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NOSS > The Neurological Exam > Flashcards

The Neurological Exam Flashcards

1
Q

What is necessary when performing the neurological exam?

A

Understanding of what each test is determining

Master each technique and interpretation of the results of that technique

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2
Q

What are the possible locations of lesions?

A

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

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3
Q

What is the aim of the neurological exam?

A

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

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4
Q

What are the tools required to perform the neurological exam?

A

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

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5
Q

What are the steps of the neurological exam?

A

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

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6
Q

How do you assess mentation?

A

Level and quality of consciousness

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7
Q

What spectrum is consciousness assessed on?

A

Alert, obtundation, stupor/semicoma or coma

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8
Q

What different elements of posture are assessed?

A

The head, the limbs and the body

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9
Q

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

A 
Tilt = vestibular disease
Turn = forebrain disease
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10
Q

What can limb posture tell you about neurological disease?

A

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

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11
Q

What is a decerebrate posture?

A

Involuntary extension of upper extremities

Head arched backwards, front legs extended, back legs extended behind animal, no mentation

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12
Q

What is a decerebellate posture?

A

Neck and forelimbs extended, hindlimbs flexed, mentation ok

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13
Q

What is a Schiff-Scherrington posture?

A

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

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14
Q

Why is gait analysis useful to assess?

A

Requires the integration of proprioceptive and motor systems

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15
Q

What do you need to ask when assessing gait?

A

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

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16
Q

What is paresis?

A

Decreased voluntary movement

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17
Q

How do you differentiate between UMN and LMN paresis?

A

By assessing postural reaction, spinal reflexes and muscle tone

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18
Q

What does UMN paresis look like?

A

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

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19
Q

What is the clinical appearance of LMN?

A

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

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20
Q

What is the definition of ataxia?

A

Incoordination

21
Q

What are the three different types of ataxia?

A

Sensory, cerebellar or vestibular ataxia

22
Q

What is sensory ataxia and how does it appear clinically?

A

Loss of sense of limb/body position

Wide based stance, increased stride length, swaying/floating gait, knuckling

23
Q

What is cerebellar ataxia and how does it appear clinically?

A

Disorder of rate and range of movement

Hypermetria, intention tremor, postural tremor

24
Q

What is the appearance of vestibular ataxia

A 
Unilateral = falling/leaning/circling to one side and head tilt
Bilateral = wide excursions of the head, +/- head tilt and crouched posture
25
Q

What postural reactions are tested?

A

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

26
Q

What tendon reflexes are tested and where do they originate?

A

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

27
Q

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

A 
Thoracic = C6-T2
Pelvic = L6-S2
28
Q

What can cause decreased to absent spinal reflexes?

A

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

29
Q

What can cause exaggerated reflexes?

A

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
Q

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

A

Vision (obstacle course)
Menace response
PLR
Fundic examination

31
Q

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

A

PLR

32
Q

How do you assess CN III, IV and VI?

A

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

33
Q

How do you assess CN V?

A

Facial sensation
Palpebral and corneal reflex
Tone of muscles of mastication

34
Q

How do you assess CN VII?

A

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

35
Q

How can you assess the function of CN VIII?

A

Cochlear branch by hearing

Vestibular = ataxia/head tilt, strabismus/nystagmus

36
Q

How do you assess CN IX and X?

A

Gag reflex

37
Q

How do you assess the function of CN XII?

A

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

38
Q

What is light palpation used to detect?

A

Swelling or atrophy

39
Q

What is deep palpation used to asses?

A

Pain

40
Q

How do you assess different types of pain?

A

Perception of pain is in the forebrain

Superficial pain is the skin and deep pain is bone

41
Q

Does limb withdrawal indicate pain?

A

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

42
Q

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

A

II or VII

43
Q

What nerves could be affected if the PLR is negative?

A

II or III

44
Q

What nerves are affected if strabismus is present?

A

III, IV or VI

45
Q

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

A

III, IV, VI or VIII

46
Q

What nerves are affected if there is no palpebral reflex?

A

V or VII

47
Q

What nerves are affected if there is no corneal reflex?

A

V or VI

48
Q

What nerves are affected if there is no gag reflex?

A

IX or X

NOSS (27 decks)

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