15. Examination of the nervous system 1.

Question 1

4 steps of the clinical examination:

Answer 1

1. ASK - history!!!
2. WATCH - general aspects (no physical contact)
3. TOUCH – physical examination without
   causing pain
4. PAIN - examination of pain perception

Question 2

Which additional information is important to get from the owner?

Answer 2

•Environmental/housing conditions:

• House or garden
• Feeding
• Other animals at home

•Vaccinations

•Breed-predisposition, age
-Familiar occurence?

Question 3

what do you inspect without move?

Answer 3

• body posture
• head position
• eye position,
• movement
• consciousness

Question 4

what do you inspect on move?

Answer 4

• walk
• turn
• sit-stand

Question 5

Physical examination: touch:

Answer 5

• palpation (symmetry, muscle atrophy, crepitation, fracture)
• postural reactions, spinal reflexes
• cranial nerves
• sensitivity of skin and mucous membranes
• manipulation

Question 6

Physical examination: pain

Answer 6

Pain sensation

• superficial
• deep pain

Question 7

Instruments for the physical examination

Answer 7

• reflex hammer
• arterial clamp, needle
• penlight

Question 8

What is the goal of the physical examination?

Answer 8

Locate the problem

Neurological or not neurological

Question 9

If it is neurologic what can it be?

Answer 9

central or peripheral

Question 10

If it is central where can it be?

Answer 10

brain or spinal cord

Question 11

Which additional examinations can be done?

Answer 11

• X-ray
• CT (computed tomography)
• MRI (magnetic resonance imaging)
• EEG (electroencephalography)
• EMG (electromyography)
• Laboratory examinations

Question 12

What is the goal of a myelography?

Answer 12

to demonstrate compression of the spinal cord (as alterations in
the subarachnoid space surrounding the spinal cord)

Question 13

What is a myelography?

Answer 13

• Special X-ray procedure

* Contrast agent is injected into the subarachnoid space

Question 14

What is the indications of a CT image?

Answer 14

brain or other structures of the head, spine, thoracic imaging etc.

Question 15

What can Contrast in a CT show?

Answer 15

-It enhance densitiy differences between lesions and surrounding parenchima
→ demonstrate vascular anatomy

Question 16

How is the MRI taken?

Answer 16

• The body is placed in strong magnetic field to align the randomly oriented protons within the water nuclei.
• This alignment is next perturbed with radiofrequency energy.
• Than the nuclei return to resting alignment through various relaxation processes, while emitting radiofrequency energy.
• The emitted signals are measured and processed by a computer.

Question 17

What do you need when you take a MRI ?

Answer 17

• instrumental background

- sedation during examination

Question 18

Advantages of X-ray:

Answer 18

-cheaper instrument, quicker, less detail (summation), better for bony structures, anaesthesia +/-

Question 19

Advantages of CT

Answer 19

•CT provides better imaging of bony structures, higher

exposure to radiation, anaesthesia needed

Question 20

Advantages of MRI

Answer 20

provides improved anatomic detail of soft tissues

(higher water content), anaesthesia needed

Question 21

What does the EEG do?

Answer 21

EEG (electroencephalography)
• surface recording of the electrical activity of the cerebral
hemispheres

Question 22

What does the EMG do?

Answer 22

EMG (electromyography)

• records the electrical activity of muscles

Question 23

Which lab examinations do we do when checking the nervous system?

Answer 23

• cerebrospinal fluid
• blood - haematology, biochemistry
• urine
→ testing for pathogens
→ testing for toxins
→ testing for metabolic alterations

Question 24

When we examine the head: which abnormal head position can be seen?

Answer 24

lateral turn, tilted, stargazing: opisthotonus

Question 25

What do we examine on the head and skull with inspection and palpation?

Answer 25

* shape (symmetrical - asymmetrical changes) * mobility * ears (drooping or pointing) * signs of pain by palpation

Question 26

What do we examine on the face?

Answer 26

- Facial expression (eyelids, nostrils, ears: function of the of facial muscles; bilateral or unilateral changes) - Detailed examination of the eyes (position and mobility of the eyeballs & pupils)

Question 27

What are the different kinds of curved spine called?

Answer 27

``` • (pseudo)kyphosis (being humpbacked, dorsal deviation) • lordosis (concave curvature of the spine, ventral deviation) • scoliosis (lateral curvature of the spine) ```

Question 28

What do we look for when we examine the vertebral column?

Answer 28

* Abnormal shape or position (luxation) | * Sensitivity (pain provocation by palpation, careful bending or percussion)