Neurologic Examination Flashcards
1
Q
Tools for a neurologic examination
A
- Reflex hammer/Pleximeter
- Hemostat
- Lens
- Light
2
Q
Things to assess when looking at the patient
A
- Mental status (Are they aware?)
- Posture (is head moving independently)
- Gait evaluation (ataxia?)
3
Q
Conscious proprioception - describe how to do. What is normal?
A
- Make sure they’re square
- Flip the feet over, contact the floor, and replace the limb
- DO they have the ability to replace the limb?
- Normal is replacing within 1 sec; compare all 4 legs to each other
4
Q
Conscious proprioception pathway
A
- Goes from the foot to the cortex and efferent motor pathway
5
Q
Where could CP deficits possibly localize?
A
- Foot, leg, spinal cord, brain
6
Q
What are other ways to test conscious proprioception?
A
- Hopping
- Hemiwalking
- Wheelbarrowing
7
Q
What’s the difference between a reflex and a response?
A
- Responses go to the cortex, while reflexes do NOT
8
Q
How many spinal cord segments are there for dogs and cats?
A
- 8 cervical
- 13 thoracic
- 7 lumbar
- 3 sacral
- 5 caudal
9
Q
Thoracic intumescence - which SPINAL CORD segments?
A
- C6, C7, C8, T1, T2
10
Q
Pelvic intumescence, which spinal cord segments?
A
L4, L5, L6, L7, S1
11
Q
How many synapses are in the patellar reflex?
A
- Monosynaptic
12
Q
Which spinal cord segments and nerves are involved in the patellar reflex (i.e. where could the lesion be if there’s an absent or decreased patellar reflex)?
A
- L4-6 spinal cord segments and nerve roots
- Also femoral nerve
13
Q
Femoral nerve function
A
- Innervates the quadriceps for extension of the stifle
14
Q
How many synapses are in the withdrawal reflex in both the forelimb and hindlimb?
A
- Polysynaptic for both
15
Q
Which spinal cord segments and nerves are involved in the withdrawal reflex in the hindlimb (i.e. where could the lesion be if there’s an absent or decreased withdrawal reflex)?
A
- L6-S1
- Sciatic nerve
16
Q
Which spinal cord segments and nerves are involved in the withdrawal reflex in the forelimb (i.e. where could the lesion be if there’s an absent or decreased withdrawal reflex)?
A
- C6-T2
- Multiple nerves
17
Q
Function of sciatic nerve
A
- Innervates muscles for flexion of the limb
18
Q
What does positive deep pain sensation require?
A
- CORTICAL response such as crying, biting, or trying to get away
19
Q
Does intact withdrawal of the hind limb suggest that the patient can feel it?
A
- No
20
Q
When is the only time you need to do deep pain testing?
A
- If there’s no motor in the hind limbs
21
Q
What are the other spinal reflexes that are less reliable but can still be done?
A
- Biceps reflex
- Triceps reflex
- Extensor carpi radialis reflex
- Gastrocnemius reflex
- Cranial tibial reflex
22
Q
Cutaneous trunci reflex - what should you see if it’s intact?
A
- Should see a BILATERAL CONTRACTION
- Travels up bilaterally
23
Q
What is a pinch dermatome?
A
- The area of skin for an individual dorsal root
24
Q
What is being tested with the cutaneous trunci reflex?
A
- Travels up bilaterally and exits at C8-T1
- Both lateral thoracic nerve (C8-T1)
25
CN I
- Which nerve?
- Sensory/Motor/Both
- What does it do?
- Olfactory nerve
- Sensory
- Smell!
26
CN II
- Which nerve?
- Sensory/Motor/Both
- What does it do?
- Optic nerve
- Sensory
- Vision!
27
CN III
- Which nerve?
- Sensory/Motor/Both
- What does it do?*
- Oculomotor nerve
- Motor
- Extraocular muscles: medial, dorsal, ventral rectus; ventral oblique; levator palpebrae; constrict muscles of the pupil (parasympathetic)
28
CN IV
- Which nerve?
- Sensory/Motor/Both
- What does it do?*
- Trochlear nerve
- Motor
- Contralateral dorsal oblique (skeletal muscle)
29
CN V
- Which nerve?
- Sensory/Motor/Both
- What does it do?
- Trigeminal nerve
- BOTH
- See separate flashcard for the different parts
30
CN VI
- Which nerve?
