Systematic neurological examination in animals

Extension of general

physical examination

Neurological Examination

It is the systematic way of accessing

functioning of nerves

NERVOUS SYSTEM

CNS PNS

FORE BRAIN HIND BRAIN

BRAIN STEMBRAIN SPINAL CORD

MID BRAIN

Metencephalon

Myelencephalon

Telencephalon

Diencephalon

Diencephalon

Mesencephalon Metencephalon

Myelencephalon

Mesencephalon

PNS

Axons and dendrites send messages to and from the CNS.

SNS (Voluntary) sends

Sensory info to the CNS and

motor messages to the muscles

ANS (Involuntary) serves our

basic life functions

Sympathetic

Nervous System

Parasympathetic

Nervous System

Readies the body

for threat

Calms the body

down and

maintains energy

Afferent Efferent

Sensory Motor

Somatic Nervous System Autonomic Nervous System

Aim of neurological examination

Confirm the problem

Lesion localization

Severity and Extent

Determine the Cause

Estimate Prognosis

NEUROLOGICAL STATUS

COMPONENTS OF NEUROLOGICAL EXAMINATION

OBSERVATION

POSTURAL

REACTION

TESTING

SPINAL

REFLEX

FUNCTION

CRANIAL

NERVE

FUNCTION

SUPERFICIAL

SENSORY

FUNCTION

OBSERVATION Mental Status and

Behaviour

NORMAL Alert with normal response

DEPRESSED Drowsiness with less response

CONFUSED AND

DISORIENTATEDResponsive(inappropriate manner)

STUPOROUSUnconsciousness with

Reduce response (external stimuli)

but aroused (painful stimuli)

COMATOSE Unconsciousness with absence of

response to any stimuli

LEVEL OF CONSCIOUSNESS

OBSERVATION

AGGRESION

HEMI NEGLECTING

SYNDROME

HEAD PRESSING

LOSS OF

LEARNED BEHAVIOUR

BEHAVIOURAL CHANGES

LESION: FORE BRAIN

Mental Status and

Behaviour

PostureOBSERVATION

HEAD TILT

SCHIFF

SHERINGTON

SPINAL

CURVATURE

DECEBRATE

RIGIDITY

LESION:

Vestibular lesionLESION:

Vertebral lesion

LESION:

Thoracic or

cranial spinal

cord lesion

LESION:

Rostral brain

stem lesion

PostureOBSERVATION

SCOLIOSIS

LORDOSIS

KYPHOSIS

OBSERVATION Gait

ATAXIASENSORY ATAXIA

VESTIBULAR ATAXIA

CEREBELLAR ATAXIA

HYPERMETRIA

HYPOMETRIA

DYSMETRIA

OBSERVATION Gait

PARESIS

MONOPARESIS

HEMIPARESIS

TETRAPARESIS

PARAPARESIS

LESION: Cranial to T-3

LESION:

Caudal to T-2

LESION:

Caudal to T-2

Ipsilateral ( T2- Caudal M.BRAIN )

C / L (Rostral M.Brain / Cerebrum)

OBSERVATION Gait

CIRCLING

• DIRECTION TOWARDS THE SIDE OF LESION

• CIRCLING + TWISTING/HEAD TILT : VESTIBULAR SYSTEM

LESION:

FORE BRAIN

LESION:

VESTIBULAR

SYSTEM

TIGHT CIRCLES WITH

BALANCE LOSS

WIDE CIRCLES WITHOUT

BALANCE LOSS

OBSERVATION Involuntary

Abnormal Movements

MYOCLONUS

EPILEPTIC SEIZURES

CATAPLEXY

MYOTONIA

HEAD BOBBINGLESION: FORE BRAIN

POSTURAL

REACTION TESTING

• Complex responses maintain normal upright

position of limbs

• Initially we perform proprioceptive positioning reaction

reaction and hopping reaction

IF NORMAL

THEN PROCEED FOR FURTHER REACTIONS

Proprioceptive

Positioning Reaction

POSTURAL

REACTIONS

SLIDE PAPER TEST

KNUCKLING TEST

Flex the paw

Immediately returns the paw to normal position

Hopping Reaction POSTURAL

REACTIONS

RELIABLE TEST

Lift the limb(opposite to suspected limb)

