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Year 3 MOD > Neurology: SA Neurological Exam, Equine Neurological Exam, Interactive > Flashcards

Neurology: SA Neurological Exam, Equine Neurological Exam, Interactive Flashcards

1
Q

What are the three components of the neurological consultation?

A

History

Observation- mentation, behaviour, posture, gait

Hands-on- physical, neuro examinations

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2
Q

What are the different mentations?

Where does altered mentation indicate dysfunction?

A

Alert- normal response to environmental stimuli

Disorientated/confused- abnormal response to environment

Depressed/obtunded- inattentive, less responsive to environment

Stuporous- unconsciour but can be roused by painful stimuli

Comatose- unconscious, unresponsive

Altered mentation- forebrain or brainstem

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3
Q

Where does alteration of behaviour indicate dysfunction?

What behaviours can change?

A

Forebrain

  • Agression
  • Compulsive walking/circling
  • Loss of learnt behaviour
  • Vocalisation
  • Hemineglect syndrome- ignore half of environment
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4
Q

Head tilt and Head and/or body turns are postural differences from neurological disease

How do they appear and where does it indicate disease?

A

Head tilt-
rotation on the medial plane of the head- one ear lower
Vestibular disease

Head and/or body turn-
Median plane of the head remains perpendicular to ground but nose to one side
Forebrain disease

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5
Q

What is decerebrate/decerebellate rigidity?

Where do they indicate lesions?

A

Decerebrare rigidity-

  • Extension of all limbs
  • Release of inhibitory UMNS descending pathways on LMNS
  • Lesion in rostral brainstem

Decerebellate rigidity-

  • Hyperextension of TLs and opisthotonus
  • Loss of inhibiton of stretch reflex mechanism of antigravity muscles
  • Lesion in rostral cerebellum
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6
Q

What is Schiff-Sherington?

What causes it?

A

Hyperextension of FLs, Paralysis of PLs

Interference with border cells- inhibitory neurons in cranial lumbar spinal cord that inhibit the FL extensor muscles

Lesion in thoracic of cranial lumbar spine

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7
Q

How can gait be affected?

What are the terms used?

A

Ataxia- uncordinated gait- drunk

Paresis- weakness, reduced voluntary movement
ambulatory- falling but can walk
non-ambulatory- weight needs supporting

Paralysis- complete loss of voluntary movement

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8
Q

What are the three causes of ataxia?

A

Spinal ataxia- usually subtle, due to decreases sensory information from limbs to CNS to know where they are

Vestibular ataxia- loss of orientation of the head with eyes, neck, trunk and limbs, causing loss of balance- leaning, falling, rolling
Towards side of lesion

Cerebellar ataxia- typically with inability to regulate rate, range or force of movement, dysmetria [overshooting]

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9
Q

How can paresis be further described?

A

Tetra- all limbs

Para- pelvic limbs/hind limbs

Mono- 1 limb

Hemi- same side

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10
Q

What are the 4 parts of a hands-on neurological examination?

A

Postural reactions

Spinal reflexes and muscle tone

Spinal pain

Cranial nerve examination

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11
Q

What is postural testing?

What is it useful for?

What are the 3 postural reactions tested?

A

Testing awareness of prescise position and movement of the body

Useful to first identify a problem but not specific

  • Paw position- turn paw so dorsal surface bears weight, see how quickly returned
  • Hopping- support 3 limbs and hop laterally, hipsway/wheelbarrow
  • Placing responses- pick up patient and bring limbs to edge of table so that dorsal surface touches surface
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12
Q

What are spinal reflexes used for?

What are the two types of reflexes used in fore and hindlimbs?
How do they differ between FL and HL?

What is the cutaneous trunci reflex and what is it useful for?

