The neurologic exam (Proceedings)


The neurologic exam (Proceedings)

Nov 01, 2010

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?
     • Brain – cerebrum, brainstem, cerebellar
     • Spinal cord – C1-5, C6-T2, T3-L3, L4-caudal
     • Neuromuscular – neuropathy, junctionopathy, myopathy
     • >1 localization? – multifocal/diffuse disease

Differential diagnoses

     • 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

     • Mentation
     • Gait/Posture
     • Cranial Nerves
     • Spinal Reflexes
     • Postural Reactions
     • Palpation

Initial observations are valuable

Pay attention to the patient while taking your history


     • Alert (bright, quiet)
     • Obtunded (mild, moderate, severe)
     • Stuporous
     • Comatose
     • Additional description as needed – e.g. compulsive, aggressive, hyper-excitable


     • 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