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VET 404: Neurology > Neurological Exam > Flashcards

Neurological Exam Flashcards

1
Q

goal of neurological exam

A

localize lesions within the nervous system, list possible causes, and evaluate severity/prognosis

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2
Q

requirements for a reflex

A

intact peripheral (sensory and motor) nerves
intact spinal cord/brainstem
NO cerebral input/processing

results in involuntary movement

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3
Q

requirements for a response

A

intact ascending/descending pathways
intact spinal cord/brainstem
intact cerebrum

results in voluntary movement

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4
Q

upper motor neurons

A

neurons that travel from cerebrum to spinal cord and synapse onto LMNs or interneurons

cell bodies: cerebrum
axons: travel to spinal cord

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5
Q

upper motor neuron function

A

controls voluntary movement
overall INHIBITORY to lower motor neurons
results in DECREASED firing of LMNs

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6
Q

lower motor neurons

A

neurons that connect CNS with effectors

cell bodies: spinal cord
axons: peripheral spinal/cranial nerves

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7
Q

lower motor neuron function

A

final effectors of voluntary movement
functional default is “on” - constantly firing
results in INCREASED muscle tone and contraction (if uncontrolled by UMN)

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8
Q

signs of UMN dysfunction

A

increased reflexes
increased tone
mild, slow atrophy

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9
Q

signs of LMN dysfunction

A

decreased reflexes
decreased tone
severe, rapid atrophy

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10
Q

signs of C1-C5 lesions

A

thoracic limbs: UMN signs
pelvic limbs: UMN signs

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11
Q

signs of C6-T2 lesions

A

thoracic limbs: LMN signs
pelvic limbs: UMN signs

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12
Q

signs of T3-L3 lesions

A

thoracic limbs: normal
pelvic limbs: UMN signs

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13
Q

signs of L4-caudal lesions

A

thoracic limbs: normal
pelvic limbs: LMN signs

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14
Q

steps of a neuro exam

A
  1. observation (mentation, posture, gait)
  2. cranial nerves
  3. postural reactions
  4. segmental reflexes
  5. palpation
  6. +/- sensation
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15
Q

mentation

A

normal
obtunded
stuporous/semi-comatose
comatose

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16
Q

obtunded

A

decreased responsiveness to environment

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17
Q

stuporous/semi-comatose

A

only responds to noxious stimuli

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18
Q

comatose

A

does not respond to any stimuli

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19
Q

opisthotonus

A

an abnormal posture where the head and neck are extended dorsally; thoracic limbs are extended and rigid

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20
Q

3 lesions that cause opisthotonus

A
  1. decerebrate
  2. decerebellate
  3. schiff-sherrington posture
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21
Q

decerebrate

A

severe lesion to the midbrain causing functional separation of the cerebrum from the rest of the body

mentation: comatose
posture: opisthotonus w/ severe UMN signs
reflexes: normal (if nerves intact)

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22
Q

decerebellate

A

lesions to the cerebellum (trauma, cerebellar hypoplasia)

mentation: normal
posture: opisthotonus w/ flexion or extension of pelvic limbs
voluntary movement is normal

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23
Q

schiff-sherrington posture

A

T3 - L5 lesion; causes disruption of an ascending inhibitory pathway up to the thoracic limbs that the spinal cord sends itself; causes disinhibition of LMNs of thoracic limbs –> increased firing

mentation: normal
posture: opisthotonus
voluntary movement is possible

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24
Q

gait descriptors

A

ambulatory or nonambulatory
paresis
paralysis
lameness
ataxia
circling (in direction of lesion)
dysmetria

mono - one limb
hemi - both limbs on one side
para - both pelvic limbs
tetra - all four limbs

