The Deconstructed Neurological Examination Marguerite Knipe, DVM, Diplomate ACVIM (Neurology) I. MENTATION: Normal, Quiet, Obtunded (mild, moderate, severe), Stuporous, Comatose Define stuporous and comatose. If an animal has abnormal mentation, which of the 3 main divisions of the brain (cerebrum, cerebellum, brainstem) may be involved, and why would a lesion in that region cause abnormal mentation? II. GAIT/CONFORMATION: Normal, Ataxia, Ambulatory, Non-ambulatory, Paresis, Paralysis, Hypermetria, Lameness, Other abnormalities of gait; Orthopedic abnormalities. Define paresis: Define paralysis: Define para-, tetra-, and hemi-paresis:
III. CRANIAL NERVES: I Olfactory II Optic III Oculomotor IV Trochlear V Trigeminal VI Abducens VII Facial VIII Vestibulocochlear IX Glossopharyngeal X Vagus XI Spinal Accessory XII Hypoglossal Cranial Nerve Examination: Menace Response: Why is the menace a response and not a reflex? What other brain structures are involved in the menace response (for this example, specifically of the right eye)? Pupillary Light Reflexes (PLRs): What region (be specific!) of the brain mediates the PLRs? Monitoring the PLRs is frequently done to evaluate a patient for evidence of increased intracranial pressure, and/or cerebral herniation. Why?
Trigeminofacial Reflexes (Palpebral, Vibrissae, Lip-pinch): Close Window to return to IVIS Corneal Reflex: Name the 3 branches of the trigeminal nerve, and whether they are sensory and/or motor. Nystagmus: Physiologic (normal): Spontaneous: Abnormal nystagmus is named for which phase (fast, slow)? In MOST cases, does nystagmus goes towards or away from the lesion? Strabismus: What is the difference between strabismus from vestibular disease and strabismus from a lesion involving one of the cranial nerves to the extraocular muscles?
Gag Reflex: List the cranial nerves that have parasympathetic function. IV. SPINAL (SEGMENTAL) REFLEXES: Describe the differences between upper and lower motor neuron signs (reflexes, tone, speed of atrophy). UMN: LMN: Pelvic Limb: Patellar Reflex: Spinal cord segments: Gastrocnemius Reflex: Spinal cord segments: Withdrawal Reflex: Spinal cord segments: Thoracic Limb: Biceps Reflex: Triceps Reflex: Panniculus Reflex: Spinal cord segments for efferent: Perineal Reflex:
List all the possible locations for a lesion that would cause UMN signs to all four limbs. V. PROPRIOCEPTIVE PLACING: List all the possible locations for a lesion that would cause proprioceptive deficits in all four limbs. VI. SPINAL PALPATION: Head, Bullae, Cervical, Thoracolumbar, Lumbosacral, Tail VII. PAIN PERCEPTION: What would be an indication to test pain perception? What structures are you pinching when you test superficial pain? Deep pain? What are you looking for to see if pain perception is present? Two Questions: 1. Neurologically normal or abnormal? 2. Where is the lesion? Brain, Spinal cord, Neuromuscular? Brain: List all possible clinical signs you could see with lesions in the following brain divisions. Cerebrum: Cerebellum: Brainstem:
Spinal Cord: List the clinical signs you may see with lesions in each of the divisions of the spinal cord. Be sure to specify whether you would see UMN or LMN signs, paresis or paralysis, and proprioceptive deficits. C1-5: C6-T2: T3-L3: L4-S3 (Cd): Neuromuscular (Motor Unit): List the clinical signs you may see with generalized neuromuscular disease. List the major subdivisions of neuromuscular disease.