Assess: weight shifting,

initiation and movement on extended limb

Wheelbarrowing

Reaction

POSTURAL

REACTIONS

Lift both pelvic limbs from ground

If normal movement

repeat with head lifted and

Neck extension

POSTURAL

REACTIONS

ASSESSMENT

SLOW INITIATION

Caused by lesion of

cervical spinal cord, brain stem, c.cortex

DYSMETRIA

Cervical spinal cord, caudal brain stem

cerebellum

Wheelbarrowing

Reaction

Hemistanding and

Hemiwalking Reaction

POSTURAL

REACTIONS

Lift the thoracic and pelvic limb

of one side

(FORWARD AND LATERAL WALKING)

Normal Animal:

support weight by opposite limbs

ABNORMAL : Unilateral disease of motor cortex

Cervical / Thoracic cord lesion (I/L limb unable to support)

Cerebellar lesion (hypermetric response)

Tonic

Neck Reaction POSTURAL

REACTIONS

With animal in normal standing position

Head is elevatedNeck extended

Turning head to side

Normal: Extends t.LimbFlexes p.Limb

Lowering the head

Normal: Flexion of t.Limb

Extension of p.Limb

Normal: Slight extension of Ipsilateral t.LimbSlight flexion of Contralateral t.Limb

Frontal lobe lesion: C/L Abnormalities

Vestibular lesion: I/L Abnormalities

CRANIAL

NERVES

CRANIAL NERVE I

SENSE OF SMELL

HYPOSMIA

ANOSMIA

OLFACTORY NERVE

CARE: DO NOT USE IRRITATING SUBSTANCE

CRANIAL

NERVES

CRANIAL NERVE II

VISION

MENANCE RESPONSE

COTTON BALL TEST

PUPILLARY LIGHT REFLEX

OPTIC NERVE

CRANIAL

NERVES

CARE: DO NOT TOUCH EYE LASHES

CRANIAL NERVE III AND VI

CRANIAL

NERVES

EYE POSITION AND MOVEMENT

VESTIBULO-OCCULAR REFLEX

STRABISMUS

OCCULOMOTOR NERVE

ABDUCENT NERVE

CRANIAL NERVE IV

CRANIAL

NERVES

Dorso-medial Strabismus may be due to damage to the nerve or

the mid brain

(with CN III and CN VI-USUALLY)

TROCHLEAR NERVE

CRANIAL NERVE V

CRANIAL

NERVES

PALPEBRAL REFLEX

DROPPED JAW

RESPOND

TO STIMULATION

OF NASALMUCOSA

RESISTANCE OF

JAW TO OPEN

THE MOUTH

TRIGEMINAL NERVE

CRANIAL NERVE VII

CRANIAL

NERVES

SCHIRMER TEAR TEST

(KERATOCONJUCTIVIS SICCA)

DROPPING

(EAR, LIP)

DEVIATION OF NOSE

(NORMAL SIDE)

ABSENT

ABDUCTION

OF NOSTRIL

INSPIRATION

FACIAL NERVE

NYSTAGMUS INDUCED

BY MOVING OF HEAD

VENTROLATERAL

STRABISMUS

(CENTRAL V.D)

VESTIBULOCOCHLEAR NERVE

CRANIAL NERVE VIII

CRANIAL

NERVES

STARTLE

REACTION

(NOISE)

CLAP/WHISTLE

CRANIAL NERVE IX AND X

CRANIAL

NERVES

SWALLOWINGREFLEX

(ABSENT IN X)