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25
cranial nerve reflexes/responses
1. olfactory 2. menace response 3. visual tracking 4. pupillary light reflex 5. corneal reflex 6. palpebral reflex 7. nystagmus 8. trigeminofacial reflexes 9. symmetry 10. gag reflex
26
olfactory nerve test
blindfold patient and see if they can localize food/treats not often done - complete loss of olfaction required to see deficits
27
menace response
make a menacing gesture towards the eye patient should blink afferent: CN II efferent: CN VII
28
visual tracking
drop a soundless/scentless object (cotton ball) in the visual field patient should track it as it falls afferent: CN II contralateral cerebrum
29
pupillary light reflex
shine a light in one eye both pupils should constrict afferent: CN II efferent: CN III
30
isocoric
equal pupils
31
anisocoria
unequal pupil size
32
miosis
small/constricted pupil
33
mydriasis
dilated pupil
34
corneal reflex
trigeminofacial reflex touch a damp cotton swab to the cornea patient should blink and retract globe afferent: CN V (1) efferent: CN VII & VI
35
palpebral reflex
trigeminofacial reflex touch the medial and lateral cantos of the eye patient should blink afferent: CN V (1 & 2) efferent: CN VII
36
physiologic nystagmus
vestibulo-ocular reflex - NORMAL move patients head side to side or up and down eye globes should move to follow the movement in fast/slow pattern afferent: CN VIII efferent: CN III, IV, VI
37
spontaneous nystagmus
pathologic nystagmus - ABNORMAL alternating smooth pursuit in one direction followed by saccadic movement in the other direction in the ABSENCE of movement fast phase moves AWAY from the side of the lesion
38
trigeminofacial reflexes
afferent: CN V efferent: CN VII corneal and palpebral vibrissae: stimulate whiskers; should blink lip pinch: pinch maxillary/mandibular lip; should pull lip/move away nasal stimulation: stimulate inside nares; should move away
39
facial symmetry
evaluate muscle mass on head/face efferent: CN VII, CN V(3)
40
gag reflex
place fingers at the back of the throat patient should gag afferent: CN IX, X efferent: CN IX, X, XII
41
conscious proprioception
awareness of oneself in space; awareness of all sensory information from the rest of the body requires sensory and motor function deficits indicate neurological disease but do not localize lesion
42
postural reactions
1. proprioceptive placing 2. hopping 3. wheelbarrowing 4. extensor postural thrust 5. visual placing 6. tactile placing
43
proprioceptive placing
paw knuckling; flip a single paw over while supporting rest of weight patient should flip paw back over
44
hopping
life one limb off the ground and push patient off center in opposite direction patient should hop on weight bearing leg to adjust center of gravity
45
wheelbarrowing
carry pelvic limbs and push forward patient should walk forward on thoracic limbs
46
extensor postural thrust
hold up animal and lower slowly until pelvic limbs reach the ground patient should adjust feet placement once reaching the ground
47
visual placing
carry animal towards a surface while extending limb towards the surface patient should put paw onto oncoming surface
47
tactile placing
carry animal blindfolded towards a surface and lightly touch paw to the surface patient should put paw on top of surface
48
pelvic limb reflexes
1. patellar reflex 2. gastrocnemius reflex 3. flexion/withdrawal reflex 4. perineal reflex
49
patellar reflex
evaluates femoral nerve (L4, 5, 6) percuss patellar tendon normal: quadriceps contracts, stifle extends
50
gastrocnemius reflex
evaluates sciatic nerve (L6, 7, S1) percuss common calcaneal tendon normal: contraction of caudal thigh muscles
51
flexion/withdrawal reflex
pelvic: sciatic nerve thoracic: musculocutaneous nerve stimulate interdigital skin normal: flexion of the limb
52
perineal reflex
evaluates pudendal nerve (S1, 2, 3) stimulate skin on each side of perineal region normal: contraction of anal sphincter
53
thoracic limb reflexes
1. biceps reflex 2. triceps reflex 3. flexion/withdrawal reflex
54
biceps reflex
evaluates musculocutaneous nerve stretch biceps and percuss insertion of biceps tendon onto the radius normal: contraction of the biceps
55
triceps reflex
evaluates radial nerve flex elbow to stretch triceps and percuss insertion of triceps onto the olecranon normal: contraction of the triceps
56
cutaneous trunci reflex
bilateral reflex pinch the skin around the T3 - L3 region of the spine normal: cutaneous trunci in C8 - T1 region should contract bilaterally afferent: T3 - L3 cutaneous nerve efferent: lateral thoracic nerve
57
lesion in T3 - L3 region effect on cutaneous trunci reflex
absence of reflex caudal to the site of the lesion blocks ascending sensory pathways from below site
58
lesion in C6 - T2 region effect on cutaneous trunci reflex
ipsilateral loss of cutaneous trunci contraction regardless of side of stimulation LMN lesion blocks motor info to one side)
59
palpation
palpate the head and along the vertebral column to evaluate muscle tone and mass (check for symmetry, atrophy) move the head through range of motion
60
hyperesthesia
abnormal increase in sensitivity to stimuli; apparent painfulness
61
nociception
the physiological system by which a person feels pain
62
what are nociceptive pathways protected by
spinal cord - difficult to have loss of function
63
prognoses for loss of nociception
poor loss of superficial pain = 85% chance of return to function loss of deep pain = 50% chance of return to function
64
when is testing for nociception indicated
paralyzed limbs only (ambulatory limbs do not need to be tested because already functional)
65
order of spinal cord loss/regain of function
lost in descending order, regained in ascending order 1. proprioceptive placing 2. voluntary movement 3. superficial pain 4. deep pain
66
superficial nociception test
use hemostats to pinch interdigital skin and look for a response (NOT a reflex - patient should turn head up, look at limb, vocalize, etc)
67
deep nociception test
pinch over a digit (stimulate periosteum) and look for a response (NOT a reflex - patient should do more than just limb flexion)

VET 404: Neurology (23 decks)

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