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156 Cards in this Set
- Front
- Back
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What are some signs of paresis?
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May decrease rate or range of motion, increase fatigability, decrease muscle tone, limit ability to perform certain motor acts
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What is the definition of plegia?
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Absence of voluntary motor movement
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What are 7 steps of patient assessment?
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1) History
2) Physical exam 3) Neuro exam (if needed) 4) Lesion localization 5) Diagnostic plan 6) Prognosis |
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What is the most important part of the initial evaluation of an animal?
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The medical history
-need to find common ground w/ owner |
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What does a chief complaint include?
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Particular abnormalities noticed by the client as well as the onset and duration of the problem
-past medical history important to know about current or past systemic disease |
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What are 3 reasons to perform a physical exam on a neuro patient?
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Identify other disorders:
-cardiac, neoplasia, orthopedic |
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What are the 2 goals of a neurologic exam?
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-Determine if neuro disease present
-determine neuroanatomic lesion location |
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What type of environment is needed to perform a neurologic exam? Why is this so important?
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Quiet environment w or w/o owner present bc sympathetic overdrive can alter reflexes
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What are 4 neurologic exam instruments?
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1) Pleximeter
2) Hemostat 3) Strong light source 4) Moistened Q-tip |
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What are the 6 components of a neurologic exam?
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1) Observation
2) Palpation 3) Cranial nerve evaluation 4) Postural reactions 5) Spinal reflexes 6) Sensory evaluation |
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What are the 3 things you need to observe on a neuro exam?
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1) Mental status
-level and content of consciousness -alert, delirium, obtund, stuporous, comatose 2) Posture 3) Movement -gait and involuntary movement |
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How do you evaluate an animal for normal consciousness? What does normal consciousness imply?
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Normal consciousness implies wakefulness & awareness of environment
-assess by observing for appropriate or inappropriate response to the environment |
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What characterizes delirium? What does delirium usually indicate?
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Alert, overactive, responds inappropriate to stimuli
-usually indicates forebrain dysfunction |
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What characterizes depression? What causes depression?
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Obtunded-inattentive, little spontaneous activity, drowsy
-systemic illness or brain disease |
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What characterizes stupor? Coma? What causes stupor and coma?
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stupor: animal appears to be asleep but can be aroused by noxious stimuli
Coma: unconscious, can't be aroused even w/ noxious stimuli -commonly caused by a brain stem lesion or severe diffuse disease of forebrain |
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What are 5 postures that need to be examined during a neuro exam?
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1) Position of eye and head w/ respect to gravity
2) Yaw/tilt -usually towards circling and therefore lesion 3) Position of body w/ respect to gravity 4) Deviations in spine 5) limbs -wide-base stance, decreased tone, increased tone |
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What is a head tilt? Yaw? What does a head tilt usually indicate?
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head tilt: One ear is held lower than the other and usually indicates vestibular disease
Yaw: when head is held level but the nose is turned to right or left -animals with forebrain lesions often have a head turn and circle in direction of head turn |
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The ability to stand and move requires intact _____ and _____ systems.
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motor and proprioceptive systems
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What are 3 abnormal postures of animals?
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1) Decerebrate rigidity
2) Decerebellate rigidity 3) Schiff-Sherrington posture |
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What does decerebrate rigidity look like?
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produces extension of all limbs and sometimes opisthotonus (dorsiflexion of head & neck)
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What lesion usually results in decerebrate rigidity?
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A rostral brain stem/ midbrain lesion
-patients usually have severe abnormalities in mentation too |
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What causes decerebellate rigidity?
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Acute cerebellar lesions
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Decerebellate rigidity is characterized by what?
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Opisthotonus, thoracic limb extension, flexion of the hips, normal consciousness
*decerebrate has abnormal mentation |
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What is the Schiff-sherrington posture?
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Extension of thoracic limbs w/ paralysis of pelvic limbs
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What lesions cause Schiff-Sherrington posture?
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Lesions affecting the thoracic and lumbar segments
-T3- L3, loses inhibition from pelvic limbs so get hyperextension |
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What is the mentation of a dog with Schiff-sherrington like? reflexes?
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normal mentation, normal reflexes
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Can animals stand up with decerebrate rigidity? decerebellar?
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No for both
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What is a big difference of shiff-sherrington from both decerebrate and decerebellar rigidity?
