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Flashcards in The Neurological Exam Deck (48):
1

What is necessary when performing the neurological exam?

Understanding of what each test is determining
Master each technique and interpretation of the results of that technique

2

What are the possible locations of lesions?

In the brain = forebrain, brainsterm and cerebellum
In the spinal cord = C1-5, C6-T2, T3-L3, L4-Cd
Neuromuscular

3

What is the aim of the neurological exam?

To determine if the animal is neurologically normal/abnormal and localise the lesion

4

What are the tools required to perform the neurological exam?

Room, chair, yoga mat, reflex hammer, haemostats, Q-tips, cotton balls, penlight, lens

5

What are the steps of the neurological exam?

Mentation, Posture, Gait, Postural reactions, Spinal reflexes, Cranial reflexes, Palpation, Nociception

6

How do you assess mentation?

Level and quality of consciousness

7

What spectrum is consciousness assessed on?

Alert, obtundation, stupor/semicoma or coma

8

What different elements of posture are assessed?

The head, the limbs and the body

9

What are the two abnormal postures of the head and what do they indicate?

Tilt = vestibular disease
Turn = forebrain disease

10

What can limb posture tell you about neurological disease?

Wide based stance = proprioceptive loss
Narrow based stance = weakness
Decreased weight bearing = pain

11

What is a decerebrate posture?

Involuntary extension of upper extremities
Head arched backwards, front legs extended, back legs extended behind animal, no mentation

12

What is a decerebellate posture?

Neck and forelimbs extended, hindlimbs flexed, mentation ok

13

What is a Schiff-Scherrington posture?

Forelimbs rigid, hindlimbs flexed, mentation ok, spinal lesion at T3-L3

14

Why is gait analysis useful to assess?

Requires the integration of proprioceptive and motor systems

15

What do you need to ask when assessing gait?

Normal/abnormal
Which limb/limbs are affected?
Paresis/ataxia/lameness/combination

16

What is paresis?

Decreased voluntary movement

17

How do you differentiate between UMN and LMN paresis?

By assessing postural reaction, spinal reflexes and muscle tone

18

What does UMN paresis look like?

Muscle tone and spinal reflexes are normal to increased in limbs caudal to the lesion
Stride length is normal to increased but can be spastic
+/- ataxia

19

What is the clinical appearance of LMN?

Muscle tone and spinal reflexes are decreased in limbs with a reflex arc containing the lesion
Stride length is normal to decreased, stiff, bunny hopping +/- collapse

20

What is the definition of ataxia?

Incoordination

21

What are the three different types of ataxia?

Sensory, cerebellar or vestibular ataxia

22

What is sensory ataxia and how does it appear clinically?

Loss of sense of limb/body position
Wide based stance, increased stride length, swaying/floating gait, knuckling

23

What is cerebellar ataxia and how does it appear clinically?

Disorder of rate and range of movement
Hypermetria, intention tremor, postural tremor

24

What is the appearance of vestibular ataxia

Unilateral = falling/leaning/circling to one side and head tilt
Bilateral = wide excursions of the head, +/- head tilt and crouched posture

25

What postural reactions are tested?

Paw positioning, hopping, wheelbarrowing, hemiwalking, placing and extensor postural thrust

26

What tendon reflexes are tested and where do they originate?

Biceps (C6-8), triceps (C7-T2), patellar (L4-6) and gastrocnemius (L6-S2)

27

Where do the flexor reflexes for the thoracic and pelvic limbs originate?

Thoracic = C6-T2
Pelvic = L6-S2

28

What can cause decreased to absent spinal reflexes?

Lesion within reflex arc
Physical limitation due to joint fibrosis/muscle contracture
Excitement/fear as muscles will have more tone
Spinal shock

29

What can cause exaggerated reflexes?

Lesion to UMN pathways cranial to the spinal cord segments tested
Excitement/fear as muscles will have more tone
Pseudohyperreflexia due to loss of antagonism

30

How do you test the optic nerve (CN II)?

Vision (obstacle course)
Menace response
PLR
Fundic examination

31

How do you test the function of CN III (oculomotor)?

PLR

32

How do you assess CN III, IV and VI?

Look for strabismus (eye position) and nystagmus (eye movement)

33

How do you assess CN V?

Facial sensation
Palpebral and corneal reflex
Tone of muscles of mastication

34

How do you assess CN VII?

Signs of facial paresis/paralysis/asymmetry
Palpebral reflex
Menace response
Schrimer tear test as autonomic innervation of lacrimal gland

35

How can you assess the function of CN VIII?

Cochlear branch by hearing
Vestibular = ataxia/head tilt, strabismus/nystagmus

36

How do you assess CN IX and X?

Gag reflex

37

How do you assess the function of CN XII?

Paresis/paralysis of the tongue, tongue atrophy/asymmetry, deviation of the tongue

38

What is light palpation used to detect?

Swelling or atrophy

39

What is deep palpation used to asses?

Pain

40

How do you assess different types of pain?

Perception of pain is in the forebrain
Superficial pain is the skin and deep pain is bone

41

Does limb withdrawal indicate pain?

No as withdrawal can still occur without pain detected as the reflex arc only hits the spinal cord and pain requires forebrain perception

42

What nerves could be affected if the menace response is negative?

II or VII

43

What nerves could be affected if the PLR is negative?

II or III

44

What nerves are affected if strabismus is present?

III, IV or VI

45

What nerves are affected if there is spontaneous nystagmus or absence of physiological nystagmus?

III, IV, VI or VIII

46

What nerves are affected if there is no palpebral reflex?

V or VII

47

What nerves are affected if there is no corneal reflex?

V or VI

48

What nerves are affected if there is no gag reflex?

IX or X