- Sensory/Motor/Both
- What does it do?*
- Abducens nerve
- Motor
- Lateral rectus and retractor bulbi
31
CN VII
- Which nerve?
- Sensory/Motor/Both
- What does it do?
- Facial nerve
- BOTH
- Sensory to middle ear, blood vessels of head; sensory to palate, rostral 2/3 of tongue for taste
- Motor to muscles of facial expression (ears, eyelid - orbicularis oculi, cheeks, lips, rostral digastricus; mandibular/submandibular salivary glands, lacrimal glands***, nasal glands)
32
CN VIII
- Which nerve?
- Sensory/Motor/Both
- What does it do?
- Vestibulocochlear nerve
- Sensory
- Hearing and vestibular system
33
CN IX
- Which nerve?
- Sensory/Motor/Both
- What does it do?
- Glossopharyngeal
- Both
- Sensory to the CAROTID body and sinus; caudal tongue and rostral pharynx
- Motor to pharyngeal muscles (skeletal); zygomatic/parotid salivary lands
34
CN X
- Which nerve?
- Sensory/Motor/Both
- What does it do?
- Vagus
- Both
- Sensory to AORTIC body/sinus, pharynx, larynx, thoracic/abdominal cavity; caudal pharynx and larynx
- Motor to the pharynx, larynx, esophagus; esophagus, organs of the thorax/abdomen
35
CN XI
- Which nerve?
- Sensory/Motor/Both
- What does it do?
- Accessory
- Motor
- Motor to esophagus, organs of thorax and abdomen via parasympathetic by joining the vagus; motor to the pharynx, larynx, esophagus by joining the vagus
- External branch is motor to the trapezius, sternocephalicus, brachicephalicus
36
CN XII
- Which nerve?
- Sensory/Motor/Both
- What does it do?
- Hypoglossal
| - Motor to the tongue (skeletal)
37
Frontal lobe - which cortex?
- Motor cortex
38
Parietal lobe - which cortex?
- Somatosensory cortex
39
Occipital lobe - which cortex?
- Visual cortex
40
Temporal lobe - which cortex?
- Auditory cortex, behavioral cortex
41
Which CN are supratentorial?
- CN I and CN II (olfactory and optic)
42
Which CN are infratentorial?
- CN 3-12
43
An animal comes in with facial paralysis, difficulty swallowing, lateral strabismus - are you thinking supratentorial or infratentorial?
- Thinking infratentorial
44
Where do most CNs exit?
- Through some important holes in the bottom of the skull
45
Mnemonic for CNs
- Some
- Say
- Marry
- Money
- But
- My
- Brother
- Says
- Big
- Brains
- Matter
- More
46
CN I - where are cell bodies? Where do axons enter through?
- Cell bodies in olfactory epithelium of the ethmoid
| - Axons enter through the cribriform plate to reach the olfactory bulb
47
CN II - where are cell bodies? Where do axons enter through?
- Cell bodies in the ganglionic layer of the retina
| - Axon enters the optic canal
48
Pathway of CN II - and at what point does it become contralateral?
- Cell bodies in the ganglionic layer of the retina --> axon enters optic canal --> optic chiasm --> optic tract* --> optic radiation* --> occipital lobe (visual cortex)*
49
What are the three branches of CN V?
- Ophthalmic
- Maxillary
- Mandibular
50
Ophthalmic branch of CN V
- Sensory/Motor/Both
- What does it do?
- Sensory to the eyeball and MEDIAL canthus
51
Maxillary branch of CN V
- Sensory/Motor/Both
- What does it do?
- Sensory to the maxilla
| - Lateral canthus maybe?
52
Mandibular branch of CN V
- Sensory/Motor/Both
- What does it do?
- Sensory to mandible
| - MOTOR to the muscles of mastication (masseter, temporalis, caudal digastricus (skeletal)
53
Which cranial nerve is sensory to the carotid body?
- Glossopharyngeal
54
Which cranial nerve is sensory to the aortic body?
- Vagus
55
Which CNs have parasympathetic function?
- CN III (constricts pupil)
- CN VII (motor to mandibular/submandibular salivary glands, lacrimal glands, and nasal glands)
- CN IX (motor to zygomatic and parotid salivary glands)
- CN X (motor to esophagus, organs of the thorax and abdomen)
- CN XI (joins with vagus)
56
Which nerve is responsible for lacrimal secretions? What is the consequence if this nerve is damaged?