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Dogs will get into sternal recumbency w/ shiff sherrington
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What type of surface do you want to use to observe an animals gait? What should you do to assess gait?
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nonslick surface such as carpet, grass or pavement
-Observe from side, front and rear -walk, trot, turn in circles, walk up and down a flight of stairs |
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What is the definition of ataxia?
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inability to perform normal coordinated motor activity and is not caused by weakness, musculoskeletal abnormality or abnormal movements such as tremor or myoclonus
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What is sensory ataxia?
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Caused by a lesion affecting the general proprioceptive pathways in peripheral nerve, dorsal root, spinal cord, brain stem and forebrain
-there is loss of sense of limb and body position--> clumsiness and incoordination, wide based stance, swaying gait -stride normal, toes may scuff |
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What are 5 abnormalities in gait to look for?
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Lamenss
Ataxia/dysmetria Paresis Plegia Circling |
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What do you want to palpate for when performing a neuro exam?
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Symmetry
Muscle Axial/appendicular skeleton Cranial: open fontanel, fractures, masses Deformity: scoliosis, lordosis, kyphosis Deviation Masses Motion (fractures) |
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What are you looking for when you palpate the spine?
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Any curvature, displacement, masses, swelling, paraspinal muscle atrophy or pain
-leave pain for last!!! |
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How do you examine the eyes for signs of neurologic damage?
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Retropulse the globe by gently pressing on the closed eyelids to detect pain or a retrobulbar mass
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what should you do during a neuro exam after palpating the muscles of mastication?
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Gently open mouth to detect pain or reduced range of motion of temporomandibular joints
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What is cranial nerve I?
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Olfactory nerve
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How do you test the olfactory nerve during a neuro exam?
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Tested with food
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Why should irritating substances such as ammonia or alcohol be used to test the olfactory nerve?
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-irritating substances such as ammonia or alcohol should not be used because they stimulate the trigeminal nerve endings in nasal passages
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What is cranial nerve II?
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Optic nerve
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what does cranial nerve II provide?
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Sensory path for vision and pupillary light reflex
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The optic nerve is assessed in conjunction with what nerves?
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Oculomotor nerve (CNIII)
which provides motor pathway for pupillary light reflex & facial nerve, which provides motor pathway for blink reflex |
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How do you assess CNII?
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Observing patient during movement and visual stimuli
-e.g. menace response, maze, tossing cotton balls, visual placing reactions |
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What animals are normally lacking a menace response?
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Puppies and kittens younger than 12 weeks of age
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Why is it important to avoid air currents when performing a menace response?
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Stimulates sensory fibers of the cornea (CNV)
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what nerve controls the efferent part of the menace response?
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Facial nerve (CN VII)
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Since the menace is a response pathway, where does the signal travel?
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Contralateral occipital lobe
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A cerebellar lesions can cause an ______ menace response deficit.
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Ipsilateral
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How do you test CN III?
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Pupillary light reflex
Normal ocular position Movement |
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What are 2 signs of abnormal CNIII?
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Assessed by physiologic nystagmus
ventrolateral strabismus |
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A dog comes in with ipsilateral pupillary dilatation, what's on the top of your differentials? What should you do to confirm this?
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CNIII damage
-turn off room lights and focus a strong light source at nose level and direct to medial canthi of each eye, evaluate direct & indirect responses, pupil should constrict in both eyes |
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What is Cranial nerve IV?
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Trochlear nerve
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What does Cranial nerve III innervate?
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motor to some extraocular muscles and levator muscle of upper eyelid
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What does cranial nerve IV innervate?
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Motor dorsal oblique muscle (eye)
-rarely solely affected |
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What are signs of cranial nerve IV damage?
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Can cause lateral deviation of the dorsal aspect of the pupil
-may be obvious in cat but not dog (round pupil) |
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What does cranial nerve V innervate?
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Motor to muscles of mastication
Facial sensation (Afferent) -ophthalmic n -maxillary n -mandibular n |
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What is the motor branch of the trigeminal nerve? What does it innervate?
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Mandibular nerve: innervates masseter, temporal, rostral digastric, pterygoid and myelohyoid muscles
-muscles of mastication |
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How does an animal present when it has bilateral trigeminal nerve paralysis?
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Dropped jaw
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What nerves should you test for sensory when testing CNV?
