the neurologic examix glossopharyngeal x vagus xi accesory xii hypoglossal optic nerve (cn ii) •...
TRANSCRIPT
The Neurologic Exam
Daniel Cuff, DVM, DACVIM (Neurology) Bush Veterinary Neurology Service Rockville, MD
The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain
What’s The Goal?
• Localization
The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception
Mental Status
• Alert • Depressed • Obtunded (drowsy but arousable) • Stuporous (sleep state but arousable) • Comatose (cannot be aroused, even with pain) • Dementia / Delirium
The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain
Posture
• Position of head and body with respect to gravity
• Examples: • Wide-base stance • Decerebrate rigidity • Decerebellate rigidity • Opisthotonus • Schiff-Sherrington
Decerebrate Rigidity
Decerebellate Rigidity
Schiff-Sherrington
11
The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain
Gait
• Lameness • Ataxia
• Spinal ataxia • Cerebellar ataxia • Vestibular ataxia
• Paresis / Paralysis
The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain
Postural reactions
• Proprioceptive positioning • Placing • Hopping • Hemi-walking • Wheelbarrowing • Extensor postural thrust
The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • CN • Spinal reflexes • Nociception / pain
Cranial nerves
I Olfactory II Optic III Oculomotor IV Trochlear V Trigeminal VI Abducent
VII Facial VIII Vestibulochlear IX Glossopharyngeal X Vagus XI Accesory XII Hypoglossal
Optic Nerve (CN II)
• Vision • Menace response
• PLR • Directed and indirect • Anisocoria
Oculomotor (CN III)
• PLR • Anisocoria • Ventrolateral strabismus
Trochlear (CN IV)
• Motor to dorsal oblique muscle of the eye • Ventromedial strabismus
Trigeminal (CN V)
• Sensory • Ophthalmic – medial canthus • Maxillary – lateral canthus • Mandibular – lower lip
• Motor • Muscles of mastication
• Symmetry of masseter and temporalis muscles
Facial (CN VII)
• Muscles of facial expression • Lip droop • Ear droop • Palpebral reflex
• Schirmer tear test
Vestibulocochlear (CN VIII)
• Sensory for vestibular inputs and hearing • Head tilt • Ataxia, falling, rolling • Nystagmus • Positional strabismus • Loss of hearing
Vestibulocochlear (CN VIII)
24
Vestibulocochlear (CN VIII)
25
Glossopharyngeal (CN IX) and Vagus (CN X)
• Muscles of larynx and pharynx • Loss of gag reflex • Dysphagia • Regurgitation • Voice change • Stridor
Accessory (CN XI)
• Motor to trapezius muscle • Atrophy
Hypoglossal (XII)
• Innervates muscles of the tongue • Abnormal prehension of food • Hanging from side of mouth • Loss of tone • Atrophy
The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception
Spinal reflexes
• Differentiate between UMN and LMN
The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain
Nociception
• Superficial pain (skin) • Deep pain (bone)
The Neurologic Exam • Mental Status • Posture • Gait • Postural reactions • Cranial nerves • Spinal reflexes • Nociception / pain
What’s The Goal?
• Localization