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Y3 MOD Neurology > Performing and interpreting the neurological exam > Flashcards

Performing and interpreting the neurological exam Flashcards

1
Q

What features can be observed in a neuro consult?

A
  • Mentation
  • Behaviour
  • Posture
  • Gait
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2
Q

Which parts of the brain is mentation linked to?

A

Forebrain or brainstem

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3
Q

What are the different types of mentation an animal may show?

A
  • Alert: normal response to environmental stimuli
  • Disorientated/confused: abnormal response to the environment
  • Depressed/obtunded: less responsive to the environment
  • Stuporous: unconscious but can be roused by painful stimuli
  • Comatose: unconscious and unresponsive to any environmental stimuli
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4
Q

Disorientated mentation is linked to where?

A

Forebrain response as it is to do with decision making

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5
Q

Stuporous and comatose mentation’s are linked to where?

A

Brainstem changes

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6
Q

Give some examples of behavioural changes linked to the forebrain

A
  • Aggression
  • Compulsive walking/circling
  • Loss of learnt behaviour e.g. urinating in the house when they are toilet trained
  • Vocalisation
  • Hemineglect syndrome: animals with structural forebrain lesions ignore half of their environment (contralateral) e.g. would only eat half of a food bowl
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7
Q

Name some examples of posture deficits

A
  • Head tilt
  • Head and/or body turn
  • Decerebellate rigidity
  • Decerebrate rigidity
  • Schiff-Sherrington
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8
Q

Explain what a head tilt is and what/where its associated with

A
  • Rotation of the median plane of the head with one ear lower than the other
  • Vestibular disease (C or P): loss of tone to the antigravity muscles of the neck
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9
Q

Explain what a head and/or body turn is and what/where its associated with

A
  • Median plane of the head remains perpendicular to ground but nose is turned to one side
  • Forebrain disease (sometimes brainstem/cerebellum, cervical spine)
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10
Q

Explain what decerebrate rigidity is and what/where its associated with

A
  • Extension of all limbs and opisthotonus (dramatic abnormal posture)
  • Release of inhibitory UMN descending pathways on LMNs
  • Lesion in rostral brainstem
  • Usually stuporous or comatose
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11
Q

Explain what decerebellate rigidity is and what/where its associated with

A
  • Hyperextension of TLs and opisthotonus
  • Loss of inhibition of stretch reflex mechanism of antigravity muscles
  • Lesion in rostral part of cerebellum
  • Mentation normal; may be episodic or postural
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12
Q

Explain what Schiff-Sherrington is and what/where its associated with

A
  • Hyperextension of TLs (maintaining voluntary movement and normal CP) and paralysis of PLs
  • Lesion in thoracic or cranial lumbar spine
  • Walk normally on the front legs and there is no movement of the hind legs
  • Appear to be very rigid on the front legs but this is due to inhibition of the back legs
  • Usually acute and is common with RTAs and falls
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13
Q

Describe the 3 possible locations of ataxia

A

Uncoordinated gait:

  • Spinal or less commonly peripheral nerve disease
  • Vestibular disease (“off balance”)
  • Cerebellar lesions (“drunken gait”)
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14
Q

Describe spinal ataxia

A
  • Usually more subtle
  • Due to decreased sensory information arriving from the limbs to tell CNS where they are in space at any given time
  • “Legs just don’t know where they are or what they should be doing”
  • Wobble: feet are slightly in abnormal areas, might cross over as they walk
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15
Q

Describe vestibular ataxia

A
  • Loss of orientation of the head with the eyes, neck, trunk and limbs and results in loss of balance
  • Typically with leaning, falling, rolling towards side of lesion
  • Have a marked head tilt that they lean towards
  • Can be mild or more severe and can be acute or chronic
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16
Q

Describe cerebellar ataxia

A
  • Typically with inability to regulate rate, range or force of movement – dysmetria
  • Cerebellum functions as regulator (not initiator) of motor activity – coordinates and smoothes out movement
  • Not weak but can be clumsy ‘drunk appearance’
  • Truncal sway, falling
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17
Q

What are the two types of dysmetria?

A
  • Hypometria (shorter protraction phase)

* Hypermetria (longer protraction phase)

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18
Q

What is paresis?

A

Weakness, reduced voluntary movement

- often will hear scuffing of feet

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19
Q

Describe non-ambulatory paresis

A

There is inability to support weight but when animal supported voluntary movement can be seen

20
Q

What are the 4 localisations of paresis?

A

Tetra – all limbs
Para – pelvic limbs
Mono – 1 limb
Hemi – 2 limbs in same side

21
Q

What is paralysis?

A

Complete absence of voluntary movement

22
Q

Name some examples of postural reactions that can be performed in the neurological exam

A 
Paw position
Hopping
Hip sway
Wheelbarrow
Extensor postural thrust
Placing responses
23
Q

How can spinal reflexes and muscle tone be assessed in the neurological exam?