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All 3 branches of ophthalmic (medial canthus, cornea), maxillary (maxilla, nasal mucosa, lateral canthus) and mandibular (lower jaw)
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How do you test the sensory branch of CN V?
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Using 3 reflexes:
-palpebral reflex -corneal reflex -trigeminal facial reflex (touch of skin may be adequate in some animals, whereas a gentle pinch w/ forceps may be needed in others |
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How do you elicit the corneal reflex to test CN V?
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Lightly touching a moistened Q-tip to the cornea
-normal response is retraction of the eye (CN VI) and attempts to close the eyelids (CNVII) CNV= sensory |
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How do you elicit the palpebral reflex when testing CNV? What other nerve does it need intact?
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Elicited by touching the medial and lateral canthus of the eye
-palpebral reflex is dependent on innervation of the muscles by the facial nerve |
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What is the facial reflex testing?
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Reflex and conscious pain perception of the pathways of the trigeminal nerve
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What is the normal response to the trigeminal facial reflex?
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respond by pulling away from the stimulus and a blink reflex w/ facial twitches elicited
-nasal mucosa= sensitive area good to test |
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If an animal doesn't respond to the trigeminal facial reflex, what should you check next?
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Check jaw tone to see if CNV is working
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What is cranial nerve VI?
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Abducent nerve
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What does cranial nerve VI innervate?
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Motor retractor bulbi
lateral recuts mm |
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How are eye movements (lateral rectus mm) due to cranial nerve VI tested?
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Evaluation of physiologic nystagmus and presence of a ventromedial strabismus
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How do you test the retractor bulbi muscle?
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Corneal reflex
Palpebral reflex |
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What does cranial nerve VII innervate?
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-facial symmetry
-motor to menace response and palpebral and corneal reflexes -Sensory to inner pinna -lacrimal salivary glands, taste to rostral tongue (parasymp) |
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How can animals appear when they have facial paralysis due to damage to CN VII?
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-Nose may be slightly deviated to normal side and nostril may not flare on inhalation
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What will happen when performing a palpebral or corneal reflex in a dog with CN VII damage? facial test?
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Palpebral fissure may be slightly widened and fails to close during reflex test
-may not produce lip twitch when pinched |
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How do you test the sensory pathway for test to the rostral 2/3rds of the tongue?
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Placing atropin on the tip of the affected side
-normal animal reacts to bitter taste |
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What are the two divisions of CN VIII?
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Vestibulocochlear nerve:
-cochlear division (hearing) -vestibular division (balance) |
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How do you test the cochlear division of CN VIII?
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Hearing is difficult to test accurately so use electrophysiologic testing: BAER (brainstem auditory evoked response)
-a clicking noise is applied to each ear and a response is recorded |
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What are 5 signs of damage to the vestibular division of CN VIII?
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1) head tilt
2) ataxia w/ ipsilateral leaning, falling or rolling 3) strabismus 4) Nystagmus 5) loss of oculovestibular reflex |
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What is the most common type of strabismus?
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Usually ventrolateral
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What do we mean strabismus' are positional?
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Forced deviation of globe may be seen when head is elevated or lowered
-ipsilateral eye deviates ventrally when head is elevated in SAs |
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What are 3 types of nystagmus?
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Spontaneous
Positional Pendular |
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What is nystagmus? How do you name them?
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Involuntary oscillation of eye
-typically has a fast and slow phase -named according to direction of fast phase -further characterized by direction oscillation e.g. vertical, rotary, or horizontal |
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What is spontaneous nystagmus? How do you elicit it?
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Abnormal involuntary oscillations of the eyes when observing the patient
-Elicit by putting head in different positions (same for strabismus, both= abnormal) -one of best ways: flip patient on back |
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Nystagmus means there's loss of the _____ reflex (physiologic nystagmus).
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Oculovestibular reflex
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How do you elicit a physiologic nystagmus?
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rotating the animals head in either direction
-nystagmus develops in normal animals when the head is moved from side to side, with the fast phase of the nystagmus in the direction of head movement -normal animals: head is turned to one side slow movement of globe occur to opposite side followed by a quick phase or jerk of the nystagmus toward (ipsilateral) the side of |
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What is cranial nerve IX called? X? XI?
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IX: glossopharyngeal
X: vagus XI: accessory nerves |
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What do CN IX, X, XI innervate?
