The Neurologic Exam

Daniel Cuff, DVM, DACVIM (Neurology) Bush Veterinary Neurology Service Rockville, MD

The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain

What’s The Goal?

• Localization

The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception

Mental Status

• Alert • Depressed • Obtunded (drowsy but arousable) • Stuporous (sleep state but arousable) • Comatose (cannot be aroused, even with pain) • Dementia / Delirium

The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain

Posture

• Position of head and body with respect to gravity

• Examples: • Wide-base stance • Decerebrate rigidity • Decerebellate rigidity • Opisthotonus • Schiff-Sherrington

Decerebrate Rigidity

Decerebellate Rigidity

Schiff-Sherrington

11

The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain

Gait

• Lameness • Ataxia

• Spinal ataxia • Cerebellar ataxia • Vestibular ataxia

• Paresis / Paralysis

The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain

Postural reactions

• Proprioceptive positioning • Placing • Hopping • Hemi-walking • Wheelbarrowing • Extensor postural thrust

The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • CN • Spinal reflexes • Nociception / pain

Cranial nerves

I Olfactory II Optic III Oculomotor IV Trochlear V Trigeminal VI Abducent

VII Facial VIII Vestibulochlear IX Glossopharyngeal X Vagus XI Accesory XII Hypoglossal

Optic Nerve (CN II)

• Vision • Menace response

• PLR • Directed and indirect • Anisocoria

Oculomotor (CN III)

• PLR • Anisocoria • Ventrolateral strabismus

Trochlear (CN IV)

• Motor to dorsal oblique muscle of the eye • Ventromedial strabismus

Trigeminal (CN V)

• Sensory • Ophthalmic – medial canthus • Maxillary – lateral canthus • Mandibular – lower lip

• Motor • Muscles of mastication

• Symmetry of masseter and temporalis muscles

Facial (CN VII)

• Muscles of facial expression • Lip droop • Ear droop • Palpebral reflex

• Schirmer tear test

Vestibulocochlear (CN VIII)

• Sensory for vestibular inputs and hearing • Head tilt • Ataxia, falling, rolling • Nystagmus • Positional strabismus • Loss of hearing

Vestibulocochlear (CN VIII)

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Vestibulocochlear (CN VIII)

25

Glossopharyngeal (CN IX) and Vagus (CN X)

• Muscles of larynx and pharynx • Loss of gag reflex • Dysphagia • Regurgitation • Voice change • Stridor

Accessory (CN XI)

• Motor to trapezius muscle • Atrophy

Hypoglossal (XII)

• Innervates muscles of the tongue • Abnormal prehension of food • Hanging from side of mouth • Loss of tone • Atrophy

The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception

Spinal reflexes

• Differentiate between UMN and LMN

The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain

Nociception

• Superficial pain (skin) • Deep pain (bone)

The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain

What’s The Goal?

• Localization