Clinical case focusing on the topic of neurological disease. The case aims to highlight commonly presenting neurological concerns and how the similar presenting complaints can represent very different disease processes. The cases are presented in a fashion so that they can be worked through in the same approach a working vet would. The level is intended for pre-veterinary students and veterinary students.
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The Neuro Consult - Understanding Neurological Disease in Animals
1. The Neuro consultThe Neuro consult
Sit back, relax
and lets learn
about
neurology!
Yeah
Baby!
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HistoryHistory
Sausage was walking a
little funny over the
weekend and went off her
back legs completely
yesterday!!
Her right leg is worse than
her left
She yelps when we try to
pick her up
She isn’t herself
Anorexic, lethargic, increased
vocalisations
Sausage 4yo FN
Dachshund
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Neurological ExamNeurological Exam
Mentation
Posture
Spinal
Reflexes
Postural
Reactions
Gait
Cranial
Nerves
Nociception
Palpation
Level of consciousness; (cerebral, brainstem or systemic dz) alert, obtudned, stupor, coma and quality of consciousness; appropriate if inappropriate
(compulsion, delirium)
Head- tilt (vestibular dz) or turn (forebrain dz)
Limbs- wide based stance (proprioceptive loss), narrow based stance (weakness), decreased weight bearing (pain)
Body- decerebrate (FL, HL and neck extended), decerebellate (FL extension, nexk extended, HL flexed), Schiff- Scherrington (rigid FL)
Normal or abnormal?
What limbs affected? Paresis- decreased voluntary movement (UMN or LMN?- asses postural, spinal reflexes and muscle tone)
Ataxia- incoordiantion, sensory (wide based stance, increased stride length, knuckling) or cerebellar ( disorder of rate and range, hypermetria intention or postural
tremor) or vestibular (unilateral or bilateral, cicrling, head tilt, crouched) Lameness? A combination?
Integration of proprioceptive and motor systems
Paw positioning, hopping, wheelbarrowing, hemiwalking, placing tactile, placing visual, extensor postural thrust
Testing: SENSORY, CENTRAL and MOTOR (* UMN indirectly)
Tendon reflexes: biceps musculocutanous C6-8, triceps radial C7-T2, patellar femoral L4-s2, Gastrocnemius sciatic L6-S2
Flexor withdrawal: Thoracic multiple nn C6-T2, pelvic limb sciatic L6-S2
Additional: perineal pudendal S1-S3, Cutaneous trunci
Vision: II optic -> forebrain
Menace response: II-> forebrain-> cerebellum->brainstem->VII Facial
PLR: II->brainstem->III Occulomotor (direct and indirect)
Fundic exam: Optic II
Horner’s Syndrome: miosis, ptosis, enopthalamus (sympathetic denervation)
Strabismus: eye position VIII Vestibulocochlear -> central vestibular/braistem-> III,IV, VI
Nystagmus: eye movement VIII-> CV/brainstem-> III,IV Trochelar, VI
Facial sensation-:V
Palpebral: V-> brainstem -> VII
Corneal: V -> brainstem -> VI Abducent
Muscles of mastication: V
Muscles of facial expression and lacrimal glands: VII
Gag reflex: IX&X -> Brainstem -> IX &X
Motor to tongue: XII Hypoglossal
Light palpation: swelling or atrophy of HEAD, SPINE and LIMBS
Deep palpation: pain perception in HEAD, SPINE and LIMBS
Conscious perception of pain
Superficial: skin
Deep: bone
9. WHY DID WE DO ALLWHY DID WE DO ALL
OF THAT????????OF THAT????????
Neurolocalization
C1-C5
C6-T2
L4-Cd
Cerebellum
FOREBRAI
N
Brainstem
T3-L3
Neuromuscular
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Sausage’s Neuro ExamSausage’s Neuro Exam
Mentation
Posture
Spinal
Reflexes
Postural
Reactions
Gait
Cranial
Nerves
Nociception
Palpation
Level of consciousness: alert quality of consciousness: appropriate
Normal or abnormal? Abnormal
What limbs affected?
Paresis- HL plegia right> left
Integration of proprioceptive and motor systems
Paw positioning, hopping, placing tactile, placing visual- decreased to absent in HLs, right> left
Testing: SENSORY, CENTRAL and MOTOR (* UMN indirectly)
Tendon reflexes: patellar femoral L4-s2 exaggerated response, increased muscle tone to HLs
Flexor withdrawal: pelvic limb sciatic L6-S2 absent
Additional:
Light palpation: pain on palpation of thorcolumbar spine
Conscious perception of pain
Superficial: skin present
Deep: bone present
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PrognosisPrognosis
Dependent on Dx and Function in neurological cases
THE most important prognostic indicator is
perception of deep pain
Good for Sausage
Following surgery very careful and slow return to
normal exercise