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Motor and sensory to pharynx and larynx
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How do you test CN IX, X, XI?
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Swallow or gag reflex
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Why are CNs IX, X and XI considered together?
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Common origin= nucleus ambiguus, and intracranial pathway
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CN IX provides sensory to ________ and pharyngeal mucosa including taste.
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Caudal 1/3 of tongue
-test w/ gag reflex |
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Why would you perform a laryngeal examination when evaluating CNs IX, X, XI?
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To observe for asymmetry of laryngeal (innervated CN X)
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A dog is having trouble swallowing, what cranial nerve(s) could be responsible?
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CN IX, X, XI
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What is Cranial nerve XII?
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Hypoglossal nerve
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What does cranial nerve XII innervate?
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Motor to tongue mm (intrinsic and extrinsic muscles)
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How do you test the hypoglossal nerve?
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Lick response: touch tip of the nose and dog should lick
-can test strength of retraction by grasping tongue -palpate for atrophy of tongue, test jaw strength |
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What are 5 postural reactions?
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1) Proprioceptive positioning
2) Hopping 3) Hemiwalking 4) Wheelbarrowing 5) Extensor postural thrust |
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What are postural reactions?
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Responses involving both spinal reflexes and input from higher centers in the nervous sytem
-sensitive indicators of neurologic dysfunction |
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What do postural reaction deficits tell you?
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That neurologic disease is present, doesn't localize a lesion, can be afferent pathways or efferent pathways
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Why do we perform postural reactions?
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To detect subtle deficiencies which may go unnoticed in the gross analysis of locomotion
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Postural reaction deficits usually occur _______ to peripheral nerve, spinal cord and most brain stem lesions, but forebrain lesions result in _____ deficits.
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Ipsilateral: peripheral nerve, spinal cord, brainstem
Contralateral: forebrain |
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How can you easily evaluate the conscious proprioception?
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Knuckling: support weight of animal by placing hand under dorsal and knuckle foot over so dorsum on floor
-normal response is immediate return of paw to normal position -may have to push them over a little bit to put weight on paw |
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Do patients with orthopedic disease have a normal conscious proprioception?
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Yes
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How do you perform hopping?
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Place most of animals weight on one limb and pus ti forward or laterally
-each limb is tested individually -sensitive to detection of subtle weakness -normal animals hop on limb while keeping foot under their body for support |
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How do you test placing?
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Cover patient's eyes, pick animal up and move it towards edge of table, when paw touches table animal should immediately place limb forward to rest paw on surface
-good for cats -can do visual placing by doing same but not covering eyes |
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How do you perform wheelbarrowing?
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Life animals pelvic limbs and torso and shift its weight forward, animal should walk normally on thoracic limbs w/ no evidence of scuffing or weakness on either leg
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How do you perform an extensor postural thrust?
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Hold animal upright so its weight is placed entirely on pelvic limbs
-animal should normally extend its legs in anticipation of touch floor and then step backwards equally with both legs in order to support its weight -small animals |
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What are the 4 spinal reflexes?
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1) Myotactic
-patellar, gastrocnemius, biceps, triceps 2) Flexor withdrawl 3) Cutaneous trunci 4) Perineal reflex |
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What do spinal reflexes assess?
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Integrity of sensory and motor components of the reflex arc and influence of descending UMN motor pathways
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What does a normal spinal reflex require?
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An intact peripheral sensory neuron, peripheral motor neuron and varying number of interneurons w/in spinal cord
-a lesion in any one of these structures= decreased or absent reflex |
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What reflexes help distinguish b/w UMN and LMN disease?
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Spinal reflex
UMN= normal to increased LMN= reduced or absent |
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What is a myotactic reflex?
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Trying to stimulate different afferent fibers connected tot he spindle fibers so when muscle or tendon is overly stretched that receptor fires and sends a signal to spinal cord which then says we need to retract that muscle so don't tear it -efferent goes down to muscle group and causes it to contract- assesses spinal cord function
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What is the flexor withdrawl reflex?
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By stretching all the tissues of limb by pulling it away from body it sends fires to spinal cord and efferent is to pull back, not trying to pinch or hurt them, just pull leg away from body
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How do you test the cutaneous trunci reflex?
