Neurological Examination Flashcards
Upper Motor Neuron Signs
Paralysis
Normal or Hyperreflexia
Normal to Increased Muscle Tone
Disuse Muscle Atrophy
Lower Motor Neuron Signs
Paralysis
Hyporeflexia or areflexia
Muscular hypotonia
Severe, rapid muscle atrophy
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
Upper Motor Neuron
responsible for the initiation of voluntary movements and maintenance of tone in extensor muscles for posture
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
Lower Motor Neurons
are under voluntary control (via UMNs) and can also be controlled by reflex activity in the spinal cord
Where do signs occur with UMN lesion in the spinal cord or brain stem?
ipsilateral
Where do signs occur with UMN lesion in the cerebral cortex or diencephalon?
contralateral
Where do signs occur with LMN lesion?
ipsilateral
Where is conscious proprioception conveyed?
Cerebellum
What do Long tract sensory neurons carry?
conscious proprioceptions
pain
touch
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
Lesions between C6-T2:
LMN of the forelimbs
UMN of the hindlimbs
Long tract sensory signs of the hind limb
Lesions between T3-L3:
Normal front limbs
UMN and long tract sensory signs in the hindlimbs
UMN Bladder
Lesions caudal to L3:
Normal front limbs
LMN signs of the hind limbs
LMN bladder
What is located at C6-T2
Cervical Intumnescence
What is located at L4 to S3
Pelvic Intumnescence
Lesions between C1 - C3:
UMN signs to all limbs
UMN Bladder
Lesions between L4-S3:
Normal Fore limbs
LMN of hindlimbs
LMN Bladder
Lesions caudal to L7:
minimal pelvic limb dysfunction
Fecal and Urinary Incontinence
Lesions of the caudal to S1
only tail dysfunction
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
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
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
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?
- Sensory (conscious proprioception
- Cerebellar
- 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?
- Withdrawal of the limb- flexion of all joints
- strength to withdrawal
- behavioral reaction to stimulus
- 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
