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Module 16-21 Spinal conditions, surgery > Neurological examination > Flashcards

Neurological examination Flashcards

1
Q

Why is neurolocalisation important prior to imaging diagnostics?

A

Clinically non-relevant findings might be picked up with advanced imaging (CT, MRI) - thus neurolocalization is key

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2
Q

What three postures are important to be able to differentiate?

A

Schiff-sherrington
Decerebrate rigidity
Decerebellate rigidity

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3
Q

What is ataxia?

A

A lack of coordination

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4
Q

What is paresis?

A

A weakness or inability to generate movement voluntarily

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5
Q

What does proprioception refer to?

A

Awareness of the position and movement of the head, body and limbs

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6
Q

Examples of systemic disease that can present neurological?

A

Aortic thromboembolism
Addison’s disease
Lymphoma

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7
Q

What are the 6 sections of a neurological exam?

A
  1. mentation
  2. gait evaluation
  3. proprioceptive testing
  4. segmental spinal reflexes
  5. sensorium
  6. cranial nerve examination
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8
Q

How can you classify the mental status?

A

Normal
Obtunded
Disoriented
Stuporous
Comatose

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9
Q

What does Schiff-Sherrington look like?

A

T2-L2 lesion
Normal mentation, no opistotonus
Forelimbs: Extensor rigidity
Hindlimbs: Flaccid

Prognosis: grave (without tx)

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10
Q

What does decerebellate posture look like?

A

Injury to the cerebellum
Obtunded or depressed
Opistothonus
Forelimbs: Extention
Hindlimbs: Active flexion

Prognosis: Guarded

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11
Q

What does decerebrate posture look like?

A

Injury to cerebrum
Obtunded
Opisthotonus
Forelimbs: Extensor ridigity
Hindlimbs: Extensor ridigity

Prognosis: Grave

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12
Q

What types of ataxia are there?

A

1) Propriceptive/sensory ataxia
2) Vestibular ataxia
3) Cerebellar ataxia

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13
Q

What is typical for proprioceptive ataxia?

A

A loss of awareness of where the limbs are in space

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14
Q

What is typical for vestibular ataxia?

A

Loss of balance - head tilt, and a tendency to lean, drift, fall or roll to one side

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15
Q

What is typical for cerebellar ataxia?

A

inability to modulate the gait generating systems in the brain resulting in abnormal “uncontrolled” limb movements
–> Hypermetria

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16
Q

Paresis?

A

weakness or inability to generate movement voluntarily - implies SOME movement

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17
Q

Plegi?

A

Inability to generate any movement - complete loss of voluntary movement

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18
Q

Tetra-plegi/pares?
Hemi-plegi/pares?
Para-plegi/pares?
Mono-plegi/pares?

A

Tetra - all four
Hemi - one side (right or left, front and hind)
Para - hindlimbs
Mono - one limb

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19
Q

UMN vs LMN signs?

A
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20
Q

Proprioceptive tests?

A

Paw positioning
Hopping
placing and visual placing
Wheel barrowing
Extensor postural trust
Hemiwalking
Paper sliding test

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21
Q

What are the 6 neuroanatomical locations?

A

Brain
C1-C5
C6-T2
T3-L3
L7-S3
Peripheral

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22
Q

What are the 4 spinal cord localisations?

A

C1-C5 Cranial cervical
C6-T2 Cervicothoracic intumescence
T3-L3 Thoracolumbar
L7-S3 Lumbosacral

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23
Q

Reflexes and corresponding neuro-anatomical localisation?

A
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24
Q

Which vertebrae corresponds to their spinal segment?

A

C1
C2
L1
L2

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25
Q

Where does the spinal cord end?

A

L5-L6, after this - cauda equinae

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26
Q

What are reliable reflexes of the thoracic vertebrae?

A

Withdrawal reflex - evaluation of the cervical intumescence and brachial plexus nerves

Extensor carpi radialis: evaluation of the caudal cervical intumescence (C7-T2 and radial nerve)

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27
Q

What are reliable reflexes of the pelvis limb?

A

Patellar reflex - evaluation of L4-L6 spinal cord segment and femoral nerve

Perineal reflex - evaluation of S1-Cd5 and pudendal nerve

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28
Q

What does evaluation of the sensorium rely on?

A

Spinal palpation
Nociception testive

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29
Q

How is nociception evaluated?

A

By conscious response of the patient to a painful stimulus

NB! Do not mix with withdrawal! Ensure the patient shows response to painful stimulus! (e.g. vocalization, turning of head, licking lips etc)

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30
Q

What are the four steps of nociception?

A

Transduction
Transmission
Modulation
Perception

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31
Q

Which tract sends pain signals?

A

Spinothalamic

32
Q

What are the three degrees of axonal injury?

A

1) Neurotmesis - poor prognosis
2) Axonotmesis - possible recovery, very slow
3) Neurapraxia - recovery within 1-5 weeksa

33
Q

What is neurotmesis?

