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99 Cards in this Set
- Front
- Back
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Absent/decreased patellar reflex
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L4-L6, femoral nerve
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Absent/decreased withdrawal reflex (thoracic)
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C6-T2
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Absent/decreased withdrawal reflex (pelvic)
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L6-S1, sciatic nerve
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Cutoff of cutaneous trunci reflex
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1-2 spinal cord segments cranial to cutoff
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Unilaterally absent cutaneous trunci reflex
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C8-T1, lateral thoracic nerve, cutaneous trunci
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CN deficit: absent menace/avisual, absent PLR, mydriasis
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CN II optic
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CN deficit: ptosis, ventrolateral resting strabismus, mydriasis
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CN III oculomotor
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Horner's syndrome
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Miosis
Ptosis Elevated third eyelid Enopthalmos |
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CN deficit: contralateral ventromedial resting strabismus
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CN IV trochlear
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Cn deficit: ventromedial resting strabismus
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CN VI abducent
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Deceased facial sensation
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CN V, CN VII, contralateral cortex
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CN: Dropped jaw, masseter atrophy
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Bilateral mandibular branch dysfunction (CN V)
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CN: Neurotropic keratitis
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Opthalmic branch dysfunction (CN V)
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Etiologies of facial paralysis
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Idiopathic
Inner/middle ear disease (hypothyroidism, trauma, neoplasia, botulism, etc.) |
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CN: Hemifacial spasm
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CN VII facial
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CN: Horizontal/rotary nystagmus
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CN VIII vestibulocochlear
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CN: Dysfunctional gag reflex
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CN IX, X glossopharyngeal, vagus
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UMN thoracic, pelvic
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Brain, C1-C5
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LMN thoracic, UMN pelvic
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C6-T2
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Normal thoracic, UMN pelvic
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T3-L3
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Normal thoracic, LMN pelvic
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L4-S3
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Case: paraparesis, normal patellar, normal withdrawal
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UMN paraparesis (normal tone), T3-L3
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Case: paraparesis, decreased patellar and withdrawal bilaterally
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LMN paraparesis; L4-S1 OR bilateral femoral and sciatic nerves
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Case: paraparesis, decreased patellar, normal withdrawal bilaterally
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L4-L6 OR femoral nerve bilaterally
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Case: paraparesis, increased patellar, absent withdrawal bilaterally
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Withdrawal: L6-S1 or bilateral sciatic
Pseudo-hyperreflexia due to lack of antagonistic muscle or alternate lesion (UMN with T3-L3) |
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Case: tetraparesis, normal spinal reflexes in all limbs
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UMN tetraparesis; C1-C5, infratentorial or supratentorial
Most likely C1-C5 as no other signs |
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Case: tetraparesis, normal spinal reflexes in pelvic, decreased withdrawal in thoracic
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UMN to pelvic
LMN to thoracic C6-T2 |
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Case: tetraparesis, decreased patellar and withdrawal in pelvic, decreased withdrawal in thoracic
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Diffuse LMN tetraparesis; C6-T2, L4-S1 OR all peripheral nerves
Tick paralysis, botulism, polyradiculoneuritis |
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Opisthotonos, extensor rigidity of all limbs, stupor or coma, +/- respiratory and HR problems
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Decerebrate rigidity, midbrain lesion
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Opisthotonos, extensor rigidity of thoracic limbs (+/- pelvic), aware of environment
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Decerebellate rigidity, cerebellar lesion
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Schiff Sherrington (extensor rigidity of thoracic, no opisthotonos)
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T3-L3
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Head turn
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Ipsilateral supratentorial
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Head tilt
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Cerebellar or vestibular (infratentorial), usually ipsilateral
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Rebound phenomenon (when neck extended and dropped, will rebound to floor)
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Cerebellar
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Vertical nystagmus, changing nystagmus, CN deficits other than 7 or 8, CP deficits
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Central vestibular
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Right head tilt, vertical nystagmus, right hemiparesis
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R central vestibular
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Left head tilt, vertical nystagmus, right hemiparesis
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R central vestibular and cerebellae with paradoxical head tilt (paresis more reliable than head tilt)
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Circling (towards size of lesion)
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Ipsilateral cerebellar/vestibular (especially if spinning tightly)
OR supratentorial (contralateral) |
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Etiology of ventral neck flexion
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Neck pain, myopathy, neuropathy, myasthenia gravis, hyperthyroidism, ethylene glycol, electrolyte abnormalities, etc.