A

Used to classify lesion as UMN or LMN- look at muscle bulk and tone, evaluate reflexes in FLs/HLs

Withdrawals- pinch digit, contraction of flexor muscles and limb should withdraw- Same for HL/FLs

Myotatic- strike muscle, contraction
FL- extensor carpi radialis, biceps, triceps
HL- patellar, cranial tibial, gastrocnemius

Cut trunci-pinch skin on back- contraction of muscle on both sides, usefil for T3-L3 lesions, brachial plexus lesions

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13
Q

How is pain perception assessed?

What is the perineal reflex?

A

Pain perception-
Gentle squeeze of digit, look for behavioural response (head turning, vocalisation)

Perineal-
Stimulation of perineum with haemostat should cause contraction of anal sphincter

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14
Q

How is spinal pain assessed?

A

Palpate all the spine, starting gently and progressively increasing the degree of pressure

Move neck in all directions- look for pain or resistance to move

Move tail and palpate lumbosacral region

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15
Q

What are the different cranial nerve examinations that can be done?

For each test list the afferent nerve, intermediate location and efferent nerve

A

Palpebral reflex- V, brainstem, VII

Corneal reflex- V, brainstem, VII /VI

Physiological nystagmus- VII, brainstem, III/IV/VI

Menace response- II, forebrain/cerebellum/brainstem, VII

Nasal mucosal stim- V, forebrain/brainstem

PLR- II, brainstem, III

Gag reflex- IX and X, brainstem, IX and X

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16
Q

Describe how to do a palpebral reflex test

Describe how to do a corneal reflex test

What is a physiological nystagmus?
What commonly causes a lost/reduced effect?

A

Palpebral- Touch medial/lateral canthus of the eye- blink

Lightly touch cornea- blink and eye retraction

Nystagmus- elicited by moving of head
Vestibular eye movement- lift head or put animal upside down
Look for evoked stabismus/nystagmus
Raised/lost most commonly due to raised intercranial pressure

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17
Q

What are the input and output nerves for corneal and palpebral reflexes?

How can you use this to diagnose nerve dysfunction?

A

Input for both- trigeminal
Output-
Facial (VII)- blink- both
Abducens (VI)- globe retraction- corneal only

  • If blink normally on both tests but doesn’t retract globe- abducens dysfunction
  • If retracts globe normally but doesn’t blink for either trigeminal fine therefore facial dysfunction
  • If neither tests result in reflex- likely trigeminal
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18
Q

What is strabismus and Nystagmus?

How can they both be futher described?

A

Stabismus- abnormal position of the eyeball that the animal cannot overcome

Nystagmus- rhythmical, involuntary movements of the eyeball

Strabismus- resting or evoked
resting- CNs III, IV, VI dysfunction
evoked- positional, vestibular dysfunction

Nystagmus- physiological, jerk, pendular
physiological- normal in response to moving of head
jerk- slow and fast phase- vestibular dysfunction
pendular- equal oscillations- visual pathway dysfunction

19
Q

Describe horner’s syndrome in SA and Horses

A

Small animals-

  • Miosis- pupil constriction
  • Ptosis [drooping] of the upper eyelid with smaller palpebral fissure
  • Protrusion 3rd eyelid
  • Subtle enophthalmos- posterior displacment of eyeball
  • Sometimes congestion of conjunctiva
  • Warmth of skin, pinkness

Horse-

  • mild miosis
  • Ptosis of upper eyelid with smaller palpebral fissure
  • Subtle protrusion of 3rd eyelid
  • Decreased angle of eyelashes
  • Excessive sweating in denervated area
20
Q

Describe how to do a nasal mucosa stimulation?

How do you do a menace response?
When can a menace response test not be done and why?

What is a pupillary light reflex?

How is a gag test done?

A

NMS- Touch nasal mucosa- head withdrawal

Menace- menacing gesture, cover other eye- blink
Not a reflex, learnt- takes 10-12 weeks in SA, 1-2 in horses

PLR- shine light into eye- constriction of pupil and other side (consensual)

Gag- open mouth or touch pharynx- contraction of pharynx

21
Q

What is wanted to be extracted from an equine neurological examination?