A

Result of complete damage to the nerve, including axon, Svchwann cells and surrounding connective tissue.

Poor prognosis, regeneration of nerve almost impossible

34
Q

What is axonotmesis?

A

Damage to the axon with preservation of endoneurium and the surrounding myelin sheath produced by the Schwann cells.

Regneration of the axon is possible if not damage is too extensive, however regeneration is very slow.

35
Q

What is Neurapraxia?

A

Interruption of the nerve conduction with no damage to the nerve. It is normally due to demyelination, with an undamaged axon, due to compression or transient lack of blood supply (= nerve shock, spinal chock)

Recovery is complete between 1 and 5 weeks

36
Q

VITAMIN D?

A

V - Vascular
I - Inflammatory
T- Toxic/traumatic
A - Anomalous
M - Metabolic
I - Idiopathic
N- neoplastic
D - degenerative

37
Q

Clinical signs caused by C1-C5 spinal cord segment lesions?

A
38
Q

Clinical signs caused by C6-T2 spinal cord segment lesions?

A
39
Q

Clinical signs caused by T3-L3 spinal cord segment lesions?

A
40
Q

Clinical signs caused by L4-S2 spinal cord segment lesions?

A
41
Q

Clinical signs caused by cerebral lesions?

A
42
Q

Diseases associated with cerebral syndrome?

A

Degenerative
- Alaskan husky encephalopathy
- dalmatian leukodystrophy
- spongy degeneration in gray matter (salukis)
- encephalomyelopathy and organic acidopathies
- yorkshire terrier encephalopathy
Developmental
- Lissencephaly, hydranencephaly, meningoencephalocele, hydrocephalus
Endogenous metabolic
- DM, HE, hypernatraemia, hypoglycemia, hyponatremia, hypothyroidism, uremic encephalopathy, acidosis, alkalosis, hyperthyroidism, hypophostphataemia, hypercalcaemia
Inflammatory
- infectious, non-infectious
Neoplasia
- Meningioma, glioma, metastatic disease
Neurovascular
- cyanogenic plants, ethylene glycol toxicity, lead poisoning, methionine, metoclopramide
Neurovascular disorders
- haemorhagic and non-haemorrhagic stroke, hypoxia
Nutritional disorders - thiamine deficiency
Storage disorders - ceroidlipofuschinosis, fuscidosis, gangliodosis, globoid leukodystrophy
Traumatic - head trauma

43
Q

Cerebellar syndrome?

A
44
Q

Brainstem syndrome?

A
45
Q

Diseases associated with brainstem syndrome?

A

Degenerative: Alaskan husky encephalopathy, fibrinoidleukodystrophy
Developmental: Chiarli malformations; intracranial intra-arachnoid cysts, hydrocephalus
Inflammatory: Infectious, non-infectious
Neoplasia: Meningioma
Neurovascular: Haemorrhagic, non haemorrhagic stroke
Nutritional: Thiamine deficiency
Storage disorders: Fucosidosis, globoid leukodystrophy
Trauma: head trauma

46
Q

Vestibular syndrome - peripheral vs central?

A
47
Q

Diseases associated with vestibular syndrome?

A

Degenerative: Idiopathic vestibular disease, multisystem neuronal abiotrphy
Developmental: Congenital vestibular dissease, Dandy-Walker syndrome, intracranial intra-arachnoid systs
Endogenous/metabolic: Hypothyroidism
Inflammatory: Infectious (abscess, neospora, FIB; otitis media, interna), non-infectious
Neoplasia: Malformation tumours, medulloblastomas
Neurotoxic: AMinog, metronidazole
Neurovascular: Stroke
Nutritional: Thiamine deficiency
Storage: Galactosialidsis
Trauma: Head trauma

48
Q

Clinical signs caused by neuromuscular lesions?

A
49
Q

Degenerative disorders associated with spinal syndrome?

A

Degerative muelopathy
Afghan hound myelopathy
Motor neuron disease in German Shepherds
Heredityar polioencephaloyelopathy in the Australian cattle dog
Hereditary Ataxia
Kooiker dog myelopathy
Labrador retriever axonoathy
Rottweiler leukoencephalomyelopathy

50
Q

Degenerative and structural compressive spinal disorders?

A

Calcinosis circumscripta/tumoral calcinosis
Cervical spondylomyelopathy
Intervertebral disc disease
Dural ossification
Osteochondromatosis
Spinal synovial cysts

51
Q

Developmental spinal disorders?