- Facial nerve
| - If it's damaged, the patient may have dry eyes, so you need to make sure that you're providing artificial tears
57
Menace response: Which CN are being tested with the afferent and efferent pathways?
- Afferent: Optic nerve
| - Efferent: Facial nerve (blink)
58
Optic nerve pathway for the menace response (remember it again and indicate which parts of the pathway are contralateral)
- Optic chiasm (ipsilateral)
- Optic tract*
- Thalamus (lateral geniculate)*
- Visual/occipital cortex*
- Motor/frontal cortex*
- Descending tracts (ipsilateral)
- Cerebellar influence (ipsilateral)
- I would draw this out too to help it make more sense
59
What should you check with pupil size?
- That they are symmetrical in normal room light
60
Pupillary light reflex - where should you be testing the reflex?
- In a dark room with a very bright light
61
Afferent and efferent pathways of pupillary light reflex
- Afferent: Optic nerve
| - Efferent: Oculomotor nerve
62
Pathway of optic nerve for PLR
- Indicate which are contralateral
- Optic chiasm
- Optic tract*
- Pretectal area*
63
Does the PLR require a cortical response?
- No
64
What is a positive PLR response that you would expect?
- Bilaterally leads to direct and indirect pupillary constriction
65
Draw out the PLR pathway
- Just do it
66
What is the oculovestibular reflex?
- Doll's eye reflex or physiologic nystagmus
67
Which CN are being tested with oculovestibular reflex?
- CN 8 (vestibular component)
- MLF (Medial longitudinal fasciculus)
- CN 3 (oculomotor nerve)
- CN 4 (trochlear nerve)
- CN 6 - abducent nerve
68
Positive response for ocular sensation
- Third eyelid retracting
| - Feel the eyelid retract, blink, and eye goes up
69
Afferent and efferent pathways for ocular sensation
- Afferent: Trigeminal nerve (CN V - ophthalmic branch)
| - Efferent: Facial nerve (blink) and abducent nerve (eyeball retraction and elevation of the third eyelid)**
70
Afferent and efferent pathways for the palpebral reflex
- Afferent: Trigeminal nerve (CN v) - maxillary and ophthalmic branches
- Efferent: Facial nerve --> blink
71
Which is sensory to medial and lateral canthus for trigeminal nerve branches?
- Medial canthus: ophthalmic branch
| - Lateral canthus: maxillary branch
72
Afferent and efferent pathways for facial reflex
- Afferent: Trigeminal nerve (CN V for ophthalmic/maxillary/mandibular branches)
- Efferent: Facial nerve (CN VII) for blink and twitch
73
What is the facial response? How does it differ from the facial reflex?
- Should have a cortical jerking away response or trying to bite
- Different than twitching which is the facial reflex
74
Facial response afferent and efferent pathways
- Afferent is ophthalmic branch of the trigeminal nerve
| - Descending pathway is to move the head/body away from the stimulus (pull-away response)
75
Facial response afferent pathway and which are contralateral?
- Thalamus*
- Somatosensory/parietal cortex*
- Motor cortex*
76
Which side is damaged if no facial response on the right side?
- Something wrong with the contralateral cortex, i.e. the left side
77
Which CN is responsible for jaw tone?
- Mandibular branch
| - CN V
78
Which nerves responsible for facial symmetry?
- CN V (without it, atrophy of the mandibular muscles like the temporalis muscle, digastricus)
- CN VII (drooping)
79
Which nerves involved in the gag reflex?
- CN 9 and CN 10
80
Which nerve responsible for innervation of the tongue?
- CN 12
81
What are the last parts of the neurologic examination?
- Neck movement
- Spinal palpation
- Rectal examination
82
Describe the perineal reflex
1. Constriction of the anus (anal tone)
| 2. Flexion of the tail
83
Which nerves involved with constriction of the anus with the perineal reflex?
- Pudendal nerve
| - S1-S3
84
Which nerves involved in flexion of the tail for the spinal cord reflex?
- Caudal spinal cord segments
85
What does a positive response for deep pain sensation look like?
- CORTICAL response such as crying, biting or trying to get away
86
Who do you test deep pain sensation in?
- Paralyzed patients only
87
Prognosis for deep pain negative?
- Poor prognosis for recovery
88
Supratentorial brain regions?
- Cerebral hemisphere
- Thalamus
- Pituitary
89
Infratentorial brain regions?
