Neurological Exam

sihirlifil's version from 2018-04-01 01:34


Question Answer
A full neuro exam is warranted whenDisplay of neuro abnormalities
Pre-purchase exam
Limitations whith neuro examLarge size of patient excludes some tests
Safety is a concern!
Recommendations for performing the examDevelop a system
Be consistent
Stay safe!
4 sections of the examEvaluate mental status
Assess cranial nerves
Check spinal reflexes & musculature in the standing patient
Perform a gait & postural analysis in the moving patient
Key equipmentPen light/ophthalmoscope
Pen/hemostat or firm pointy object
Video recording/camera
Neuro exam form
Gloves if exhibiting encephalopathic signs
Your own brain lol
How do you assess mental status?Observe in natural habitat (stall, pasture), enceophalopathic behavior can be readily seen
Encephalopathic behavior =Head-pressing
Significant change in mentation
Cortical/central blindness
If encephalopathic signs, what do you keep in mind/ask about?Prompt caution! including gloves (unknown rabies status = gloves and minimal contact)
Neuro exam will be limited
Must ask about vaccination history
Different mental statuses (6)Hyperesthetic
Alert & responsive
Depressed or lethargic
Hyperesthetic =Hyper-responsive to stimuli, jerk or tremor when stimulated
Depressed/lethargic mental status can be due to?Pain, systemic dz, increased intra-cranial pressure
Obtunded =Do not respond to normal stimuli
Must exaggerate the stimuli in order to get a response: louder noises, firmer pressure
Stuporous =Respond only to painful stimuli: pinching with hemostats
Comatose =NO response to any stimuli
Cranial nerve exam (regional approach): eyes?Perform menace response
Look at pupil size
Perform PLR
Check eye position (eyelashes)
Observe normal nystagmus
Cranial nerve exam: how do you check 5 & 7?Check palpebral reflex
Assess prominence of 3rd eyelid
Evaluate for normal facial expression: ability to move ears, blink, wiggle muzzle/lips
Cranial nerve exam: what can you check in the mouth region?Palpate muscles of mastication
Observe horse eating
Note jaw tone
Tongue strength
Ability to swallow
CN1: Name? Fxn? Test?
CN2: Name? Fxn? Test?
CN3: Name? Fxn? Test?
CN4: Name? Fxn? Test?
CN5: Name? Fxn? Test?
CN6: Name? Fxn? Test?
CN7: Name? Fxn? Test?
CN8: Name? Fxn? Test?
CN9: Name? Fxn? Test?
CN10: Name? Fxn? Test?
CN11: Name? Fxn? Test?
CN12: Name? Fxn? Test?
Lesion: blindness, loss of PLR. Which CN?2
Lesion: loss of PLR, lateral & ventral strabismus, ptosis, mydriasis. Which CN?3
Lesion: dorso-medial strabismus. Which CN?4
Lesion: loss of sensation in face, PLR, and corneal reflex. Which CN?5
Lesion: Atrophied muscles of mastication & dropped jaw. Which CN?5
Lesion: medial strabismus, loss of corneal reflex. Which CN?6
Lesion: facial paralysis, loss of palpebral reflex & blink, dry eye. Which CN?7
Lesion: head tilt, nystagmus, loss of balance, deafness. Which CN?8
Lesion: dysphagia, displaced soft palate. Which CN?9
Lesion: dysphagia, laryngeal paralysis, displaced palate. Which CN?10
Lesion: Tongue atrophy & paralysis. Which CN?12
Spinal reflexes & musc tone: how do you test?Tendon & withdrawal reflexes ONLY IN RECUMBENT PATIENTS
Cervicofacial/auricular & cutaneous trunci (panniculus)
Tail tone
Perineal reflex
Anal tone
Assess any areas of abnormal sweating
Check for muscle atrophy
Look for areas of no skin sensation
Gait/postural reactions: How to test?Assess posture from distance
Gait: Steps of gait evaluationWalk in straight line
Trot in straight line
Walk in serpentine
Walk with head elevated
Walk while pulling tail (both sides)
Back up
Try uneven ground/hills
Gait: What are the placement tests?Foot placement, hopping
May not be valuable... normal horses varied in response
How do you document the neuro exam?Use the neuro form
Not all findings in patient's record
Using the abnormalities: determine location of lesion, possible differentials, diagnostics, treatment
Mayhew grade system for ataxia: 0?Normal
Mayhew grade system for ataxia: 1?
Mayhew grade system for ataxia: 2?
Mayhew grade system for ataxia: 3?
Mayhew grade system for ataxia: 4?
Mayhew grade system for ataxia: 5?