A
  • Withdrawals; extensor carpi radialis; biceps; triceps
  • Withdrawals; patellar; cranial tibial; gastrocnemius; perineal
  • Cutaneous trunci
24
Q

Which tests can be carried out to assess cranial nerves in the neurological examination?

A

Palpebral; corneal; physiological nystagmus; menace response; nasal mucosa stimulation; PLR; gag

25
Q

What is postural testing?

A

Testing awareness of precise position and movement of the body (especially limbs)

26
Q

Which parts of the brain/spinal cord are being tested with postural testing?

A
  • Information from proprioceptors (joints, tendons and muscles)
  • → Contralateral forebrain (conscious perception) or ipsilateral cerebellum (unconscious perception)
  • Problem could be in nerves, spinal cord, all of brain, everywhere! – very sensitive but poorly specific
27
Q

What is the aim of testing spinal reflexes?

A

To classify lesion as Upper Motor Neuron or Lower Motor Neuron

28
Q

How can spinal reflexes be assessed in the thoracic limb?

A

Withdrawals – pinch digit → reflex contraction of flexor muscles and withdrawal of limb

29
Q

How can spinal reflexes be assessed using the cutaneous trunci, where can lesions be localised?

A
  • Pinch the skin on the back to see contraction of the muscle
  • T3-L3 lesions: Can get a ‘cut off’ point where the reflex stops/starts which can localise the lesion on the spine
  • Brachial plexus lesions (C6 – T2): can get a hemi-cut off where the reflex works on one side of the body e.g. due to a brachial plexus rupture
30
Q

What are some behavioural responses which indicate that pain is being percieved?

A
  • Turning head
  • Vocalising
  • Trying to bite
  • WITHDRAWAL IS NOT A SIGN OF PAIN – can get withdrawal without pain
31
Q

How can you look for spinal pain?

A
  • Palpate all spine, starting gently and progressively increasing the degree of pressure
  • Move neck in all directions; look for pain and resistance/reluctance to move
  • Move tail and palpate lumbosacral region
32
Q

The palpebral reflex is testing which cranial nerves?

A

Blink after touching medial or lateral canthus of eye

  • CN V Trigeminal (afferent)
  • CN VII Facial (efferent)
33
Q

The menace response is testing which cranial nerves?

A

CN II Optic (afferent)

CN VII Facial (efferent)

34
Q

The pupillary light reflex is testing which cranial nerves?

A 
CN II Optic (afferent)
CNIII Occulomotor (efferent)
35
Q

How can the corneal reflex determine if the loss in the palpebral reflex is due to the trigeminal or facial nerve?

A

If it was the trigeminal, when the cornea is touched nothing would happen, if it is a facial nerve problem, they wont blink but there will still be globe retraction

36
Q

How is nystagmus elicited?

A

By moving the head

37
Q

What is the most likely cause of loss of nystagmus?

A

Due to raised intracranial pressue

38
Q

How can the vestibular system be challenged?

A

Lift head or put animal upside down

39
Q

What is strabismus?

A

Abnormal position of the eyeball that the animal cannot overcome

40
Q

What is nystagmus?

A

Rhythmical, involuntary movements of the eyeball

41
Q

Describe the different types of nystgmus

A
  • Physiological: normal in response to moving of the head (vestibular and CNs III, IV and VI)
  • Jerk: with slow and fast phase – vestibular dysfunction
  • Pendular: equal oscillations – visual pathway dysfunction
42
Q

What are the signs of Horner’s syndrome in small animals?

A
  • Miosis: tiny pupil
  • Drooping of the upper eyelid with smaller palpebral fissure
  • Protrusion 3rd eyelid
  • Subtle bulging of the eyeballs
  • Sometimes congestion of conjunctiva (lack of vasoconstriction)
  • Warmth of skin, pinkness, decreased sweating
43
Q

What are the signs of Horner’s syndrome in horses?

A
  • Mild miosis
  • Drooping of the upper eyelid with smaller palpebral fissure
  • Subtle protrusion 3rd eyelid
  • Decreased angle of eyelashes
  • Excessive sweating in denervated area
44
Q

Describe nasal mucosa stimulation and where its localised

A
  • Touch nasal mucosa → head withdrawal
  • Input – Trigeminal (V) ophthalmic
  • Forebrain, brainstem
45
Q

The menace only develops in animals at what age?

A

~10-12 wks in cats and dogs

~1-2 weeks in horses and ruminants

46
Q

If the gag reflex is lost the patient will be prone to?

A

Aspiration pneumonia

47
Q

Which 2 nerves are involved in the gag reflex?

A

Glossopharyngeal (IX) and Vagus (X)

Y3 MOD Neurology (5 decks)

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