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Irregular/sporadic packing of limb (thoracic)
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C1-T2 nerve root signature
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Irregular/sporadic packing of pelvic limb
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Sciatic nerve root signature
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Increased step distance
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UMN lesion; C1-C5, infra-, or supratentorial
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Decreased step distance
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LMN lesion or pain
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Central Cord syndrome (worse paresis in thoracic than pelvic)
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Spinal cord, more central than lateral trauma
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Top 5 differentials of intracranial origin
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Tumor
Encephalitis/meningitis Vascular event Trauma Hydrocephalus |
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Prioritize structural, metabolic, and idiopathic:
<6 months old, no interictal deficits |
Metabolic, structural, idiopathic
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Prioritize structural, metabolic, and idiopathic:
<6 months old, focal interictal deficits |
Structural, metabolic, idiopathic
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Prioritize structural, metabolic, and idiopathic:
>5 yrs old, no interictal deficits |
Metabolic, structural, idiopathic
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Prioritize structural, metabolic, and idiopathic:
>5 yrs old, focal interictal deficits |
Structural, metabolic, idiopathic
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Prioritize structural, metabolic, and idiopathic:
1-5 yrs old, no interictal deficits |
Idiopathic, metabolic, structural
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3 indications for seizures
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More than 1 seizure per month
Cluster seizures Status epilepticus |
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Top 3 diffuse LMN dz
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Tick paralysis
Botulism Polyradiculoneuritis (Coonhound paralysis) |
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Dropped pelvic hocks/plantograde stance
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Diabetic neuropathy
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Locked jaw, painful masseter
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Masticatory myositis (dx 2M antibody titer)
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Components of lower motor neuron unit
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Afferent nerve, dorsal root ganglion, spinal cord segment, ventral cell body, efferent nerve, neuromuscular junction, muscle
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Top 5 spinal dz
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Trauma
Tumor IVDD Meningitis/myelitis Discospondylitis |
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DMNITV of PNS
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Degenerative (neuropathy)
Metabolic (diabetes, Cushing's, hypothyroidism) Neoplastic (nerve sheath tumors) Inflammatory, infectious (botulism, toxo) Inflammatory, non-infectious (polyradiculoneuritis, MG) Trauma (brachial plexus avulsion) Toxic (tick paralysis, botulism) Vascular (aortic thromboembolism) |
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Positional strabismus with no resting strabismus
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Vestibular dysfunction (CN VIII)
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Intention tremors
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Cerebellar
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Ataxia/hypermetria
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Cerebellar, vestibular, spinocerebellar tracts
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Degenerative intracranial
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Storage diseases, cerebellar abiotrophy, etc; dx signalment, organomegaly if storage
Batten's disease (MRI with cortical atrophy, normal CSF, histopathology) |
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Anomalous intracranial
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Hydrocephalus, lissencephaly, cerebellar hypoplasia, caudal occipital malformation syndrome
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Hydrocephalus ID, rx
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Small breeds, "sunset eyes," supratentorial signs; dx MRI, CSF to rule out inflammatory disease
Rx: prednisone, omeprazole |
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COMS ID, Rx
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Signalment (CKCS, toy), phantom itching, paresis, vestibular/cerebellar, seizures; Dx MRI, CSF (titers for rule-out)
Rx: Prednisone, Sx (foramen magnum decompression |
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Metabolic intracranial
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Liver dz, renal encephalopathy, glucose abnormalities, electrolytes, thyroid, adrenal
Signs: waxing/waning; episodic/facial jerking; symmetric neuro deficits; icterus, etc. |
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Nutritional intracranial
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Thiamine deficiency
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Neoplasia intracranial types, dx
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Meningiomas, gliomas (brachycephalic), choroid plexus tumor, pituitary tumor, metastatic tumor
Dx: baseline, rads, BPs, thyroid status, MRI, CSF (Meningioma rx: corticosteroid, surgery, radiation) |
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Inflammatory intracranial
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Fungal, ciral, protozoal, rickettsial, parasites, bacterial
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Rhythmic contraction of a group of muscles in dog
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Myoclonus, think distemper
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Meningitis Rx
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Must have (-) antigen test if fungal, antifungal, cage rest, bladder management, PT, seizure watch
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Granulomatous meningoencephalitis
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Signalment: toy. Variable signs, rx immunosuppressive drugs + cytosine arabinoside
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Generalized tremor disorder
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Toy breeds, young; CSF has mild lymphocytic pleocytosis, MRI normal. Responds to pred
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Toxin intracranial
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Lead, strychnine, ethylene glycol, metoclopramide, aminoglycosides, lidocaine, ivermectin, metronidazole
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Vascular dx