A

Is the horse neurologically normal

Where is the lesion

What is it

What can be done

22
Q

What are the limitations of equine neurological examinations?

A

Size

Behaviour/ danger

Recumbancy

23
Q

What should be assessed about a horse for a neurological exam from a distance?

A

Mentation- curious, paying attention/ dropped head, depressed, head pressing (forebrain)

Behaviour- aggression, compulsive walking/circling, loss of learnt behaviour, vocalisation

Posture- head tilt, head or body turn, wide-base stance

24
Q

How can the following cranial nerves be tested?:

  • Olfactory
  • Optic
  • Trochlear
  • Trigeminal
  • Abducens
A
  • CN I- difficult, polo mint test
  • CN II- sight, menace, PLR (less obvious), very good at compensating with one eye for bad sight
  • CN III- PLR, eye position with vestibular system
  • CN IV- eye position with vestibular system
  • CN V- mastication muscle atrophy, facial sensation- palpate and observe response
  • CN VI- eye position with vestibular system
25
Q

How can dysfunction of CN VII be assessed?

A

Facial nerve- muscles of expression, sensory tongue/ear

Muscles of facial expression- ears, eyes, blinking, dilation of nostrils, lips

Assess facial symmetry

Palpation can be useful

26
Q

How can CN VIII be assessed?

What is the most common sign of dysfunction?

A

Head posture- dysfunction= tilt

Induced eyeball movment

Normal vestibular nystagmus (following train)- hold horses head and move side to side- should keep rhythmically moving

Normal gait- dysfunction=ataxic

Blindfold to eliminate eyes of vestibular

Hearing- clap to see it ears move

Dysfunction- ventral strabismus

27
Q

How can CN IX, X and XI be assessed?

How can CN XII be assessed?

A

Let the horse eat some grass

Sensory and motor to pharynx and larynx-
Swallowing, can endoscopy
Slap test- adduction of horses contralateral arytenoid cartilage

XI motor to trapezius and cranial sternocephalicus

XII- tongue size, tone and symmetry

28
Q

How is the neck, trunk, back, tail and anus assessed for a neurological exam?

A
  • Observation and palpation of neck and back- atrophy, asmmetry, swelling
  • Range of movements of neck and back- use food, not if fracture suspected
  • Cervicofacial reflex- poke neck with pen, twitches lips- some do some don’t- asymmetry
  • Testing back flexion- pen on withers and rub in midline- horses should dip then arch at lumbar area, pen in sternum
  • Cutaneous trunci reflex- gently touch flanks, horse should shake skin (flies), if not present move cranially
  • Perineal reflex, tail clamp, anal tone
  • Male external genitalia- penis not retracting
  • Rectal- assess lumbar, sacral vertabrae and bladder volume and tone
29
Q

What are the two broad causes of abnormal postures in horses?

A

Orthapaedic problem- broken leg

Neurological-
Loss of spatial awarness- doesn’t correct
Inability to move limb

30
Q

What are you looking for with gait of a horse in neuro exam?

What is ataxia?

A

Looking for abnormalities in spontaneous and induced, posture and movement interpreted as ataxia and weakness

Ataxia- subconscious proprioceptive defecits seen as irregular or unpredictable movement

31
Q

What are signs of ataxia in horses?

How can signs be exaggerated?

What are the 3 places of origin for ataxia?

A

Signs- poor coordination, swaying, limb moving excessively during swing phase

Exaggerated by tight circles- pivoting, circumduction, serpentine, sudden stopping, backing

Cerebellar, Vestibular or Spinal origin

32
Q

What signs are associated with ataxia in horses with the cerebellum, vestibular system and spinal?

