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Flashcards in Neuro examination Deck (28):
1

What are the 6 parts of a neurological exam?

1) Observe mental status gait and posture

2) Palpate muscular and skeletal system

3) Evaluate postural reactions

4) Evaluate cranial nerves

5) Evaluate spinal nerves--C6-T2; L3-S3

6) Evaluate sensation

2

What is the point of lesion localization?

To decrease length of MRI's and other scans (safer for the animal)

 

3

What would you see with a lesion from C1-C5?

Upper signs in all 4 limbs

4

What lesion is associated with lower motor neuron signs in the forelimbs but upper signs in the hindlimbs?

C6-T2

5

What signs would you see with a lesion between T3-L3?

Normal forelimbs, upper signs in hindlimbs

6

If a dog entered your clinic and your neuro exam showed normal forelimbs but lower motor neuron signs in the hindlimbs, where would the lesion most likely be located?

L4-S3

7

When observing the mental state of an animal, what is the difference between:

  1. Alert
  2. Depression
  3. Stupor 
  4. Coma

1) Alert = Apprehensive (usually), notices sounds, movements, etc.; knows what's going on in the room

2) Depression = Not taking note of surroundings

3) Stupor = Animal only responds to pain stimulus 

4) Coma = Animal doesn't respond to anything

8

What is the reticular activating system controlled by? 

What will be affected if it stops functioning?

Brainstem

Intelligence, cranial nerves; animal will seem lethargic, somnolent

9

What will you see with a lesion in the thalamocortex?

Behavioral changes:

Pacing, head pressing, inability to distinguish day/night, incontinence; owner will complain that the animal "isn't the same," or "doesn't know me anymore"

 

Seizures can also occur

10

What changes can you see when observing posture during the neuro exam?

Orientation of body parts:

Head tilt, ventroflexion, knuckling

*Often see orientation problems due to muscle weakness in cats with potassium deficiency

11

Tell me about ataxia

Observed when looking at gait; incoordination 

Can be cerebellar problem: important in coordination of movement; animal will sway from side to side ('drunken' state)

Can be vestibular problem: no balance information

12

What do you palpate in the neuro exam?

Musculoskeletal system--atrophy, joints, discs

Palpate up and down spinal cord to look for pain response

13

What do postural reactions tell?

What are the 6 postural tests?

Mostly only tell if there is a problem or not

1) CP deficits

2) Hopping

3) Placing

4) Wheelbarrowing

5) Extensor postural thrust

6) Hemi-walking

14

Cranial nerves--which are observed and where do they all come from?

Facial, vestibulocochlear, trigeminal, trochlear oculomotor abducens

They all go through the brainstem

15

What structure does the facial nerve run through?

Why is this an issue?

How do you differentiate what could be causing issues with the nerve?

The facial nerve runs through the ear.

Problems could easily be due to the ear and not the brainstem

When due to ear issues: animal shakes head, can see problems through otoscope

When due to brainstem issue: animal will not be acting right, will have gait issues, etc.

16

What nerves respond to the pupillary light reflex? The menace reflex?

How do you administer the 'vision test?'

  • Pupillary light reflexes--optic and oculomotor
  • Menace--optic and facial
  • Vision test: throw cotton ball in field of vision (multiple areas)--animal should respond to it

17

Which nerves are responsible for the following:

  • Oculocephalic refex
  • Jaw tone
  • Tongue tone
  • Gag reflex

  • Oculocephalix reflex = vestibulocochlear
  • Jaw tone = trigeminal
  • Tongue tone = hypoglossal
  • Gag reflex = vagus, glossopharyngeal 

18

Spinal reflexes:

  • Lateral recumbency 
  • Perineum
  • Hind limb:
  • Forelimb: 

  • Lateral recumbency--upper limb
  • Perineum--perineal reflex
  • Hind limb:
    • flexor--sciatic and femoral
    • patellar--femoral
    • cranial tibial--sciatic
  • Forelimb:
    • flexor--musculocutan, median, ulnar
    • extensor carpi radialis--radial nerve

19

MOTOR SIGNS (super duper important)

know: function, tone, reflexes, atrophy

  • Complete LMN
  • Partial LMN
  • Complete UMN
  • Partial UMN

20

Abnormal reflexes (3)

Hyporeflexia/areflexia with LMN lesions

Hyper-reflexia with UMN lesions

Crossed extensor (not present when animal is lying on side)

21

Perineal reflex

Most reliable reflex

Keep in mind that the spinal cord ends around L4-L5 in the dog (why the cauda equina exists)

22

Patella

Best and easiest reflex! 

 

23

Cranial tibial flexor withdrawal

All joints

Sensation

Strength

Crossed?

24

Extensor carpi radialis flexor withdrawal

25

What happens to functionality with an UMN bladder?

Small, reflex incomplete emptying (difficult to express)

Constantly toned = easily palpated

Drugs: Pressessin (alpha blocker), phenoxybenzamine--blocks alpha receptors at sphincter-->dilation

26

What happens to functionality with a LMN bladder?

Markedly dilated, atonic, easily expressed

Very stretched = difficult to palpate

As soon as pressure is applied urine will start spilling out

Drugs: estrogen (?)--adds tone

27

Sensation: pain

  • Superficial = flexor withdrawal
    • withdrawal reflex without pain response = UMN
  • Deep = digit clamping
    • no response = severe damage to spinal cord = poor prognosis
  • Panniculus (PTO)
  • Hyperesthesia 

28

Panniculus reflex

Muscle twitch