- Cerebellum
| - Brainstem
90
What are the spinal cord segments?
- C1-C5
- C6-T2
- T3-L3
- L4-S3
- Caudal
91
What are clinical signs in the thoracic limbs if you have a lesion cranial to the thoracic intumescence?
- UMN signs (i.e. hypermetria, decreased CPs, normal to increased reflexes)
92
What are clinical signs in the thoracic limbs if you have a lesion at the thoracic intumescence?
- LMN signs (i.e. decreased withdrawal reflexes, decreased CPs)
93
What makes up the lower motor neuron unit?
- Spinal cord segments (C6-T2, L4-sacral)
- Peripheral nerves - afferent and efferent
- Neuromuscular junction
- Muscle (effector organ)
94
What are the parts of the PNS with the LMN?
- Peripheral afferent and efferent nerves
- Neuromuscular junction
- Muscle (effector organ)
95
What are the CNS parts of the lower motor neuron unit?
- Spinal cord segments (i.e. C6-T2, L4-sacral)
96
UMN signs
- Reflexes
- Muscle tone
- Type of atrophy
- NORMAL to increased spinal REFLEXES
- Normal to increased muscle tone
- Disuse muscle atrophy
97
LMN signs
- Reflexes
- Muscle tone
- Type of atrophy
- Decreased to absent spinal reflexes
- Decreased to absent muscle tone
- Neurogenic muscle atrophy
98
How long does it take to have disuse muscle atrophy?
- Slowly over time
99
How long does it take to have neurogenic muscle atrophy?
- within 7-10 days (VERY ACUTE)
- Limbs are completely atrophied
- If muscle isn't working, it's LMN
100
How long does primary myopathic atrophy take?
- Variable amount of time
101
Clinical signs in thoracic limbs and pelvic limbs if lesion is in the brain?
- UMN to both
102
Clinical signs in thoracic limbs and pelvic limbs if lesion is in C1-C5?
- Thoracic: UMN
| - Pelvic: UMN
103
Clinical signs in thoracic limbs and pelvic limbs if lesion is in C6-T2?
- Thoracic: LMN
| - Pelvic: UMN
104
Clinical signs in thoracic limbs and pelvic limbs if lesion is in T3-L3?
- Thoracic: normal
| - Pelvic: UMN
105
Clinical signs in thoracic limbs and pelvic limbs if lesion is in L4-S1/3?
Thoracic limbs: Normal
Pelvic limbs: LMN
106
Case:
CP deficits in both pelvic limbs
Normal patellar reflexes bilaterally
Normal withdrawal reflexes bilaterally
Lesion is where?
- T3-L3
- UMN problem to pelvis
Tone is normal to increased
Disuse atrophy
107
Case:
CP deficits to both pelvic limbs
Decreased patellar reflexes bilaterally
Decreased withdrawal reflexes bilaterally?
- LMN problem to pelvis
- L4-S1 or
bilateral femoral and sciatic nerves
- Tone is decreased to absent
- neurogenic atrophy
108
Case:
CP deficits to both pelvic limbs
Decreased patellar reflexes bilaterally
Normal withdrawal reflexes
L4-L6 or femoral nerve bilaterally
109
Case:
CP deficits to both pelvic limbs
Increased patellar reflexes bilaterally
Absent withdrawal reflexes bilaterally
- Bilateral sciatic nerve OR
| - CNS lesion at L6-S1
110
Why increased patellar reflexes with sciatic nerve deficits or lesion at L6-S1?
- UMN --> T3-L3
OR Pseudohyperreflexia
111
Describe pseudohyperreflexia?
- Due to loss of antagonistic muscles from lack of sciatic/L6-S1 function
112
Case:
- CP deficits to all four limbs
- Normal spinal reflexes in all four limbs
- Brain (infratentorial or supratnetorial) or C1-C5
| - Likely C1-C5 if no mentation changes or CN deficits
113
Case:
- CP deficits to all four limbs
- Normal spinal reflexes to the pelvic limbs
- Decreased withdrawal reflexes in the thoracic limbs
- C6-T2
114
Case:
CP deficits to all four limbs
Decreased patellar and withdrawal reflexes in the pelvic limbs
Decreased withdrawal reflexes in the thoracic limbs
- Diffuse LMN
- Either C6-T2 and L4-S1 OR
- ALl the peripheral nerves within the limbs
115
What is the name for all the peripheral limbs being affected?
- Polyneuropathy
