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Neurology Exam Review
Neurology Exam Review
100
Veterinary Medicine
Graduate
02/07/2011

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Term
What reflex arc can we place the following symptoms:
Acute onset paraplegia;
No CP reflexes in R forelimb (limp);
Some Horner's signs (droopy R eye)
Hemiparesis on R side (front R limb is affected more than the R hindlimb)
Definition
C7-T2
Symptoms of FCE (Fibrocartilagenous Embolization)
Term
Pathophysiology of FCE?
Definition
Ventral spinal arteries are in greater number in cervical and lumbar areas;
Fibrocartilage found in the veins, access the artery by retrograde propultion;
Schmorl's nodules;
Fibrocartilage is a product of a hypertrophied endothelial cell;
Term
How can we diagnose FCE?
Definition
Rule out other DDX!
Rads may look normal
Myelography (may show cord swelling in 41%)
Term
Paresis
Definition
partial motor paralysis
Term
Monoparesis
Definition
Paresis affecting a single extremity or part of one.
Term
Monoplegia
Definition
paralysis of one extremity, muscle, or muscle area
Term
Hyperesthesia
Definition
an abnormally acute sense of pain, heat, cold, or touch; algesia.
Term
Paresthesia
Definition
an abnormal sensation, as prickling, itching, etc.
Term
LOCALISATION OF THE LESION IN THE PATIENT WITH MONOPARESIS
Definition
LOCALISATION OF THE LESION IN THE PATIENT WITH MONOPARESIS

The monoparesis in the front limbs is most commonly caused by the diseases of the peripheral nerve(s) or nerve roots. The diseases of endplates or muscles affecting just one limb are very rear. Diseases of the spinal cord in the cervical area usually cause hemiparesis or tetraparesis. Therefore, monoparesis in the front limb is usually caused by the lesion in nerves or nerve roots of the affected limb.

Monoparesis in the hind leg is also usually caused by nerve or nerve root lesion. It can be outside the spinal canal (peripheral nerve) or inside the canal (cauda equina). Additionally, also unilateral spinal cord lesions caudal to Th2 can cause monoparesis in the rear extremity. This is the exception from the general localization scheme. Vascular lesions are the most often causes of such unilateral spinal cord diseases (ex. fibrocartilaginous embolism).
Term
DIFFERENTIAL DIAGNOSES OF THE MONOPARESIS
Definition
Vascular Fibrocartilaginous embolism, ischemic encephalopathy (D,C)
Inflammatory-infectious Plexus brachialis neuritis (D,C)
Traumatic Trauma (neuropraxia, axonotmesis, neuronotmesis) of plexus brachialis or isolated nerve(s) (D,C)
Anomalous -
Metbolic Hypothyroidism (D)
Idiopathic -
Neoplastic Primary: malignant nerve sheath tumor (D,C). Secondary: lymphoma, skeletal tumors (D,C)
Degenerative Lateralised disk herniation, degenerative foraminal stenosis causing nerve root compression (nerve root signature)

PS: D-dog, C-cat.
Term
What segments of the spinal cord can be tested by the reflexes of the peripheral nerves?
Definition
Femoral n - L4-5-6
Sciatic n. - L4-S2
Peroneal n. - L6 -S2
Tibial n. - L6 - L2
Term
What are some symptoms of FCE?
Definition
- Loss of voluntary reflexes or extention of one or more joints;
- Loss of spinal reflexes of the limb;
- Loss of pain sensation;
Term
What are the signs of "root signature?"
Definition
- Varying degree of LMN dysfunction in the legs (L4-S2);
- No CP reflexes'
- ?
Term
Signs of Cauda Equina?
Definition
-Reduced tail wag;
- No tone in the tail;
- Lameness or difficulty rising in the pelvic limbs;
- Dilated anus, absent anal reflex;
- Absent sensation in the perineal area;
- Lumbosacral pain;
Term
Diagnosis of Cauda Equina?
Definition
Onset: acute or chronic
Is p painful or nonpainful
Bladder or bowel incontinance?
