Neuro/orto examination

Question 1

ABC:s of neuro exam (6)

Answer 1

-Start evaluating the patient while taking the anamnesis
-If needed, take the animal outside, to the corridor, or use equipment to help you
-Have a system, make notes
-If needed, skip some tests
- With cats, be quick and alert. Usually you only have one possibility to do the test
-With exotics, do not overinterpret

Question 2

Four categories for mental state

Answer 2

Normal - BAR/QAR

Depressive - Conscious, but lethargic, uninterested

Stuporous - Unconscious, reacts to strong stimuli, feels pain

Coma - Deep unconsciousness, does not respond, does not feel pain

Question 3

Head tilt can be a sign of

Answer 3

Peripheral/central vestibular problem
Usually tilted towards the lesion

Question 4

Head turn can be a sign of

Answer 4

Problem of brain or brainstem

Body might turn together with the head and there might be circle movement
Usually towards the lesion

Question 5

Ventroflexation can be a sign of

Answer 5

Myasthenia gravis, thiamine deficiency, hypokalemia

Question 6

What is opistotonus?

Answer 6

Full body hyperextension

Question 7

What could a broad-base stance be a sign of?

Answer 7

Balance problem
Central/peripheral vestibular system problem

Question 8

Different types of spinal curvature (3)

Answer 8

Cyphosis - upward hump
Lordosis - downward concave
Scoliosis - laterally curved

Can be caused by pain, malformation of vertebrae, syringomyelia

Question 9

What is limping and what is the cause of it?

Answer 9

Lessened ability to support bodyweight on a limb
Problematic limb- short step, other side limb- long step
Caused by pain

Question 10

What is ataxia and what can be the cause of it?

Answer 10

Unnormal coordination of movements

Spinal, vestibular or cerebellar

Question 11

What is paresis?

Answer 11

Neurological weakness
Partial paralysis - some voluntary movement is left and also deep pain

Question 12

What is plegia?

Answer 12

Paralysis. Total loss of voluntary movement. Deep pain might be present or lost

Question 13

Differences in monoparesis, paraparesis, hemiparesis, tetraparesis

Answer 13

Mono - one limb is affected
Para - either both front limbs or both hind limbs
Hemi - limbs on one side affected
Tetra - all limbs affected

Question 14

Dysmetria

Answer 14

Change in stepping pattern

Question 15

Hypermetria

Answer 15

abnormally long steps, lifting legs unusually high

Question 16

Hypometria

Answer 16

Tipping, short steps

Question 17

4 types of tremors

Answer 17

Resting tremor - seen in resting
Intention tremor - animal is focusing on something (food, toy)
Action tremor - in physical action
Generalized tremor - during a seizure

Question 18

Two types of epileptic seizures

Answer 18

Focal - affects only a part of body, animal is conscious
Generalized - whole body affected, animal can be conscious or unconscious

Question 19

What is myoclonus?

Answer 19

Strong rhythmic contractions of a muscle or muscle group

Question 20

What is menace reflex?

Answer 20

A threatening movement towards the eye, animal should close the eye. Is not present in young animals, <10-12 weeks.

Optic nerve, facial nerve
+ Retina, cerebral cortex, brainstem, cerebellum, facial muscles

Question 21

What is pupillary light reflex?

Answer 21

Directing a strong light into the eye, pupil should react.
Indirect + direct

Optic nerve, oculomotor nerve
+Retina, optic junction, tract, brainstem, iris muscles

Question 22

What is nystagmus?

Answer 22

Tested by turning the head, should also turn the animal on its back

Physiological - stabilizes the image on the retina when the head moves
Pathological - Horizontal, vertical, rotary, pendular

Fast phase is directed away from the lesion

Vestibular cochlear nerve, oculomotor nerve, block/trochlear nerve, abductor nerve + eye muscles

Question 23

What is palpebral reflex?

Answer 23

A gentle touch to the inner and outer corner of the eye, eye should close

Trigeminal nerve, facial nerve
+sensory receptors on skin, brain stem, eyelid muscles

Question 24

What is corneal reflex?

Answer 24

Gentle touch to the eyeball, eye should close

Only test if palpebral reflex is incomplete!

Trigeminal nerve, facial nerve, abductor nerve
+corneal sensory receptors, brainstem

Question 25

What is proprioceptive positioning?

Answer 25

When you turn the paw, animal should correct it
Mostly tests for upper motoneuron problem
Can be helpful in identifying dysfunctions and asymmetries

Question 26

How are spinal reflexes tested and most trusworthy tests?

Answer 26

Spinal reflexes asses how well a certain segment of the spinal cord corresponds to peripheral stimulation

Most trustworthy tests are flexor withdrawal reflexes (both front and hindlimbs) and patellar reflex

Others are extensor reflex, tibialis cranialis reflex, perineal reflex, bulbo/vulvourethral reflex, panniculus reflex

Question 27

What is deep pain test?

Answer 27

Squeeze toe on top of bone with fingers or clamp
Expect a reaction: head turn, vocalization, biting, limb withdrawal

NB! If limb withdrawal is the only reaction, test is negative and deep pain is missing

Very good prognostic indicator for damage to the spinal cord and peripheral nerves

Not a routine test! Only do when needed

Question 28

Spinal cord segments (4)

Answer 28

1. Cranial cervical (C1-C5)
2. Cervicothoracic intumescence (C6-Th2), innervates thoracic limb
3. Thoracolumbar (Th3-L3)
4. Lumbosacral intumescence (L4-S3), innervates pelvic limb

Intumescences are thickened

Question 29

Difference between lower motoneurons and upper motoneurons

Answer 29

Lower motoneuron - direct innervation of muscles
Higher motoneuron - originates from brain and controls lower motoneurons

Damage in LMN causes flaccid paresis/plegia.
Damage in HMN causes spastic paresis/plegia.

Question 30

Neurological differentials!

Answer 30

VITAMIN D

Vascular
Inflammatory (/immune-mediated/infectious)
Trauma / toxic
Anomaly
Neoplastic / nutritional
Idiopathic
Degenerative

Question 31

What abnormal movement can you feel when palpating in case of cranial cruciate ligament rupture

Answer 31

Drawer movement - abnormal cranial movement of the tibia in relation to the femur

NB! Fixate femur and only move tibia. Don’t twist randomly or you might cause CCLR.