The Neurologic Examination - Detecting neurological diseases and deficiencies starts with a thorough examination

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Drs Carolyn Nye and Mark Troxel, DACVIM (Neurology), take you through all its aspects. Review the intricacies of the neurologic exam from assessment of mental status, to gait analysis, to muscle tone.

There are 5 main sections of the neurologic examination: mental status, gait analysis and body posture, cranial nerves, postural reactions, and spinal and withdrawal reflexes. There are several additional tests that do not fall into these categories, such as assessment of muscle tone and muscle atrophy, perineal reflex, and cutaneus trunci reflex and evaluation for nociception and neck and/or back pain. As with a general physical examination, the neurologic examination should be conducted the same way every time to develop a routine and prevent errors. Using a neurologic examination form is strongly recommended.

Mental status

The patient’s mental status should be assessed during history-taking and throughout the appointment. The patient should be alert and responsive at all times. The patient’s interactions with humans and its environment should be noted, including:

  • Whether the patient is fully alert and responsive
  • Whether the patient has difficulty navigating corners or tight spaces
  • Whether the patient walks in circles
  • Whether the patient responds to its name

 

Gait analysis and body posture

Analysis of gait and body posture early in the examination is especially important in cats that are nervous or stressed, as they may refuse to walk later if gait is analyzed after the hands-on portion. Dogs should be walked on a short leash away from, toward, and in profile to the observer, ideally on a surface with good traction (eg, concrete, grass, nonslip floors). The gait should be observed for signs of weakness (paresis) or paralysis (plegia), ataxia, and lameness. When describing the gait, first identify whether the patient is ambulatory or nonambulatory, then identify which limbs are affected and the degree of weakness. For instance, a dog with nonambulatory paraparesis is too weak to walk on its own but retains voluntary motor function in the pelvic limbs and is normal in the thoracic limbs. The patient should be evaluated for ataxia (ie, incoordination). There are 3 types of ataxia: proprioceptive, cerebellar, and vestibular. Proprioceptive ataxia is characterized by scuffing or dragging the paws on the ground, knuckling over, crossing over, or interference (ie, limbs hitting each other when walking). Vestibular ataxia is characterized by leaning or falling to one side. Patients with vestibular ataxia often use a wall for support while walking. Cerebellar ataxia is characterized by dysmetria (ie, unequal range and force of each step), often with hypermetria (ie, overflexion of the elbows in the thoracic limbs or hips/stifles in the pelvic limbs).

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