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By pricking or pinching the skin adjacent to the vertebral column from the level of the iliac crest to the shoulder
-sensory info is transmitted into spinal cord through spinal nerves, ascends spinal cord to C8 and TI spinal cord segments -Lateral thoracic nerve originates from brachial plexus and serves as efferent arm--> innervates cutaneous trunci muscle--> skin twitch |
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What lesions result in a loss of the cutaneous trunci reflex?
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Spinal cord lesions that impair superficial pain sensation leads to loss of sensation caudal to the point of injury OR
lesion to nerve roots of lateral thoracic nerve (e.g. brachial nerve plexus avulsions) |
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What segment of the spinal cord does the patellar reflex evaluate?
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Femoral nerve (L4-L6)
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How do you perform patellar reflex?
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Support pelvic limb w/ stifle slightly flexed and tap the straight patellar tendon
-observe for a brisk contraction of the quadriceps m. w/ extension of the stifle -want leg in position that causes tension on tendon |
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What are the 2 myotactic reflexes you want to make sure to properly evaluate?
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Patellar and bicep
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What section of the spinal cord is evaluated using the gastrocnemius reflex?
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Tibial/sciatic n (L7-S1)
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How do you perform the gastrocnemius reflex?
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Flex and externally rotate the hock joint to put
tension on the gastrocnemius tendon. Tap the tendon just proximal it its insertion of the tuber calcanei. Observe for extension of the hock and/or contraction of the semimembranosus m. -tendon has to be taught |
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What section of the spinal cord is evaluated via the biceps reflex?
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Musculocutaneous n. (C6-C8)
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How do you perform the biceps reflex?
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Isolate the biceps tendon at its attachment on the
head of the radius. Pull the limb caudally. Tap the tendon and observe for flexion of the elbow and movement of the biceps mm. *key is tension on tendon!!! |
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What segment of the spinal cord is being testing with the triceps reflex?
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Radial n (C7-T2)
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How do you perform the triceps reflex?
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Externally rotate the elbow and position the limb cranially.
Tap the triceps tendon just proximal to its insertion on the olecranon and assess for extension of the elbow. |
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How do you initiate the flex withdrawl reflex?
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initiated by gently clamping a digit, which should normally
initiate flexion of the carpus and elbow and shoulder in the thoracic limb and of the hock, stifle and coxofemoral joint in the pelvic limb. |
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What does the flexor withdrawl reflex tell you?
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Only tells you that region in the spinal cord is intact
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What are 3 things to look for when trying to evaluate sensory?
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Hyperesthesia
Paresthesia/dysesthesia anesthesia (superficial pain and deep pain perception) |
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What is the definition of hyepresthesia?
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A painful response to an innocuous stimulus
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What is the defintiion of dysesthesia (paresthesia)?
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Pain without being induced by stimuli
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What is the definition of anesthesia (with regards to sensory evaluation)?
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Absence of a conscious response to a noxious stimulus
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How do you elicit hyepresthesia?
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palpating the paraspinal muscles or by flexing or
extending the cervical spine. Downward pressure on the sacrum often elicits pain in animals with L-S lesions. The tail is palpated, extended and flexed. |
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If you suspect hyperesthesia in the lumbosacral joint, how can you extent the joint?
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lace one hand under the pelvis while the animal is
standing. Raise the pelvis and press downward on the seventh lumbar vertebra with the other hand. |
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Why is spinal hyperesthesia useful?
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Useful in localizing sign and can indicate a focal lesion such as a disc or tumor, or it may indicate a diffuse problem such as meningitis
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How do you check for cervical hyperesthesia?
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Manipulated using lateral, ventro-and dorsoflexion positions
-dog should put chin on chest and touch nose to thorax on both sides -Deep palpation not useful due to musculature of cervical spinal region |
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**What is the main reason to check for deep pain perception?
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Determines prognosis
-pain is last thing to go means there's no spinal cord left if absent |
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How do you elicit superficial pain?
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by pricking or pinching the skin.
Webbing b/w digits is sensitive area for evalaution |
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How do you elicit deep pain?
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clamping the bone of a digit; assess for limb
withdrawal and evidence of conscious perception of the stimulus (such as turning around, crying out, biting). |
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When does a loss of deep pain perception really indicate a poor prognosis?
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After 24 hours, at this time have about a 5% chance of regaining use
-48 hours= done for |
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Compare pain sensation and the withdrawl reflex?