A

Cerebellar- uncommon
No weakness
Hypermetric ataxia- accelerated range of movements
Other signs- tremor, lack of menace

Vestibular
Loss of balance, hypometric ataxia, wide based
Other signs- head tilt, nystagmus

Spinal-
Dysmetric ataxia
+/- weakness

33
Q

How are equine ataxia defectits classified?

A
  1. Subtle- just barely detected at normal gait, occur during backing, stopping, turning
  2. Mild- detected at normal gate, exagerated by above movements
  3. Moderate- prominent at normal gait, buckle with above movements
  4. Severe- tripping and falling spontaneously at normal gait
34
Q

What creates weakness?

What are the different types in horses?

What can cause them?

A

Interruption to general somatic efferent (motor) pathways

Extensor weakness- sinking/buckling, weak when pulling tail

Flexor weakness- toe drag/delay, swinging movement

Motor tract lesion- UMN- tail pull during movement

Motor neuron- LMN- tail pull at rest

35
Q

Timmy a border terrier has the following symptoms:

Obtundation- dull
Right circling

Abscent proprioception in left limbs- paw position

Abscent menace response in left eye

Reduced facial ensation in left side

What is the location of the lesion?

A

Right Forebrain

Circle towards lesion- right

Proprioception contralateral

Vision contralateral

36
Q

Max has the following symptoms:

Ataxia with leaning to the right

Head tilt to right

No proprioceptive defectits

Right positional strabismus

Spontaneous nystagmus with fast left phase

Where is the lesion?

A

Right Peripheral Vestibular System

Signs of central vestibular disease- multiple cranial nerves affected not seen, proprioceptive defecits

No cerebellar signs- truncal sway, tremors

37
Q

Milly has the following neurological signs:

Mild leaning to the right

Right head tilt

Hypermetria left thoracic limb

Clumsy hopping on left limb

Where is the lesion?

A

Left Cerebellum

Hypermetria- cerebellum
Paradoxical head tilt- opposite side

Proprioception on the same side- left

38
Q

Gingerboy- cat

No menace bilaterally

No PLRs bilaterally

Normal proprioception

Normal fundus exam and ERG- retina and fundus normal

Where is the lesion?

A

Optic chiasm or Bilateral CN2 (optic nerves)

If both PLR and menace affected- must be cranial to chiasm

39
Q

Buster

Generalised ataxia with hypermetria

Reduced proprioception in all limbs

Owners has seen 3 seizures- difficult to train

Where is the lesion?

A

Multifocal

Cerbellar- hypometria, ataxia, can give reduced proprioception

Seizures- forebrain, behaviour

40
Q

Bertie

Absent proprioception in hindlimbs
Normal in forelimbs

Spinal reflexes unaffected

Absent pain sensation in pelvic limbs

Cutaneous trunci cut-off

Localise the lesion

A

T3-L3

Forelimbs not affected- must be caudal to T3

Reflexes intact L4-S3 normal

41
Q

Natasha- cat

Tetraplegia- possible slight movement

Proprioception absent/reduced in all limbs

Normal spinal reflexes in pelvic limbs

Reduced spinal reflexes in thoracic limbs- some pain

Where is the lesion?

A

C6-T2

All limbs- cranial to T3

At reflexes in forelimbs reduced- must be C6-T2

42
Q

Sam

Monoparesis left forelimb

Absent spinal reflexes in left FL

Reduced sensation in left FL

ipsilateral Horner’s syndrome

Where is the lesion?

A

Left brachial plexus- neuropathy

Not C6-T2 should affect back leg on left side

43
Q

Charlie

Flaccid tetraparesis/plegia

Absent spinal reflexes in HL/FL

Abnormal bark

Where is the lesion?

A

polyneuropathy- diffuse

Cannot be C6-T2- reflexes on HL reduced

44
Q

Minky

Weakness

Stiff, stilted gait

Normal neural exam

Where is the lesion?

A

Myopathy- no neurological defecits

Year 3 MOD (42 decks)

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