A

Arachnoid cysts
Atlantoaxial subluxation
Shiari malformations
Dermoid sinus
Syringomyelia and hydromelia
Spina bifida
Infectious (e.g. toxoplasma, neospora, rabies)
Non-infectious (Meningomyelitis)

52
Q

Other spinal disorders?
Inflammatory
Neoplastic
Neurovascular
Nutritional
Storage
Trauma

A

Inflammatory
- Infectious (e.g abscess FIP, neospora, otitis interna)
- non-infectious
Neoplastic - meningioma, ependymoma, peripheral nerve sheath
Neurovascular: Ischaemic myelopathy and haemorrhagic myelopathy
Nutritional - Hypervitaminosis A
Storage - globoid leukodystrophy, mucopolysaccharidosis type I/VI
Trauma - spinal trauma, brachial plexus avulsion

53
Q

Differential diagnosis with neuromuscular lesions?

A

Metabolic
- electrolyte
- haematological
- endocrine
- misc
Muscular
- infectious, non infectious
Junctionopathy
- myasthenia gravis
Neuropathy
- breed specific
- laryngeal paralysis
polyneuropathy
Aortic thromboembolism

54
Q

Radiography in neurodiagnostics?

A
  • great survey when trauma patient
  • can diagnosie disckospondylitis bone neoplasia and vertebral anomalies

Care when interpreting - couple with clinical signs

55
Q

What can be seen on this radiograph?

A

Atlantoaxial subluxation

56
Q

What is myelography?

A

Survey radiographs of the spinal cord after injection of contrast material

57
Q

Where can you inject contract material when performing myelography?

A

Cisterna Magna
L5-L6
L6-L7

58
Q

What should be performed prior to myelography?

A

Plain radiographs
CSF

59
Q

What is the dosage of contrast when performing a myelography?

A

0,2-0,3ml/kg

Given slowly (rapid -> bradycardia!)

60
Q

What can be the localisation when finding spinal cord lesions?

A

Extradural

Intradural, extramedullary

Intramedullary

61
Q

Examples of extradural lesions?

A

-> cause deviation of contrast column
Intervertebral disc disease
Fractures
Subluxation
Neoplasia

62
Q

Examples of Intradural - extramedullary lesions?

A

-> Golf tee sign
Arachnoid cysts
Meningioma
Nerve root tumours

63
Q

Examples of intradural - intramedullary lesions?

A

-> may be unremarkable myelogram, may show divergence of the dorsal and ventral contrast column
Glioma
Muelitis
Ischaemic myelopathy

64
Q

What can CT be used for investigation of?

A

Fractures
Tympanic bullae
Bone neoplasia
Hemorrhage
Surgical planning

With myelogram: -> spinal cord lesions

65
Q

What is the dose of contrast medial used for CT myelogram?

A

0,2-0,3ml/kg, but DILUTED to 1/10

66
Q

What is MRI preferred for?

A

Evaluation of the brain. spinal cord and peripheral nerves

67
Q

What can ultrasonography be used for in neurology?

A

Hydrocephalus
Soft tissue masses (e-g. in brachial plexus)
Intraoperative identification of intramedullary lesions
Postoperative to check for remaining disc material after hemilaminectomy

68
Q

how can scintigraphy be useful?

A

A radiopharmaceutical agent is injected to highlight areas where the blood-brain barrier has broken down or fails to exclude the injected radionucleotide
Lesions shows up as hot spots

69
Q

Where should you collect CSF from?

A

Caudal to or anatomically close to the suscpected lesion

70
Q

How to interpret CSF in case of blood contamination?

A

Protein: for every 1000 RBC -> Adjust protein down 1mg/dL

Leucocytes: For every 500 RBC -> leukocyte can be adjusted down by 1WBC/uL

71
Q

Interpretation of CSF?

A

Macroscopic: Clear
Protein: <25 and <40mg/dL (cisterna magna, lumbal)
RBC: 0
WBC: <5WBC/uL

72
Q

What is increased protein with normal cell count in CSF called?

A

Albuminocytological disassociation

Caused by:
- secondary to alterered BBB
- increased production in the CNS
- obstruction of outflow

73
Q

Differential cell counts in CSF?

A

Lymphocytic pleocytosis - lymphona, necrotizing non-suppurative meningoencephalitis ++

Mixed cell pleocytosis - GME, fungal and protozoal disease ++

Neutrophilic pleocytosis - STMA, bacterial meningitis, post-myelogram

Eosinophilic pleocytosis - parasitic or idiopathic pathology

74
Q

Other tests of CSF?

A

PCR can be performen in case of infectious aetiology suspected:
- Canine distemper, neospora, toxoplasma (dog)
- Toxoplasma, Coronavirus (cat)

Aerob/anaerob culture usually negative

75
Q

What electrodiagnostic tests can we perform?

A

Electromyography - assessing muscle activity
- cannot differentiate primary myopathy or denervation causing myopathy
Nerve conduction velocity - nerve conduction, ulnar or sciatic
- can differentiate between axonopathy and demyelinization
Repetitive nerve stimulation - neuromuscular junction
- in cases of Myasthenia -> signals drop when test repeated
F-waves - proximal part of peripheral nerves, nerve root
- useful in suspected foraminal stenosis, trauma to plexus, polyradiculoneuritis

Module 16-21 Spinal conditions, surgery (18 decks)

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