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The Neurological Exam Flashcards

1
Q

What is necessary when performing the neurological exam?

A

Understanding of what each test is determining

Master each technique and interpretation of the results of that technique

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2
Q

What are the possible locations of lesions?

A

In the brain = forebrain, brainsterm and cerebellum
In the spinal cord = C1-5, C6-T2, T3-L3, L4-Cd
Neuromuscular

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3
Q

What is the aim of the neurological exam?

A

To determine if the animal is neurologically normal/abnormal and localise the lesion

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4
Q

What are the tools required to perform the neurological exam?

A

Room, chair, yoga mat, reflex hammer, haemostats, Q-tips, cotton balls, penlight, lens

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5
Q

What are the steps of the neurological exam?

A

Mentation, Posture, Gait, Postural reactions, Spinal reflexes, Cranial reflexes, Palpation, Nociception

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6
Q

How do you assess mentation?

A

Level and quality of consciousness

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7
Q

What spectrum is consciousness assessed on?

A

Alert, obtundation, stupor/semicoma or coma

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8
Q

What different elements of posture are assessed?

A

The head, the limbs and the body

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9
Q

What are the two abnormal postures of the head and what do they indicate?

A 
Tilt = vestibular disease
Turn = forebrain disease
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10
Q

What can limb posture tell you about neurological disease?

A

Wide based stance = proprioceptive loss
Narrow based stance = weakness
Decreased weight bearing = pain

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11
Q

What is a decerebrate posture?

A

Involuntary extension of upper extremities

Head arched backwards, front legs extended, back legs extended behind animal, no mentation

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12
Q

What is a decerebellate posture?

A

Neck and forelimbs extended, hindlimbs flexed, mentation ok

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13
Q

What is a Schiff-Scherrington posture?

A

Forelimbs rigid, hindlimbs flexed, mentation ok, spinal lesion at T3-L3

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14
Q

Why is gait analysis useful to assess?

A

Requires the integration of proprioceptive and motor systems

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15
Q

What do you need to ask when assessing gait?

A

Normal/abnormal
Which limb/limbs are affected?
Paresis/ataxia/lameness/combination

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16
Q

What is paresis?

A

Decreased voluntary movement

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17
Q

How do you differentiate between UMN and LMN paresis?

A

By assessing postural reaction, spinal reflexes and muscle tone

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18
Q

What does UMN paresis look like?

A

Muscle tone and spinal reflexes are normal to increased in limbs caudal to the lesion
Stride length is normal to increased but can be spastic
+/- ataxia

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19
Q

What is the clinical appearance of LMN?

A

Muscle tone and spinal reflexes are decreased in limbs with a reflex arc containing the lesion
Stride length is normal to decreased, stiff, bunny hopping +/- collapse

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20
Q

What is the definition of ataxia?

A

Incoordination

21
Q

What are the three different types of ataxia?

A

Sensory, cerebellar or vestibular ataxia

22
Q

What is sensory ataxia and how does it appear clinically?

A

Loss of sense of limb/body position

Wide based stance, increased stride length, swaying/floating gait, knuckling

23
Q

What is cerebellar ataxia and how does it appear clinically?

A

Disorder of rate and range of movement

Hypermetria, intention tremor, postural tremor

24
Q

What is the appearance of vestibular ataxia

A 
Unilateral = falling/leaning/circling to one side and head tilt
Bilateral = wide excursions of the head, +/- head tilt and crouched posture
25
What postural reactions are tested?
Paw positioning, hopping, wheelbarrowing, hemiwalking, placing and extensor postural thrust
26
What tendon reflexes are tested and where do they originate?
Biceps (C6-8), triceps (C7-T2), patellar (L4-6) and gastrocnemius (L6-S2)
27
Where do the flexor reflexes for the thoracic and pelvic limbs originate?
``` Thoracic = C6-T2 Pelvic = L6-S2 ```
28
What can cause decreased to absent spinal reflexes?
Lesion within reflex arc Physical limitation due to joint fibrosis/muscle contracture Excitement/fear as muscles will have more tone Spinal shock
29
What can cause exaggerated reflexes?
Lesion to UMN pathways cranial to the spinal cord segments tested Excitement/fear as muscles will have more tone Pseudohyperreflexia due to loss of antagonism
30
How do you test the optic nerve (CN II)?
Vision (obstacle course) Menace response PLR Fundic examination
31
How do you test the function of CN III (oculomotor)?
PLR
32
How do you assess CN III, IV and VI?
Look for strabismus (eye position) and nystagmus (eye movement)
33
How do you assess CN V?
Facial sensation Palpebral and corneal reflex Tone of muscles of mastication
34
How do you assess CN VII?
Signs of facial paresis/paralysis/asymmetry Palpebral reflex Menace response Schrimer tear test as autonomic innervation of lacrimal gland
35
How can you assess the function of CN VIII?
Cochlear branch by hearing | Vestibular = ataxia/head tilt, strabismus/nystagmus
36
How do you assess CN IX and X?
Gag reflex
37
How do you assess the function of CN XII?
Paresis/paralysis of the tongue, tongue atrophy/asymmetry, deviation of the tongue
38
What is light palpation used to detect?
Swelling or atrophy
39
What is deep palpation used to asses?
Pain
40
How do you assess different types of pain?
Perception of pain is in the forebrain | Superficial pain is the skin and deep pain is bone
41
Does limb withdrawal indicate pain?
No as withdrawal can still occur without pain detected as the reflex arc only hits the spinal cord and pain requires forebrain perception
42
What nerves could be affected if the menace response is negative?
II or VII
43
What nerves could be affected if the PLR is negative?
II or III
44
What nerves are affected if strabismus is present?
III, IV or VI
45
What nerves are affected if there is spontaneous nystagmus or absence of physiological nystagmus?
III, IV, VI or VIII
46
What nerves are affected if there is no palpebral reflex?
V or VII
47
What nerves are affected if there is no corneal reflex?
V or VI
48
What nerves are affected if there is no gag reflex?
IX or X

NOSS (27 decks)

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