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Module 16-21 Spinal conditions, surgery > Neurological examination > Flashcards

Neurological examination Flashcards

1
Q

Why is neurolocalisation important prior to imaging diagnostics?

A

Clinically non-relevant findings might be picked up with advanced imaging (CT, MRI) - thus neurolocalization is key

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2
Q

What three postures are important to be able to differentiate?

A

Schiff-sherrington
Decerebrate rigidity
Decerebellate rigidity

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3
Q

What is ataxia?

A

A lack of coordination

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4
Q

What is paresis?

A

A weakness or inability to generate movement voluntarily

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5
Q

What does proprioception refer to?

A

Awareness of the position and movement of the head, body and limbs

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6
Q

Examples of systemic disease that can present neurological?

A

Aortic thromboembolism
Addison’s disease
Lymphoma

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7
Q

What are the 6 sections of a neurological exam?

A
  1. mentation
  2. gait evaluation
  3. proprioceptive testing
  4. segmental spinal reflexes
  5. sensorium
  6. cranial nerve examination
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8
Q

How can you classify the mental status?

A

Normal
Obtunded
Disoriented
Stuporous
Comatose

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9
Q

What does Schiff-Sherrington look like?

A

T2-L2 lesion
Normal mentation, no opistotonus
Forelimbs: Extensor rigidity
Hindlimbs: Flaccid

Prognosis: grave (without tx)

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10
Q

What does decerebellate posture look like?

A

Injury to the cerebellum
Obtunded or depressed
Opistothonus
Forelimbs: Extention
Hindlimbs: Active flexion

Prognosis: Guarded

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11
Q

What does decerebrate posture look like?

A

Injury to cerebrum
Obtunded
Opisthotonus
Forelimbs: Extensor ridigity
Hindlimbs: Extensor ridigity

Prognosis: Grave

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12
Q

What types of ataxia are there?

A

1) Propriceptive/sensory ataxia
2) Vestibular ataxia
3) Cerebellar ataxia

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13
Q

What is typical for proprioceptive ataxia?

A

A loss of awareness of where the limbs are in space

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14
Q

What is typical for vestibular ataxia?

A

Loss of balance - head tilt, and a tendency to lean, drift, fall or roll to one side

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15
Q

What is typical for cerebellar ataxia?

A

inability to modulate the gait generating systems in the brain resulting in abnormal “uncontrolled” limb movements
–> Hypermetria

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16
Q

Paresis?

A

weakness or inability to generate movement voluntarily - implies SOME movement

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17
Q

Plegi?

A

Inability to generate any movement - complete loss of voluntary movement

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18
Q

Tetra-plegi/pares?
Hemi-plegi/pares?
Para-plegi/pares?
Mono-plegi/pares?

A

Tetra - all four
Hemi - one side (right or left, front and hind)
Para - hindlimbs
Mono - one limb

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19
Q

UMN vs LMN signs?

A
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20
Q

Proprioceptive tests?

A

Paw positioning
Hopping
placing and visual placing
Wheel barrowing
Extensor postural trust
Hemiwalking
Paper sliding test

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21
Q

What are the 6 neuroanatomical locations?

A

Brain
C1-C5
C6-T2
T3-L3
L7-S3
Peripheral

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22
Q

What are the 4 spinal cord localisations?

A

C1-C5 Cranial cervical
C6-T2 Cervicothoracic intumescence
T3-L3 Thoracolumbar
L7-S3 Lumbosacral

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23
Q

Reflexes and corresponding neuro-anatomical localisation?

A
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24
Q

Which vertebrae corresponds to their spinal segment?