Trauma or animal bites
Young Manx or a Bulldog (deformed tail)
Term
Neurapraxia
Definition
an injury to a nerve that interrupts conduction causing temporary paralysis but not degeneration and that is followed by a complete and rapid recovery
Term
Axonotmesis
Definition
axonal nerve damage (as from compression or crushing) that does not completely sever the surrounding endoneurial sheath so that regeneration can take place
Term
Neurotmesis
Definition
The condition in which there is complete division of a nerve.
Term
Case:
9 year old, GSD, MN
Has been on Rymadil for 8 months;
PE:
Mentation normal;
NO CP deficits on L hindlimb, but the tail is flaccid!!!
Normal muscle reflexes
Where is the lesion?
What are DDX?
What is the diagnosis?
Definition
Lumbosacral regioun - L6 -S2
Differentials: Disc disease, tumor, discospondylitis, GME, Too chronic to be trauma, LS instubility.
Diagnosis: LS INstubility (lumbosacral instability, cauda equina, lumbosacral sclerosis)
Term
What is a typical presentation of Lumbosacral Sclerosis?
Definition
Common in large dogs,
Initially painful
Progressive nerve root compression leads to incontinence;
Term
Dogs with what skeletal defect can have an up to 8 times greater chance of developing Lumbosacral sclerosis?
Definition
Transitional vertebrae at L7
Term
Are there any medical or surgical treatments for Lumbosacral degeneration?
Definition
Medical: NSAIDS, Tramadol, Acupuncture, Might use steroids?
Best treatment: surgery (Dorsal Laminectomy and LS)
Term
Prognosis for animals with lumbosacral stenosis?
Definition
- if incontinence already exists- difficult to reverse, even after surgery;
- Long-term success ranges from 69-94%;
Term
What disease has a signature "Marilyn Monroe" walk in hindlimbs?
Definition
Hip dysplasia
Term
How can we differentiate hip dysplasia from lumbosacral stenosis?
Definition
Dogs with hip dysplasia do not have CP deficits in the hindlimbs
Term
Case:
7 yo, GSD,
Low tail carriage, lumbosacral pain (acute);
Muscle reflexes are present
Did this dog have trauma? o confessed that dog came home howling.. from the road
Definition
Lumbosacral and sacrocaudal fracture/luxation
Term
What can happen to cats with fractured tail?
Definition
they may have a singling sensation that causes them to chew off their tail;
May have urinary incontinance;
Tail amputation may be necessary;
Term
What should we do during a neurologic exam?
Definition
be very good at neuroanatomy
be able to conduct good p overview
perform a neuro exam
lesion localization
Term
Where is the lesion if p is having seizures and has CP deficits in the R side of the body?
Definition
left side of the brain
Term
A dachshund comes in with posterior limb paresis, what is the DAMNIT list?
Definition
Term
What nerve is tested when we pinch the lip with a hemostat?
Definition
Maxillary branch of Trigeminal nerve
Term
What nerves are resp. for palpebral reflexes?
Definition
Trigeminal and Facial
Term
What can cause a middle age Labrador be unable to blink his eye? just one
Definition
If he had matching CBC and Chem signs (low T4, anemia, high Cholesterol), then it is Hypothyroidism Associated Facial Nerve Paralysis

Treat with Soloxone (they recover in 3 months)
Term
How many % of p with acute otitis have OM?
Definition
16%
Term
How many p with Chronic otitis have OM?
Definition
89%
Term
Describe Hypothyroidism Associated Facial Nerve Paralysis
Definition
Supplement p with Soloxone
Gets better in 3 months
Two theories: one is that the more obese Hypothyroid p has more chance of compression of the nerves as they come out of the foramen; Another theory is Axonal flow.
DO NOT use Steroids!!!
