Neurologic Exam Flashcards
What are the goals of a neruo exam?
ID neuro deficits
Grade and describe deficit
Localize Lesion
What are the parts of a neuro exam?
Observation, palpation and cranial nerve exam and dynamic exam
Cranial Nerve Exam:
What does the Menace Response test?
CN2, brain and CNVII
Cranial Nerve Exam:
What does PLR test?
Eye, CN II and CN III
Cranial Nerve Exam:
What does the dazzle test?
Eye, CNII, brainstem
Where do you localize a lesion when a horse has no menace but has a PLR in the eye?
Brain
Cranial Nerve Exam:
What does the palpebral reflex test?
CN V - opthalmic and maxillary sensory
CNVII - facial -motor to muscle of facial expression
Cranial Nerve Exam:
What does the observation of facial symmetry test?
CN V - Mandibular - motor to muscle mastication
CNVII - Motor to muscle facial expression
Cranial Nerve Exam:
What does the evaluation of swallowing test?
Prehension- CNVII and facial
Jaw Tone - CNV, mandibular - motor mastication
Protection
-CN IX glossopharyngeal
-CN X reccurent laryngeal
CN XI spinal acessory
Tongue tone CN XII, hypoglossal
What does the slap test test?
Slap left wither, right arytenoid adducts (LlHP)
What does the dynamic exam consist of?
Straight line walk and trot
serpentine
circles
walk with head elevated
hill and curb navigation
tail pull
blind fold
What are the grades of the modified mayhew grading scale?
0 - Normal
1 - Inconsistently abnormal under special circumstance
2 - consistently abnormal under special circumstance
3- abnormal all the time
4 - extremely ataxic, may fall
5 - down and cant rise
What are the locations that a lesion can be localized to?
Peripheral Nerves
Brain
Brain Stem
C1-C6
C6-T2
T3-L2
L3-S3
S3 Caudal
What does it look like if you localize a lesion to the brain?
mentation change, head press, circle, central blindness, seizure
What does it look like if you localize a lesion to the brainstem?
Somnolence, obtundation, multiple CN deficit
What does it look like if you localize a lesion to the cerebellum?
Hypermetria, intention tremor, paradoxic vestibular sign
How do you know the difference between central or peripheral disease?
Cental - change mentation or multiple CN affected
Peripheral - normal mentation, single CN or ones in close area
Describe the differences between the following vestibular diseases:
-Peripheral
-Cental
-Paradoxical
Peripheral: head tilt and circle towards he lesions
Nystagmus horizonal fast away from the lesion and head tilt
Ataxia: Base wide, staggering
Mention: Normal/anxious/CN VII
Central: head tilt and circle toward the lesion
Nystagmus: variable, away from the lesion
Ataxia: mild/moderate/CP deficit
Mentation: altered
Paradoxical: headtils and lean away from the lesion
Nystagmus: variable, fast toward the lesion
Ataxia: Hypermetria and ipsilateral cp deficit
Mentation: Good or not
What are signs that your lesion is localized to C1-C6?
Neuro deficit all 4 limbs
Hind worse than fore
Hypometria flexor paraesis - limited carpal or tarsal flexion
spasticity and proprioceptive deficit
Hindlimb toe-dragging and circumduction
What are signs that your lesion is localized to C6-T2?
Neurological deficit all limbs
Forelimb weakness with extensor paresis and short strife marching gait
Hindlimb flexor paresis with limited tarsal flexion - toe dragging and circumduction
What are signs that your lesion is localized to T3-L2?
Neuro deficit hindlimb only
-Hind limb flexor paresis with limited tarsal flexion - toe dragging and circumduction
-may or may not have incontinence - bladder distended, taut and not easily expressed
What are signs that your lesion is localized to L3-S3?
Neuro deficit to hindlimb only
-Hindlimb weakness with extensor paresis and toe dragging
-urinary incontinence, bladder easy to express, dribble urine with abdominal press, poor tail tone and fecal incontinence
What are signs that your lesion is localized to S3 and caudal?
No ataxia
Urinary incontinence - urine dribble and sabulous cycstis
Fecal incontinence and obstipation
What are some ancillary diagnostic tests for neurologic disease?
Rads, ultrasound, CT, CSF
What things should you being looking at on rads?
Alignment, intervertebral foramen and disk, articular facets, transverse process
Both lateral and orthogonal view
IVRs - not the most sensitive or specific
How does contrast cervical myelography work?
Inject iodinated contrast in subarachnoid space to ID cervical compression
Whats CT?
Computed tomography
-3D
Standing (C7-T1)
Anesthetized
Can add contrast
What are normal qualities of CSF fluid?
Clear and colorless
TNCC<6 cells/ul (mononuclear)
Protein <100mg/dl
RBC - cell/ul
What does it mean if CSF is xanthochromia?
Metabolized RBC, Vasculitis, Trauma (neutophilic- menigitis, mononuclear pleocytosis - viral or neoplasia)
Where can you take a CSF tap?
Lumbosacral (hard but safe) -18G 5.5inch (sedate detomidine and opiod)- 1-2ml
C1-C2 - ultrasound guided, can be fatal - 18G 3.5inch - painful
Atlantooccipital space- TIVA, 18G 3.5inch
