Neurologic Exam

Question 1

What are the goals of a neruo exam?

Answer 1

ID neuro deficits
Grade and describe deficit
Localize Lesion

Question 2

What are the parts of a neuro exam?

Answer 2

Observation, palpation and cranial nerve exam and dynamic exam

Question 3

Cranial Nerve Exam:
What does the Menace Response test?

Answer 3

CN2, brain and CNVII

Question 4

Cranial Nerve Exam:
What does PLR test?

Answer 4

Eye, CN II and CN III

Question 5

Cranial Nerve Exam:
What does the dazzle test?

Answer 5

Eye, CNII, brainstem

Question 6

Where do you localize a lesion when a horse has no menace but has a PLR in the eye?

Answer 6

Brain

Question 7

Cranial Nerve Exam:
What does the palpebral reflex test?

Answer 7

CN V - opthalmic and maxillary sensory

CNVII - facial -motor to muscle of facial expression

Question 8

Cranial Nerve Exam:
What does the observation of facial symmetry test?

Answer 8

CN V - Mandibular - motor to muscle mastication

CNVII - Motor to muscle facial expression

Question 9

Cranial Nerve Exam:
What does the evaluation of swallowing test?

Answer 9

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

Question 10

What does the slap test test?

Answer 10

Slap left wither, right arytenoid adducts (LlHP)

Question 11

What does the dynamic exam consist of?

Answer 11

Straight line walk and trot
serpentine
circles
walk with head elevated
hill and curb navigation
tail pull
blind fold

Question 12

What are the grades of the modified mayhew grading scale?

Answer 12

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

Question 13

What are the locations that a lesion can be localized to?

Answer 13

Peripheral Nerves
Brain
Brain Stem
C1-C6
C6-T2
T3-L2
L3-S3
S3 Caudal

Question 14

What does it look like if you localize a lesion to the brain?

Answer 14

mentation change, head press, circle, central blindness, seizure

Question 15

What does it look like if you localize a lesion to the brainstem?

Answer 15

Somnolence, obtundation, multiple CN deficit

Question 16

What does it look like if you localize a lesion to the cerebellum?

Answer 16

Hypermetria, intention tremor, paradoxic vestibular sign

Question 17

How do you know the difference between central or peripheral disease?

Answer 17

Cental - change mentation or multiple CN affected

Peripheral - normal mentation, single CN or ones in close area

Question 18

Describe the differences between the following vestibular diseases:
-Peripheral
-Cental
-Paradoxical

Answer 18

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

Question 19

What are signs that your lesion is localized to C1-C6?

Answer 19

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

Question 20

What are signs that your lesion is localized to C6-T2?

Answer 20

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

Question 21

What are signs that your lesion is localized to T3-L2?

Answer 21

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

Question 22

What are signs that your lesion is localized to L3-S3?

Answer 22

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

Question 23

What are signs that your lesion is localized to S3 and caudal?

Answer 23

No ataxia
Urinary incontinence - urine dribble and sabulous cycstis
Fecal incontinence and obstipation

Question 24

What are some ancillary diagnostic tests for neurologic disease?

Answer 24

Rads, ultrasound, CT, CSF

Question 25

What things should you being looking at on rads?

Answer 25

Alignment, intervertebral foramen and disk, articular facets, transverse process

Both lateral and orthogonal view

IVRs - not the most sensitive or specific

Question 26

How does contrast cervical myelography work?

Answer 26

Inject iodinated contrast in subarachnoid space to ID cervical compression

Question 27

Whats CT?

Answer 27

Computed tomography
-3D
Standing (C7-T1)
Anesthetized
Can add contrast

Question 28

What are normal qualities of CSF fluid?

Answer 28

Clear and colorless
TNCC<6 cells/ul (mononuclear)
Protein <100mg/dl
RBC - cell/ul

Question 29

What does it mean if CSF is xanthochromia?

Answer 29

Metabolized RBC, Vasculitis, Trauma (neutophilic- menigitis, mononuclear pleocytosis - viral or neoplasia)

Question 30

Where can you take a CSF tap?

Answer 30

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