Term
Diabetic Neuropathy
Definition
Can be muscular or Metabolic reasons
Characteristic pelvic limb posture in a cat (stands on hocks)
Vascular: involves decreased vasodilatory molecues(prostacyclin, prostaglandin E1) and increased vasoconstrictive molecules (thromboxane A2, endothelin) in vascular endothelium;
Abnormal thickening of the perineurium;
Metabolic hypothesis: describes several cellular aberrations in diabetic p (polyol pathway, enzyme aldose reductase, accumulation of sorbitol;
Immune-Mediate Hypothesis: Myelin is attacked by the immune system
Term
Diabetic Neuropathy clinical signs:
Definition
- can be sublclinical
- symmetric neurogenic m. atrophy (symmetric pelvic limb LMN paresis) with CP deficits, decreased reflexes, and muscle atrophy;
-may show Horners
-plantigrade posture in cats (hocks on the ground)
-decreased patellar reflexes
Term
What is a test for Masticatory Myocytis?
Definition
Type II M Antibody test
Term
One of few cases when we can prescribe Steroids to neurologic p?
Definition
Masticatory Myocytis to reduce inflammation
Term
What is typical signalment of a dog with Masticatory Myocytis?
Definition
- Does not want you to touch the mouth
- Painful when we try to open the mouth
- May have concurrent polyarthritis
Term
Describe a typical p with POLYMYOCYTIS?
Definition
GSD
has good CP
Exercise intolerance
Regurgitation
Looks like an immune mediated attack on muscle tissue of the patient, may go away by itself, may be triggered by stress, etc
-Treat it as an immune-mediated dz
Term
What is the name for hypertonicity syndrome of Cavalier King Charles Terriers?
Definition
Episodic falling
Term
List all verterbral segments:
Definition
C1-C3
T1-T13
L1-L7
S1-S3
Term
6 SUBDIVISIONS OF BRAIN:
Definition
Cerebrum
Diencephalon
Midbrain
Cerebellum
Pons
Medulla oblongata
Term
Lobes of the cerebrum
Definition
Frontal
Parietal
Occipital
Temporal
Term
Diencephalon
Definition
Major pathway to and from the four lobes
Term
Frontal lobe
Definition
Movement
Intellect
Behaviour
Consciousness
Term
Parietal lobe
Definition
Sensation
CP
Touch
Pain
Temperature
Term
Occipital lobe
Definition
Vision (manace reflex)
Term
Temporal lobe
Definition
Hearing, etc
Term
CN3
Definition
PUPILS, EXTRAOCULAR MUSCLES
Term
CN4
Definition
Extraocular muscles
Term
PONS (Metencephalon)
Definition
Consciousness
All motor and sensory tracts
Term
CN5
Definition
Trigeminal
Chewing (know Trigeminal Neuritis)
Term
Medulla oblongata
Definition
Consciousness
Motor and sensory tracts
Term
CN7
Definition
Facial n
defect causes loss of palpebral reflex
Term
Why are sensory tracts more prone to damage?
Definition
Motor tract-covered by parenchyma, not as easy to damage;
Sensory tracts are on the periphery, contain fast fibers, so if pressure is applied on the cord, these suffer most.
Term
Case: GSD, 11 yo
hit by car 2 years ago
down on sound limb
hind limbs are limping, too
No CP deficits
Definition
Take rads: show degenerative changes in the hips;
DDX: HIP DYSPLASIA, ELBOW DYSPLASIA
Term
Wobbly kittens
Definition
Cerebellum lesion
Term
If p is BLIND and lost pupillary light reflexes, where is the lesion
Definition
CN2, Dienecephalon
Term
If p is BLIND but has normal pupillary response?
Definition
diencephalon or cerebrum
Term
Medial Strabismus (eyes meet at the nose)
Definition
CN6
Term
Ventrolateral strabismus
Definition
CN3, VERY RARE (CN4)
Term
What nerves are responsible for mvt and sensory innervation to the cheek, lip, palpebrae, ear?
Definition
CN5 (SENSORY), 7 (MOTOR)
Term
Facial paralysis
Definition
CN7
Term
MEDIAL STRABISMUS
Definition
CN6
Term
Vestibular signs
Definition
CN8
A head tilt usually indicates vestibular signs that may be a problem in the animal's middle or inner ear.
Term
Swollowing
Definition
CN 9,10,12
Term
Tongue paralysis
Definition
CN9-10: Dysphagia, meagesophagus, laryngeal paralysis, paresis.
