The neurologic exam is the most important diagnostic test in the evaluation of neurologic disease.
A routine should be used for every exam, just as for a physical examination
• Easier to perform a complete exam if you have a pattern, especially in non typical scenarios (e.g. spinal cord trauma,
painful or fractious animals)
•
Easier to remember all of the components when documenting exam and interpreting findings
Many parts of the exam can be subjective – knowing the expected response of each test in a normal patient makes abnormalities
more apparent
• Examine neurologically normal patients!
Goals of NE
Is patient neurologically normal?
If yes, where is the neuroanatomic localization of abnormality?
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Brain – cerebrum, brainstem, cerebellar
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Spinal cord – C1-5, C6-T2, T3-L3, L4-caudal
•
Neuromuscular – neuropathy, junctionopathy, myopathy
• >1 localization? – multifocal/diffuse disease
Differential diagnoses
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DAMNIT V
o
Degenerative
o
Anomalous/congenital
o
Metabolic
o
Neoplastic, nutritional
o
Infectious, inflammatory, idiopathic, iatrogenic
o
Traumatic, toxic
o
Vascular
Diagnostic plan formulated from list of likely causes
•
Signalment and history are as important as physical and neurologic examinations in ranking potential causes of signs
An accurate exam is essential in working towards these goals
Components of NE
6 basic categories
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Mentation
•
Gait/Posture
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Cranial Nerves
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Spinal Reflexes
•
Postural Reactions
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Palpation
Initial observations are valuable
Pay attention to the patient while taking your history
Mentation
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Alert (bright, quiet)
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Obtunded (mild, moderate, severe)
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Stuporous
•
Comatose
• Additional description as needed – e.g. compulsive, aggressive, hyper-excitable
Gait/Posture
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Posture, body position at rest
o
Head tilt or turn, leaning, involuntary movements, wide based stance
•
Gait evaluation
o
Ambulatory or non ambulatory
o
Ataxia, paresis, plegia, lameness
• If plegic, are superficial and deep pain perception present?
o Other abnormalities associated with movement – e.g. intention tremors, circling, dysmetria
