Neurologic Exam

Question 1

Conditions affecting peripheral nerves result in??

Answer 1

Monoparesis/monoplegia -> partial or complete loss of voluntary motor function

Hyp/anesthesia of dermatones

Question 2

Monoparesis/plegia with nerve root signs is usually due to??

Answer 2

Stretching or inflammation of nerve roots -eg disc protrusion or pressure from a tumor

Question 3

What are ‘nerve root signs’?

Answer 3

Lameness from hyperpathia

Question 4

What is the DDX for nerve root signs

Answer 4

Musculoskeletal disorder

Peripheral nerve condition

Question 5

Traumatic nerve injuries can result in what three conditions?

Answer 5

Neuropraxia

Axonotmesis

Neurotmesis

Question 6

What is neuropraxia?

Answer 6

Degeneration of the myelin sheaths but the nerve is intact

Question 7

What is axonotmesis ?

Answer 7

Degeneration of axons but myelin sheath is intact

Question 8

What is neurotmesis ?

Answer 8

Complete severed of nerve and degeneration of distal portion and shwaan cell

Question 9

What are signs of peripheral nerve injuries?

Answer 9

Anesthesia and absence of peripheral reflexes and anesthesia of the skin inervated by the nerve

Question 10

Knuckling if the carpus indicates?

Answer 10

Radial nerve paralysis

Question 11

Dropped hock in cats is associated with what disease?

Answer 11

Diabetes mellitus

Glucose binds to protein causing damage to nerves and blood vessels

Question 12

Dog

HBC 
non-progressive LMN signs
Hypanesthesia 
Hyporeflexia 
Hypotonicity 
Neurogenic muscle atrophy

Answer 12

Peripheral nerve injury

Question 13

What is the treatment for a peripheral nerve injury?

Answer 13

Glucocorticoids to decrease inflammation

Decompress nerve surgically
Protect- self mutilation

Physio

If no regeneration after 6months- amputate

Question 14

A brachial plexus avulsion usually results from?

Answer 14

Abduction of the front limb that forces it caudally or cranially

(C6 - T2)

Question 15

Disruption of nerve roots C8 and T1 leads to denervation of the __________

Answer 15

Extensor and flexors of the elbow andcarpus

Question 16

Disruption of C6 and C7 will result in denervation of___________

Answer 16

Extensors and flexors of the shoulder

Question 17

If you have lost the panniculus reflex, what area is damaged?

Answer 17

C8 to T1

-lateral thoracic nerve

Question 18

Miosis, ptosis, enopthalmos and protrusion of the nicitan membrane are all signs of what? What nerves are damage?

Answer 18

Horners syndrome

T1 ventral nerve roots -> sympathetic ganglion

Question 19

How can you treat a brachial plexus avulsion ??

Answer 19

Glucocorticoids to decrease inflammation
Protect limb and wait for regeneration. -> 6months
PHYSIO

If no regeneration after 6 months ->amputate

Question 20

Wha is the prognosis of a brachial plexus avulsion without a deep pain reflex?

Answer 20

Very poor

Question 21

Where do malignant peripheral nerve sheath tumors most often occur?

Answer 21

Caudal cervical area, associated with brachial plexus

Question 22

Dog with chronic progressive monoparesis of the forelimb. Has nerve root sign hyperesthesia.

What is the best DDX?

Answer 22

Malignant peripheral nerve sheath tumor

Question 23

What is the best treatment for a nerve roots/peripheral nerve neoplasia?

Answer 23

Surgical resection -

Results in further loss of function -> requires amputation

Question 24

What is the prognosis for nerve root/peripheral nerve neoplasia?

Answer 24

High rate of occurrence

Radiation and chemo have limited benefit.

Question 25

How can you diagnose a nerve sheath tumor?

Answer 25

History- slow progressive monoparesis with nerve root signs

Myelogram -> contrast in epidural space is blocked by tumor (golf T sign)

CT and MRI

Question 26

Where do fibrocartilaginous emboli originate from?

Answer 26

Nucleus pulposus of intervertebral discs

Question 27

What type of injury does a fibrocartiaginous emboli cause?

Answer 27

Ischemic myelopathy

Question 28

Fibrocartilaginous emboli are most common in what dogs?

Answer 28

Large breed gos
Miniature schnauzers

Most 1-7yrs

Question 29

Large dog
History- sudden onset of paresis in the right forelimb after exercise.

PE- no evidence of pain.
-LMN reflexes -> hyporeflexia

What is your DDX?

Answer 29

Fibrocartilaginous emboli

Question 30

T/F: fibrocartilaginous emboli are most common at the brachial intumescence in both cats and dogs

Answer 30

False

True for cats
In dogs it is more common in the pelvic intumescence

Question 31

Large dog
History- sudden onset of paresis in the right forelimb after exercise.

PE- no evidence of pain.
-LMN reflexes -> hyporeflexia

What is your next step in order to diagnose this dog?

Answer 31

Radiographs
Myelography
MRI (esp in non-ambulatory cases)

Myelogram often appears normal in fibrocartilaginous emboli -> diagnosis of exclusion

Question 32

What is the best treatment of fibrocartilaginous emboli?

Answer 32

Supportive therapy!!

Rest. Clean, turn, PHYSIO

Question 33

Is a better outcome expected if you see UMN or LMN signs in a case of fibrocartilaginous emboli?

Answer 33

UMN has better prognosis

Question 34

If your fibrocartilaginous emboli is in the L6-S1 area, what signs would you expect to see?

Answer 34

Normal forelimb

Hindlimb -LMN signs

• hyporeflexia and CP deficits
• No crossed extensor reflex

Bladder -UMN signs
-small tight bladder

Question 35

What could you do to manage the bladder signs in a dog with a lesion at cranial to S1 ?

Answer 35

UMN bladder
-tight urinary sphincter

A1 antagonists
-phenoxybenzamine -> longhalf life and takes several days to accumulate and take effec

• prazosin -> caution can cause hypotension
• tamsulosin

Question 36

What could you used to treat bladder signs from a lesion caudal to S1?

Answer 36

LMN bladder
- atonic detrussor muscle and sphincter

Muscarinic agonist
-bethanecol -> detrussor muscle

A1 agonist
-phenopropanolamine -> tighten sphincter