CN12 - Tongue paralysis
Term
Knee jerk reflex (Patellar reflex)
Definition
Femoral n., spinal segments L4-L6
Term
2 main spinal reflexes of the thoracic limb
Definition
Musculocutaneous (Biceps m)
Radial (Triceps, caudal half)
Term
Pelvic limb reflexes
Definition
Gastrocnemius m
Cranial tibial m
Term
Toe pinch checks what nn?
Definition
Flexor muscles and Sciatic nerve
Term
What segment are Gastrocnemius, Cranial tibial n, and Sciatic nerve belong to?
Definition
L6-S2
Term
wHAT SPINAL SEGMENT IS CHECKED BYU ANAL TONE REFLEX?
Definition
S1-S3
Term
What does Babinski sign indicate?
Definition
Crossed extensor (UMN dz)
Muscle atrophy (disuse, neurogenic)
Urination (large, easily expressible bladder)
Term
Postural tests?
Definition
CP
Hopping, hemi, barrel walking
Placing toes back
Term
How do we assess neck and back pain?
Definition
deep palpation
range of motion exam
Term
Signs of disc disease:
Definition
Quadraparesis or quadriplegia
UMN signs to all legs
Neck pain
Term
Root signature
Definition
Limb lameness due to neurologic disease, usually due to inflammation of the spinal cord or nerve root by compression with an intervertebral disc extrusion
Term
If a patient showing depressed or missing reflex, put it in:
Definition
The Reflex Arc
Term
If p can't walk (paresis paraplegia) what are ddx?
Definition
IV Disc disease;
Botulism
Tick paralysis
Coral snake envenomation

Metabolic(Hypoglycemia, liver dz, Diabetic neuropathy, Hyperkalemia, Uremic toxicity)
Idiopathic: Trigeminal neuritis
Toxic: Tetanus, plants, pesticides, heavy metals (lead)
Term
When is CSF tap indicated?
Definition
Eisures,
Encephalopathy
Myelopathy
Prelude to myelography
Meningiopathies and Radiculopathy
Term
What are some counterindications to CSF tap?
Definition
increased ICP, Anesthetic risk patient
Term
What was the old way of diagnosing Neoplasia via CSF?
Definition
Tupor gives increased ICP
No elevation in cell count of CSF
Elevation in protein (bc mass causes cellular destruction)
Term
Locations for CSF tap?
Definition
L4-L5 or Cicternal Magna: dogs
l5-l6: CATS
Term
cICTERNAL TAP?
Definition
THE OCCIPITAL PROTRUBERANCE, LATERAL TIPS OF THE WINGS OF ATLAS
Term
Why woudl levels of IgG or IgM increase in CSF?
Definition
Intrathecal immunoglobulin production or BBB breakdown
Term
Diagnosis of Distemper and FIP with serum and CSF?
Definition
Do paired titers,
If levels of titer are higher in CSF, very suspicious of the disease
Term
Name 3 reasons for protein elevation and normal cell count in the CSF?
Definition
Neoplasia
Disc dz
Neurodegenerative dz
Term
What should be the predominant protein in CSF?
Definition
Albumin
Term
What are major causes of bacterrial meningitis in cats and dogs?
Definition
dogs: SRMA
Cats: FIP
Term
Lymphocytic pleocytosis
Definition
Most common (viral meningitis)
Dogs: RV, CDV, SRM, "Pug encephalitis"
Young cats: Feline polioencephalomyelitis
Lymphoma in any species
Term
Mixed Pleocytosis
Definition
Dogs( GME, SRME, Other infectious agens)
Cats (FIP chronic)
Term
Eosinophilic Pleocytosis
Definition
Rare
Parasites
Eosinophilic meningitis (tx with steroids)
Term
Other abnormalities that can be found in CSF?
Definition
Hemorrhage, Infection (Crypto), Myelin fragments, Tumor cells, Cellular inclusions
Term
Osteosarcoma
Definition
Most common bone tumor
Usually above L2
Term
A mass that has uniformally distributed contrast on MRI is most likely?
Definition
Meningioma
Term
8 yo Doberman,
CM,
ABNORMAL WALK, GAIT OF HIND LIMBS
CN are great!
Definition
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