A

C1
C2
L1
L2

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25
Where does the spinal cord end?
L5-L6, after this - cauda equinae
26
What are reliable reflexes of the thoracic vertebrae?
Withdrawal reflex - evaluation of the cervical intumescence and brachial plexus nerves Extensor carpi radialis: evaluation of the caudal cervical intumescence (C7-T2 and radial nerve)
27
What are reliable reflexes of the pelvis limb?
Patellar reflex - evaluation of L4-L6 spinal cord segment and femoral nerve Perineal reflex - evaluation of S1-Cd5 and pudendal nerve
28
What does evaluation of the sensorium rely on?
Spinal palpation Nociception testive
29
How is nociception evaluated?
By conscious response of the patient to a painful stimulus NB! Do not mix with withdrawal! Ensure the patient shows response to painful stimulus! (e.g. vocalization, turning of head, licking lips etc)
30
What are the four steps of nociception?
Transduction Transmission Modulation Perception
31
Which tract sends pain signals?
Spinothalamic
32
What are the three degrees of axonal injury?
1) Neurotmesis - poor prognosis 2) Axonotmesis - possible recovery, very slow 3) Neurapraxia - recovery within 1-5 weeksa
33
What is neurotmesis?
Result of complete damage to the nerve, including axon, Svchwann cells and surrounding connective tissue. Poor prognosis, regeneration of nerve almost impossible
34
What is axonotmesis?
Damage to the axon with preservation of endoneurium and the surrounding myelin sheath produced by the Schwann cells. Regneration of the axon is possible if not damage is too extensive, however regeneration is very slow.
35
What is Neurapraxia?
Interruption of the nerve conduction with no damage to the nerve. It is normally due to demyelination, with an undamaged axon, due to compression or transient lack of blood supply (= nerve shock, spinal chock) Recovery is complete between 1 and 5 weeks
36
VITAMIN D?
V - Vascular I - Inflammatory T- Toxic/traumatic A - Anomalous M - Metabolic I - Idiopathic N- neoplastic D - degenerative
37
Clinical signs caused by C1-C5 spinal cord segment lesions?
38
Clinical signs caused by C6-T2 spinal cord segment lesions?
39
Clinical signs caused by T3-L3 spinal cord segment lesions?
40
Clinical signs caused by L4-S2 spinal cord segment lesions?
41
Clinical signs caused by cerebral lesions?
42
Diseases associated with cerebral syndrome?
Degenerative - Alaskan husky encephalopathy - dalmatian leukodystrophy - spongy degeneration in gray matter (salukis) - encephalomyelopathy and organic acidopathies - yorkshire terrier encephalopathy Developmental - Lissencephaly, hydranencephaly, meningoencephalocele, hydrocephalus Endogenous metabolic - DM, HE, hypernatraemia, hypoglycemia, hyponatremia, hypothyroidism, uremic encephalopathy, acidosis, alkalosis, hyperthyroidism, hypophostphataemia, hypercalcaemia Inflammatory - infectious, non-infectious Neoplasia - Meningioma, glioma, metastatic disease Neurovascular - cyanogenic plants, ethylene glycol toxicity, lead poisoning, methionine, metoclopramide Neurovascular disorders - haemorhagic and non-haemorrhagic stroke, hypoxia Nutritional disorders - thiamine deficiency Storage disorders - ceroidlipofuschinosis, fuscidosis, gangliodosis, globoid leukodystrophy Traumatic - head trauma
43
Cerebellar syndrome?
44
Brainstem syndrome?
45
Diseases associated with brainstem syndrome?
Degenerative: Alaskan husky encephalopathy, fibrinoidleukodystrophy Developmental: Chiarli malformations; intracranial intra-arachnoid cysts, hydrocephalus Inflammatory: Infectious, non-infectious Neoplasia: Meningioma Neurovascular: Haemorrhagic, non haemorrhagic stroke Nutritional: Thiamine deficiency Storage disorders: Fucosidosis, globoid leukodystrophy Trauma: head trauma
46
Vestibular syndrome - peripheral vs central?
47
Diseases associated with vestibular syndrome?
Degenerative: Idiopathic vestibular disease, multisystem neuronal abiotrphy Developmental: Congenital vestibular dissease, Dandy-Walker syndrome, intracranial intra-arachnoid systs Endogenous/metabolic: Hypothyroidism Inflammatory: Infectious (abscess, neospora, FIB; otitis media, interna), non-infectious Neoplasia: Malformation tumours, medulloblastomas Neurotoxic: AMinog, metronidazole Neurovascular: Stroke Nutritional: Thiamine deficiency Storage: Galactosialidsis Trauma: Head trauma
48
Clinical signs caused by neuromuscular lesions?
49
Degenerative disorders associated with spinal syndrome?
Degerative muelopathy Afghan hound myelopathy Motor neuron disease in German Shepherds Heredityar polioencephaloyelopathy in the Australian cattle dog Hereditary Ataxia Kooiker dog myelopathy Labrador retriever axonoathy Rottweiler leukoencephalomyelopathy
50
Degenerative and structural compressive spinal disorders?
