Neurological Examination Flashcards by Kimberlee Ward

Upper Motor Neuron Signs

Paralysis
Normal or Hyperreflexia
Normal to Increased Muscle Tone
Disuse Muscle Atrophy

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Lower Motor Neuron Signs

Paralysis
Hyporeflexia or areflexia
Muscular hypotonia
Severe, rapid muscle atrophy

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Upper motor neuron location

composed of cell bodies (in the cerebral cortex or brain stem) and their axons in the brain stem or spinal cord

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Upper Motor Neuron

responsible for the initiation of voluntary movements and maintenance of tone in extensor muscles for posture

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Lower Motor Neuron locations

cell bodies in the brain stem (cranial nerves) or ventral horn of the spinal cord (Peripheral nerves) supplying muscles and glands of the body

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Lower Motor Neurons

are under voluntary control (via UMNs) and can also be controlled by reflex activity in the spinal cord

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Where do signs occur with UMN lesion in the spinal cord or brain stem?

ipsilateral

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Where do signs occur with UMN lesion in the cerebral cortex or diencephalon?

contralateral

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Where do signs occur with LMN lesion?

ipsilateral

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Where is conscious proprioception conveyed?

Cerebellum

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What do Long tract sensory neurons carry?

conscious proprioceptions
pain
touch

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Lesions to the long tract sensory neurons results in?

Anesthesia or hypoesthesia caudal to the lesion
Normoreflexia
abnormal positioning of feet
dysmetria (usually hypermetria: steps are longer and higher than normal)
Ataxia

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Lesions between C6-T2:

LMN of the forelimbs
UMN of the hindlimbs
Long tract sensory signs of the hind limb

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Lesions between T3-L3:

Normal front limbs
UMN and long tract sensory signs in the hindlimbs
UMN Bladder

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Lesions caudal to L3:

Normal front limbs
LMN signs of the hind limbs
LMN bladder

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What is located at C6-T2

Cervical Intumnescence

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What is located at L4 to S3

Pelvic Intumnescence

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Lesions between C1 - C3:

UMN signs to all limbs

UMN Bladder

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Lesions between L4-S3:

Normal Fore limbs
LMN of hindlimbs
LMN Bladder

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Lesions caudal to L7:

minimal pelvic limb dysfunction

Fecal and Urinary Incontinence

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Lesions of the caudal to S1

only tail dysfunction

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Lesions of the brain

unilateral or bilateral UMN signs in the limbs
Seizures
Changes in behavior 
cranial nerve deficits
decreased consciousness
cerebellar signs
vestibular signs

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What are the 9 steps to approaching a patient with neurological dysfunction

Determine case signalment and owners complaint
Obtain History
general physical exam
neurological exam and localize lesion/s
DDx
Collect Minimum database
Do special diagnostic tests
Establish prognosis with and without treatment
Initiate therapy if necessary

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What is the sequence of a neurological exam?

Observation of mental status, posture, and gait
Palpation of muscular and skeletal systems
Evaluation of postural reactions
Evaluation of cranial nerves
Evaluation of spinal nerves
Evaluation of sensation

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Depression

lack of responsiveness to nornal environmental stimulation.

Stupor

the animal is severely depressed but can be aroused with painful stimuli

Coma

when the animal is severely depressed and cannot be aroused by stimuli

Reticular Activating System

responsible for the arousal of the cerebrum

What controls goal directed behavior?

Cerebrum | Thalamus

Site of Intelligence and goal-direct behaviors

Thalamocortex

What are signs of a lesion in the Thalamocortex?

circling head pressing a decrease and absence of awareness of what is going on around the animal

Ataxia

lack of coordination indicated by lack of awareness of limb position

What are the 3 forms of Ataxia?

1. Sensory (conscious proprioception 2. Cerebellar 3. vestibular

What are signs of a cerebellar lesion?

