinal nerves, originating from the spinal cord peripheral cranial nerves - nerve roots spinal nerves neuromuscular synapse muscle
42
Clinical signs of peripheral nervous system deficits: (5)
* monoparesis, tetraparesis * decreased/absent spinal reflexes in one or all limbs * paw replacement deficit * decreased muscle tone * NB! There may be a CN deficit!
43
Describe the brachial plexus. (3)
* innervates the muscles of the front limb * located on the medial surface of the scapula * C6-T1 nerve roots involved (essentially the cervicothoracic intumescence)
44
Describe the lumbosacral plexus (plexus lumbosacralis). (3)
* innervates the muscles of the hind limb * located in the pelvic cavity * L4-S3 nerve roots involved (the lumbosacral intumesence
45
Monoparesis involves damage to
the peripheral nerve of one limb! At least one spinal reflex is decreased/absent in that limb.
46
Tetraparesis and generally decreased spinal reflexes suggest a
generalised PNS problem! Either nerve roots, spinal nerves, neuromuscular synapses or muscles are damaged.
47
Bengal Cat Polyneuropathy is
a hereditary or acquired polyneuropathy that tends to impact young Bengal cats, typically under a year old. The disease affects the myelin sheath or axon of peripheral nerves, leading to decreased nerve signal transmission. This results in progressive weakness, ataxia (lack of coordination), and difficulty walking.
48
There are exceptions to the typical rules of lesion localization. Name 4.
1. Unilateral, very lateralized spinal cord damage may occur in a patient with monoparesis! (as opposed to the typical damage to the peripheral nerve of one limb) 2. Some patients with diffuse or multifocal spinal cord injury may have impaired reflexes in all limbs! (as opposed to the typical suggestion of generalized PNS problem) 3. Cranial nerve deficits can be caused by extracranial (peripheral) nerve disease! (metabolic, infectious, polyneuropathies etc.) 4. Cranial nerve deficits may coexist with generally decreased spinal reflexes (e.g. polyneuropathy).
49
hypothyroidism polyneuropathy sign
the palpebral reflex can be slowed in hypothyroid animals due to: Facial nerve (CN VII) dysfunction, Reduced thyroid hormones lead to impaired nerve function, slowed conduction, and muscle weakness. Also, Low thyroid hormone levels decrease ATP-dependent sodium-potassium pump activity, impairing nerve signal transmission so Generalized Neuromuscular Sluggishness. Myxedema → Accumulation of mucopolysaccharides and fluid in nerve sheaths can compress nerves.
50
Describe the panniculus reflex and its testing.
* sensory portion of the spinal nerves, motor response by the lateral thoracic nerve * cutaneus trunci muscle (m. cutaneus trunci) involved * area to test/pinch is between Th2- L4/L5 * testing begins at the level of the ilial wings, on both sides * this testing helps to determine damage in the thoracolumbar area * don't localize on this test alone! use it in conjunction with spinal reflex assessment. * reflex may be absent individually (brachys...)
51
Describe the perineal reflex.
* Stimulate perineum with a haemostat, followed by anal sphincter contraction and tail flexion. * Tests: integrity of the caudal nerves, pudendal nerve (n.pudendal) and spinal cord segments S1-Cd5.
52
Describe "Cauda equina" syndrome.
“Cauda equina” syndrome involves * L6-7, S1-3 or Cd1-5 segment-lesions. CLINICAL SIGNS are variable: * lameness/paresis if the sciatic nerve is affected (L6-S2 segment) * decreased paw replacement, decreased flexor reflexes in hind legs * "nerve root signature" * low tail carriage, reduced tone and sensitivity * perineal reflex decreased/absent, anal sphincter tone decreased/absent * pain in the lumbosacral region * urinary incontinence * fecal incontinence
53
steroid responsive meningitis-arteritis (SRMA)
is an immune-mediated inflammatory disease affecting the **meninges and small arteries** of young, medium to large-breed dogs (e.g., Boxers, Beagles, Bernese Mountain Dogs). It is characterized by **severe neck pain, fever, and lethargy**, often without neurological deficits unless advanced. The condition is caused by an abnormal immune response leading to **meningeal inflammation and vasculitis**, primarily involving the cervical spinal cord. Diagnosis is based on **clinical signs, cerebrospinal fluid (CSF) analysis showing neutrophilic pleocytosis, and ruling out infections**. SRMA is highly responsive to corticosteroids (e.g., prednisone), with long-term immunosuppressive therapy required to prevent relapses. Classic presentation: arched back, dropped head and neck. neck muscles may even tremble when you palpate Turning head to flank test: they will resist, maybe yelp, be spastic, will be unable to turn head towards flank.
54
Describe testing for deep pain sensation. (4)
* Pinch the toe(bone) with your finger or haemostat. * This must be followed by a behavioural response (head turn, vocalisation, attempt to bite) and limb flexion (flexor reflex). * If only limb flexion (flexor reflex) follows, there is no deep pain! * Important prognostic value in spinal cord and peripheral nerve damage! If there are deficits, prognosis is probably bad. ## Footnote The flexor reflex is a low reflex, it doesn't go all the way to the brain.
55
Localize the lesion to the correct area of the spinal cord based on the following information: * dog * non-ambulatory * paraplegia * increased spinal reflexes in both hind limbs * both front limbs norm. * CN: norm
T3-L3
56
Localize the lesion to the correct area of the spinal cord based on the following information: * dog * non-ambulatory * tetraparesis * decreased spinal reflexes in both front limbs, normal spinal reflexes in both hind limbs * CN: norm
C6-Th2
57
Localize the lesion to the correct area of the spinal cord based on the following information: * dog * non-ambulatory * paraplegia * absent spinal reflexes in the hind limbs * both front limbs norm. * CN: norm
L4-S3
58
Localize the lesion to the correct area of the spinal cord based on the following information: * dog * ambulatory * tetraparesis * increased spinal reflexes in all limbs * CN: normal
C1-C5
59
Localize the lesion to the correct area of the spinal cord based on the following information: * dog * ambulatory * tetraparesis * decreased spinal reflexes in all limbs * CN: norm
peripheral nervous system affected

Neurology (7 decks)

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