Calcinosis circumscripta/tumoral calcinosis Cervical spondylomyelopathy Intervertebral disc disease Dural ossification Osteochondromatosis Spinal synovial cysts
51
Developmental spinal disorders?
Arachnoid cysts Atlantoaxial subluxation Shiari malformations Dermoid sinus Syringomyelia and hydromelia Spina bifida Infectious (e.g. toxoplasma, neospora, rabies) Non-infectious (Meningomyelitis)
52
Other spinal disorders? Inflammatory Neoplastic Neurovascular Nutritional Storage Trauma
Inflammatory - Infectious (e.g abscess FIP, neospora, otitis interna) - non-infectious Neoplastic - meningioma, ependymoma, peripheral nerve sheath Neurovascular: Ischaemic myelopathy and haemorrhagic myelopathy Nutritional - Hypervitaminosis A Storage - globoid leukodystrophy, mucopolysaccharidosis type I/VI Trauma - spinal trauma, brachial plexus avulsion
53
Differential diagnosis with neuromuscular lesions?
Metabolic - electrolyte - haematological - endocrine - misc Muscular - infectious, non infectious Junctionopathy - myasthenia gravis Neuropathy - breed specific - laryngeal paralysis polyneuropathy Aortic thromboembolism
54
Radiography in neurodiagnostics?
- great survey when trauma patient - can diagnosie disckospondylitis bone neoplasia and vertebral anomalies Care when interpreting - couple with clinical signs
55
What can be seen on this radiograph?
Atlantoaxial subluxation
56
What is myelography?
Survey radiographs of the spinal cord after injection of contrast material
57
Where can you inject contract material when performing myelography?
Cisterna Magna L5-L6 L6-L7
58
What should be performed prior to myelography?
Plain radiographs CSF
59
What is the dosage of contrast when performing a myelography?
0,2-0,3ml/kg Given slowly (rapid -> bradycardia!)
60
What can be the localisation when finding spinal cord lesions?
Extradural Intradural, extramedullary Intramedullary
61
Examples of extradural lesions?
-> cause deviation of contrast column Intervertebral disc disease Fractures Subluxation Neoplasia
62
Examples of Intradural - extramedullary lesions?
-> Golf tee sign Arachnoid cysts Meningioma Nerve root tumours
63
Examples of intradural - intramedullary lesions?
-> may be unremarkable myelogram, may show divergence of the dorsal and ventral contrast column Glioma Muelitis Ischaemic myelopathy
64
What can CT be used for investigation of?
Fractures Tympanic bullae Bone neoplasia Hemorrhage Surgical planning With myelogram: -> spinal cord lesions
65
What is the dose of contrast medial used for CT myelogram?
0,2-0,3ml/kg, but DILUTED to 1/10
66
What is MRI preferred for?
Evaluation of the brain. spinal cord and peripheral nerves
67
What can ultrasonography be used for in neurology?
Hydrocephalus Soft tissue masses (e-g. in brachial plexus) Intraoperative identification of intramedullary lesions Postoperative to check for remaining disc material after hemilaminectomy
68
how can scintigraphy be useful?
A radiopharmaceutical agent is injected to highlight areas where the blood-brain barrier has broken down or fails to exclude the injected radionucleotide Lesions shows up as hot spots
69
Where should you collect CSF from?
Caudal to or anatomically close to the suscpected lesion
70
How to interpret CSF in case of blood contamination?
Protein: for every 1000 RBC -> Adjust protein down 1mg/dL Leucocytes: For every 500 RBC -> leukocyte can be adjusted down by 1WBC/uL
71
Interpretation of CSF?
Macroscopic: Clear Protein: <25 and <40mg/dL (cisterna magna, lumbal) RBC: 0 WBC: <5WBC/uL
72
What is increased protein with normal cell count in CSF called?
Albuminocytological disassociation Caused by: - secondary to alterered BBB - increased production in the CNS - obstruction of outflow
73
Differential cell counts in CSF?
Lymphocytic pleocytosis - lymphona, necrotizing non-suppurative meningoencephalitis ++ Mixed cell pleocytosis - GME, fungal and protozoal disease ++ Neutrophilic pleocytosis - STMA, bacterial meningitis, post-myelogram Eosinophilic pleocytosis - parasitic or idiopathic pathology
74
Other tests of CSF?
PCR can be performen in case of infectious aetiology suspected: - Canine distemper, neospora, toxoplasma (dog) - Toxoplasma, Coronavirus (cat) Aerob/anaerob culture usually negative
75
What electrodiagnostic tests can we perform?
Electromyography - assessing muscle activity - cannot differentiate primary myopathy or denervation causing myopathy Nerve conduction velocity - nerve conduction, ulnar or sciatic - can differentiate between axonopathy and demyelinization Repetitive nerve stimulation - neuromuscular junction - in cases of Myasthenia -> signals drop when test repeated F-waves - proximal part of peripheral nerves, nerve root - useful in suspected foraminal stenosis, trauma to plexus, polyradiculoneuritis

Module 16-21 Spinal conditions, surgery (18 decks)

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