Broad based stance dymetria (exaggerated advancement of limbs): Hypometria or Hypermetria Intention tremors signs seen on the opposite limbs

Signs of vestibular lesions

``` falling circling rolling toward the affected side head tilt nystagmus ```

How do you tell which side has the lesion with Nystagmus?

Slow phase is always towards the lesion

What are signs of cranial nerve I damage?

unable to smell

What are signs of cranial nerve II damage?

inability to see

What are signs of cranial nerve III damage?

paralysis of eyeball | strabismus

What are signs of cranial nerve IV damage?

lateral rotation of the eyeball (slanted pupil in cats) | rotation of the dorsal retinal vein

What are signs of cranial nerve V damage?

atrophy of the masseter muscle and temporal muscles decreased jaw tone with bilateral lesion does not respond to tactile sensation such as twitching of nose or ear

What are signs of cranial nerve VI damage?

medial strabismus | inability to retract the globe

What are signs of cranial nerve VII damage?

``` dropped lip drooping ear loss of palpebral reflex dry eyes decreased salivary production ```

What are signs of cranial nerve VIII damage?

``` Does not respond to auditory stimuli Head tilt circling falling to affected side Nystagmus ```

What are signs of cranial nerve IX damage?

Loss of gag reflex | dysphagia

What are signs of cranial nerve X damage?

Loss of gag reflex

What are signs of cranial nerve XI damage?

Atrophy of the neck muscles | deviation of the neck to one side

What are signs of cranial nerve XII damage?

Lack of tongue tone deviation of tongue to one side atrophy and fibrosis of the tongue

Cranial Nerve I

Olfactory

Cranial Nerve II

Optic

Cranial Nerve III

Oculomotor

Cranial Nerve IV

Trochlear

Cranial Nerve V

Trigeminal

Cranial Nerve VI

Abducens

Cranial Nerve VII

Facial

Cranial Nerve VIII

Vestibulocochlear

Cranial Nerve IX

Glossopharyngeal

Cranial Nerve X

Vagus

Cranial Nerve XI

Accessory

Cranial Nerve XII

Hypoglossal

What does the perineal reflex test?

the pudendal nerve

What should happen in the perineal reflex test?

contraction of the anus lifting of the vulva dropping of the tail

What does the patellar reflex test?

Femoral nerve

What does the cranial tibial reflex test?

Sciatic nerve

What does the Flexor withdrawal reflex test in the hindlimbs?

Sciatic and Femoral nerve

What does the Flexor withdrawal reflex test in the fore limbs?

Musculocutaneous and median/ulnar nerves

What does the Extensor Carpi radialis reflex test?

Radial nerve

What are the 4 things tested for with the Flexor Withdrawal reflex?

1. Withdrawal of the limb- flexion of all joints 2. strength to withdrawal 3. behavioral reaction to stimulus 4. no cross extensor reflex present

What disease process decreases the strength of the flexor withdrawal reflex?

Myopathies

What are the clinical signs of a UMN Bladder?

small easily palpable urethral sphincter is closed brief forceful expulsions of urine not easily expressed manually

What are clinical signs of a LMN Bladder?

``` atonic markedly dilated no sphincter tone urine exits freely by gravity bladder is easily expressed ```

What drugs do you treat an UMN bladder with?

Phenoxybenzamine Prazosin Flomax

What drugs do you treat an LMN bladder with?

phenylpropanolamine | bethanecol

What is a sign of a grave prognosis?

absence of deep pain

Hyperesthesia

touch causes immense pain usually due to stretching of the nerve roots

What causes elevated CSF pressure?

``` Neoplasia severe metabolic and toxic disturbances abscesses meningitis status epilepticus ```

What causes low CSF pressure?

poor technique hydrocephalus severe dehydration

Yellow or xanthochromic CSF

old hemorrhage vascular disorders infection systemic icterus

Cloudy or turbid CSF

Bacterial infection

Pink or red CSF

Blood contamination | Recent Hemorrhage

Elevated CSF Protein levels

trauma vascular disorders primary or secondary neoplasia spinal cord degeneration