Neuro Exam Flashcards
(41 cards)
1
Q
Six components of neuro exam
A
- mentation
- gait & posture
- cranial nerves
- postural reactions
- segmental reflexes
- palpation & range of motion
2
Q
mentation
A
- alert & appropriate
- obtunded (dull, lethargic but responsive)
- stuporous (responsive to noxious stimuli)
- comatose (not responsive to noxious stimuli)
- dead
3
Q
gait
A
- ambulatory vs. non-ambulatory
- ataxia
- paresis or plegia? (mono-, hemi-, para-, tetra-)
- lameness?
4
Q
ataxia
A
- lack of coordination
- cerebellar, vestibular, proprioceptive
5
Q
cerebellar ataxia
A
wide-based stance, +/- hypermetria, truncal sway
no CP deficits, no weakness
6
Q
vestibular ataxia
A
wide-based stance, leaning, listing, “drunken sailor”
7
Q
proprioceptive ataxia
A
lack of coordination with a lack of awareness and paresis
“spinal ataxia”
8
Q
posture
A
- head
- tilt or turn
- resting or intention tremors
- head held low, neck guarding
- body
- kyphosis, lordosis, scoliosis
- torticollis
- laterally recumbent
- decerebrate vs. decerebellate vs. Schiff-Sherrington
9
Q
decerebrate
A
- cerebrum disconnected
- comatose
- rigid extension in all limbs
10
Q
decerebellate
A
- acute cerebellar lesions
- extended TLs, flexed PLs
11
Q
Schiff-Sherrington
A
- severe, acute T3-L3 lesions-plegia +/- pain perception
- not prognostic
- when placed on side: TLs rigid, HLs weak
- extensor hypertonia of TLs
- due to loss of ascending inhibition
- distinguish from decerebrate and decerebellate posutres (mentation and CNs)
12
Q
what do decerebrate, decerebellate and Schiff-Sherrington have in common?
A
oposthotonus (star gazing), extended neck and rigid thoracic limbs
13
Q
menace
A
afferent: CN II
efferent: CN VII
14
Q
PLR
A
afferent: CN II
efferent: PS CN III
15
Q
palpebral
A
- medial canthus:
- afferent: V (ophth)
- efferent: VII
- lateral canthus
- afferent: V (max)
- efferent: VII
16
Q
facial symmetry
A
CN VII
17
Q
physiologic nystagmus
A
afferent: CN VIII
efferent: CN III, IV, VI
- MLF
- strabismus, positional nystagmus
18
Q
gag
A
afferent: CN IX, X
efferent: IX
19
Q
tongue function
A
CN XII
(lesions here are not as common in dogs and cats as horses)
20
Q
postural reactions
A
- placing/knuckling (CP)
- hopping
- hemistanding & hemiwalking
- wheelbarrow
- visual & tactile placing
- extensor postural thrust
21
Q
hemistanding & hemiwalking
A
walk laterally slowly- don’t have musculature to hop medially
should be 1:1 thoracic:pelvic limb steps
22
Q
segmental reflexes: thoracic limb
A
-
withdrawal (reliable)
- biceps, musculocutaneous n., C6-C8, triceps, radial n., C8-T2
- biceps & triceps
23
Q
segmental reflexes: pelvic limb
A
-
patellar (reliable)
- femoral n., L4-L6
- gastrocnemius
- cranial tibial
-
withdrawal (reliable)
- mostly sciatic n.
- L6-S1
24
Q
segmental reflexes: cutaneous trunci
A
- lateral thoracic n.
- C8-T1
- not a simple reflex
25
segmental reflexes: perineal reflex
tail tuck and anal sphincter
26
neurolocalization
* normal vs. abnormal
* brain vs spine vs LMN vs multifocal
* 1: brain
* 2: C1-C5
* 3: C6-T2
* 4: T3-L3
* 5: L4-S3
* 6: motor unit (LMN)
27
brain and cranial nerves
* forebrain
* cerebrum: I
* diencephalon: II
* cerebellum
* brainstem
* midbrain: III-IV
* pons: V
* medulla oblongata: VI-XII
28
forebrain lesions-clinical signs
* seizures
* circling
* compulsive
* behavior changes (inapp, getting stuck in corners)
* blindness, non-ocular (amaurosis)
* postural reaction deficits
* gait should be normal (no paresis)
29
idiopathic head tremors
"head bobbing"
labs
try feeding PB and will stop
30
cerebellar lesions-clinical signs
* head tilt
* nystagmus
* loss of menace
* intention tremors
* truncal sway
* ataxia
* **hypermetria**"spastic"
* DO NOT have: paresis, behavior changes, CP deficits
31
32
brainstem lesions-clinical signs
* decreased mentation (ARAS)
* obtunded to stuporous to comatose
* CN deficits: III-XII
* usually some CN VIII involvement
* check for physiologic nystagmus
* vestibular or proprioceptive ataxia (if ambulatory)
* may seem cerebellar depending on lesion
33
vestibular: central vs peripheral
* central
* CP deficits
* paresis
* ataxia
* hypermetria
* mentation changes
* +/- other CN
* peripheral
* head tilt
* nystagmus
* other CN deficits (VII)
* ataxia
34
spinal cord lesion
* postural reactions = there is a lesion
* segmental reflexes = where it is
35
muscle tone
* extended, difficult to flex limb
* implies UMN lesion
* normal, resting tone
* flaccid, unable to support any weight
* implies LMN involvement
* consider spinal shock
36
C1-C5
* +/- ambulatory (knuckling, stumbling, "face-planting"
* tetraparesis
* ataxia (PL\>TL)
* reflexes: N to increased in all limbs
* +/- muscle fasiculations
* +/- pain
37
C6-T2
* +/- ambulatory
* knuckling, stumbling, "face-planting"
* "two-engine" gait
* tetraparesis
* ataxia
* reflexes
* TL: N to decreased
* PL: N to increased
* +/- muscle fasiculations
* +/- pain
38
T3-L3
* +/- ambulatory
* paraparesis (increased PL tone!)
* PL ataxia
* +/- kyphosis
* reflexes:
* TL: N
* PL: N to increased
* +/- panniculus cut-off
* +/- pain
39
spinal shock
* T3-L3
* physiologic or anatomic transection of the spinal cord that results in temporary loss or depression of all or most muscle tone and spinal reflex activity below the level of injury
* acute injury
* patellars return within hours in dogs
* withdrawal reflexes can take days
* not prognostic
40
L4-S3
* +/- ambulatory
* PL ataxia
* +/- pain
* paraparesis-decreased PL muscle tone
* reflexes:
* TL: N
* PL: decreased to absent
* +/- panniculus cut off
41
LMN
* +/- ambulatory
* no ataxia
* no pain
* +/- CN weakness (facial, gag)
* paresis: decreased muscle tone all over
* reflexes:
* decreased to absent
* panniculus may or may not be affected
* exercise intolerance