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Baseline, bile acids, endocrine, coagulation panel, BP monitoring, MRI, CSF
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Common intracranial treatments
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Seizure management (Diazepam, Phenobarb/KBr)
Encephalitis protocol (TMPS, Clindamycin/Doxycycline, Pred) Managing ICP (mannitol, furosemide, hypertonic saline) Decompressive surgery Ventricular shunting (hydrocephalus) Tumor resection Fractionated radiation therapy Radiosurgery Chemotherapy Treating underlying metabolic dz Rehabilitation |
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IVDD signalment, dx, rx
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Type 1: long dogs (extrusion, acute)
Type 2: larger older dogs (protrusion, progressive) Dx: myelography, MRI, CT, rads, etc. Rx: steroids questionable, strict rest; surgery if acute worsening; some may need immediate surgery |
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Fibrocartilagenous Embolism, dx, rx
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Large athletic dogs; acute lateralized presentation w/o hyperesthesia
Dx: MRI Rx: time, PT (better prognosis if C1-C5) |
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Caudal Cervical Spondylomyelopathy, dx, rx
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Young Great Danes, Mastiffs; older Dobermans, Rottweilers. Shuffling "twin engine" gait, progression
Dx: myelography, CT, MRI Rx: can do conservative medical w/ rest, corticosteroids (except when young); definitive treatment is surgery |
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Lumbosacral spondylomyelopathy (Cauda Equina Syndrome), dx, rx
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Young/middle-aged labs, shepherds
Dx: MRI (CT, myelogram) Rx: SX |
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Diskospondylitis, dx, rx
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Young to middle-ages, sick animals (febrile)
Dx: plain radiographs Rx: antibiotics based on c/s; rarely surgical curettage (but generally non-surgical) |
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Degenerative myelopathy, dx, rx
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Shepherds, corgis, boxers, Chesapeake bay retrievers - 6-9 yrs old
Dx: genetic testing, necropsy (diagnosis of exclusion) Rx: Non-surgical; Vit E and physical therapy |
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Atlantoaxial malformation/subluxation, dx, rx
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Young toy breeds
Dx: Radiographs (C1-C2) Rx: If at least partially ambulatory, then splint; if it doesn't work, then surgical intervention |
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Caudal occipital malformation syndrome, dx, rx
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Young CKCS, toy breeds
Dx: MRI Rx: Medical: steroids, Gabapentin, Omeprazole; +/- surgery to remove occipital bone (may not be curative) |
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Spinal cord neoplasia, dx, rx
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Any signalment
Dx: MRI (myelography, CT) Rx: Depends on location, type; may be steroids, may be surgical/radiation |
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Myelitis/meningitis, dx, rx
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Usually young to middle-aged toys
Dx: MRI, CSF, titers Rx: steroids, Ab's, immunosuppressives |
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Paraparesis, normal patellar, decreased withdrawal in pelvic, normal thoracic, normal cranial nerves
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L6-S1 bilaterally
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R pelvic monoplegia and L pelvic monoparesis, normal spinal reflexes, Schiff Sherrington, Cutaneous trunci cut-off at L1
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T12-T13 R-sided (R>L)
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R hemiparesis, normal spinal reflexes in all limbs, circling to left, head turn to left
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L supratentorial
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R front monoparesis, decreased R front withdrawal, absent cutaneous trunci no matter where pinched
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C8-T1, R-sided
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Tetraparesis, R side > L side, normal spinal reflexes in all limbs, Horner's in R eye, neck pain
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C1-C5, R-sided (R>L)
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Tetraparesis, R > L, normal spinal reflexes in all limbs, head tilt to left, vertical nystagmus, menace deficit on left but dog is visual
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R sided central vestibular AND cerebellar with paradoxical head tilt
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Tetraparesis, R pelvic > L pelvic, decreased patellar and withdrawal reflex in pelvic, normal spinal nerves in all other limbs, normal cranial nerves
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C1-C5 bilaterally AND L4-S1, R-sided
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Bilaterally dilated pupil in normal room light, absent menace bilaterally, absent PLRs (direct and indirect) when light is shone in either eye, normal palpebral bilaterally
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Optic chiasm or bilateral optic nerves or bilateral retinas
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Anisocoria in normal room light L pupil > right pupil, normal menace bilaterally, normal palpebral bilaterally; when dog placed in dark environment, L pupil dilates normally but right pupil does not dilate
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Horner's syndrome, R; lesion is somewhere on sympathetic pathway to right eye
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Bilaterally dilated pupils in normal room light, absent menace in left eye, normal palpebral bilaterally; when light shone in left eye, no direct or consensual PLR; when light shone in right eye, no direct but consensual PLR
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R-sided CN III AND L-sided pre-chiasmic
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L menace deficit, normal PLR, normal palpebral
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R supratentorial (lat. gen., cortex) if avisual
L cerebellar if visual |
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L menace deficit; if light shone in left eye, no direct or indirect PLR; if light shone in right eye, normal direct and indirect PLR; normal palpebral
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L-sided prechiasmic (optic nerve, retina)
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L menace deficit, normal PLR, absent palpebral on left
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Left CN VII, nucleus or nerve
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Normal menace; if shine light in left eye, no direct yes indirect; if shine light in right eye, yes direct, no indirect; palpebral normal
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Left CN III, nucleus or nerve
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