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Withdrawal of the limb alone does not mean that the animal has deep pain; the limb withdrawal is a spinal reflex only. Absence of deep pain is a grave prognostic sign because of the relative resilience of deep pain fibers and the fact that these pathways are diffuse and bilateral within the spinal cord.
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**What are 5 clinical signs of a lesion in the forebrain (cerebral cortex, thalamus)?
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1) Seizures
2) Change in attitude 3) Circling to side of lesion 4) Contralateral postural reaction and visual deficits 5) Blunted contralateral facial sensation |
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**What are 3 clinical signs of vestibular disease?
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1) Ataxia
2) Falling, rolling, head tilt towards side of lesion 3) Nystagmus |
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**What's a big difference b/w central and peripheral vestibular lesions?
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Central: signs of brain stem involvement= CP deficits
Peripheral: no signs of brain stem involvement= reflexes and conscious propioception are normal |
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**What are 3 clinical signs of a brainstem lesion?
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1) Cranial nerve deficits
2) Postural reaction deficits 3) Depression, stupor, coma |
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**What are 4 clinical signs of cerebellar lesions?
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1) Ataxia
2) Dysmetria 3) Intention tremor 4) Broad based stance |
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**What are the signs of a lesion from C1-C5?
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Lesions result in tetraparesis/plegia or ipsilateral hemiparesis/plegia. Spinal reflexes are normal or exaggerated. Horner's syndrome is possible with severe lesions. Severe lesions can cause respiratory paresis or apnea.
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**What are the signs of a lesion from C6- T2?
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Lesions result in tetraparesis/plegia or ipsilateral hemiparesis/plegia. limb reflexes are weak or absent with hypotonic and rapid muscle atrophy. Spinal reflexes in the pelvic limb are normal or exaggerated. An
ipsilateral horner's syndrome may be present due to damage of the T1-3 spinal roots or nerves. |
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**What are the clinical signs of a T3-L3 lesion?
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Lesions many cause varying degrees of weakness in the pelvic limbs with normal reflexes in the thoracic limbs. Reflexes are normal or exaggerated. Acute lesions may elicit a Schiff-Sherrington posture. Panniculus reflex may be absent caudal to the lesion and in severe cases conscious proprioception of deep pain is lost.
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**What are the clinical signs of of a lesion from L4-S3?
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lesions may cause LMN weakness in the pelvic limbs. Spinal and perineal reflexes may be weak or absent. Severe lesions will result in loss of deep pain to pelvic limbs and tail.
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What is the mental status of a patient that has a peripheral lesion? Central?
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Peripheral: alert, disoriented
Central: obtund, stupor |
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What will the posture of an animal with a peripheral vestibular disease be? central?
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Peripheral: Ipsilateral head tilt; yaw; leaning; wide-base stance; increased limb tone (contralateral)
Central: Same as peripheral, head tilt can be contralateral (paradoxical) |
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What is the gait of an animal with a peripheral vestibular disease like? Central?
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Peripheral: ipsilateral circling, rolling
Central: circling, rolling, dysmetria, hemi/tetraparesis |
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What is the eye position of an animal with a peripheral vestibular lesion? Central?
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Peripheral: ipsilateral strabismus
Central: strabismus |
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What direction is the spontaneous nystagmus of an animal with a peripheral vestibular lesion? Central?
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Peripheral: horizontal, rotary
Central: horizontal, rotary, vertical |
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How is physiologic nystagmus affected in an animal with a peripheral vestibular lesion? Central?
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Decreased toward side of lesion for both
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What other cranial nerve dysfunction can occur with a peripheral vestibular lesion? central?
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Peripheral: VII, horner's syndrome
central: V-XII |
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What postural reaction deficits does an animal with a peripheral vestibular lesion have? Central?
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Peripheral: none
Central: present ipsilateral side |
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What are the spinal reflexes like an animal with a peripheral vestibular lesion? central?
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Peripheral: normal, except w/ polyneuropathy
Central: norma, increased ipsilateral |
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What is the biggest difference b/w peripheral and central vestibular lesions?
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No deficits in conscious proprioception or postural reactions w/ peripheral
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What can be done for neuro diagnostics after localizing the lesion?
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Radiographs
CT scan/ MRI scan -brain and/or cord Myelogram CSF tap- cytology, culture, serology Intra-operative ultrasonagraphy CBC, Chemistry panel, urinalysis |