GLOSSOPHARYNGEAL NERVE

VAGUS NERVE

GAG REFLEX

(ABSENT IN IX)

CRANIAL NERVE XI

CRANIAL

NERVES

TRAPEZIUS MUSCLE

ATROPHY

(CHRONIC)

SPINAL ACESSORY NERVE

DEVIATION AND ATROPHY

OF TONGUE

APPLY FOOD PASTE ON NOSE

(ASSESS TONGUE MOVEMENT)

HYPOGLOSSAL NERVE

CRANIAL NERVE XII

CRANIAL

NERVES

SUPERFICIAL

SENSORY

FUNCTION

• OBJECTIVES: HYPERESTHESIA , HYPESTHESIA AND

TO ENSURE THAT THE ANIMAL HAS A

CONSCIOUS RESPONSE TO NOXIOUS

STIMULI

HYPERESTHESIA

• Testing start from distal to proximal and caudal to cranial

• Increase muscle tension noticed: when painful area is palpated

even under light anesthesia

• S.cord / nerve root lesions: produces an area of hyperesthesia

SUPERFICIAL

SENSORY

FUNCTION

PANNICULUS REFLEX

• Evaluation of the cutaneous trunci muscles

• Most prominent at saddle area of the trunk

• Reflex absent caudal to lesion which disrupt the

superficial pain pathway

SUPERFICIAL PAIN

SUPERFICIAL

SENSORY

FUNCTION

WITHDRAWL REFLEX OF LIMB

SUPERFICIAL PAIN

SUPERFICIAL

SENSORY

FUNCTION

Thoracic limb

Evaluate the integrity of spinal cord segment C6-T2 as well as

Brachial plexus and peripheral nerves

NORMAL REFLEX: Reflex contraction of the flexor muscles

and withdrawal of the tested limb

Evaluate the integrity of spinal cord segment L4-S2 as well as

femoral nerve and sciatic nerve

NORMAL REFLEX: Flexion of hip joint(femoral nerve function)

Flexion of stifle and hock(sciatic nerve)

Pelvic limb

DEEP PAIN

• Useful prognostic indicator : SPINAL CORD DISEASE

•Expected Reaction is a behavioral responses: gentle cry

(turning the head, trying to bite or vocalization)

PALPATION

HEAD

SPINE

LIMBS

SUPERFICIAL

SENSORY

FUNCTION

SENSORY

(AFFERENT)

AUTONOMIC

(EFFERENT

+

AFFERENT)

CEREBRAL CORTEX IN ALL SPINAL CORD SEGMENTS

SENSORY

SYSTEM

SENSORY

SYSTEM

SPINAL

REFLEXES PATELLAR REFLEX

MOST RELIABLE TEST

MEDIATED VIA THE CORD

SEGMENTS L4 TO L6

IT ALSO EVALUATE

FEMORAL NERVE

NORMAL: BRISK AND

SLIGHT EXTENSION

OF THE STIFLE

ASSESSMENT: ABSENT(0), DEPRESSED(1), NORMAL(2),

EXAGGERATED(3), EXAGGERATED WITH CLONUS(4)

SPINAL

REFLEXESCRANIAL TIBIAL

REFLEX

STRIKE TO JUST DISTAL

TO PROXIMAL END

OF TIBIA

NORMAL: FLEXION OF HOCK

ABNORMAL: ABSENT / DECREASE REFLEX

EXAGGERATED: LESION CRANIAL TO L6-7

SPINAL

REFLEXESGASTROCNEMIUS

REFLEX

STRIKE AT TENDON JUST

DORSAL TO THE TIBIAL

TARSAL BONE

SLIGHT FLEXION NECESSARY

NORMAL:

EXTENSION OF HOCK

FOLLOWED BY FLEXION

CONTRACTION OF CAUDAL

THIGH MUSCLES

ABNORMAL: ABSENT / DECREASE REFLEX

SPINAL

REFLEXESEXTENSOR CARPI

RADIALIS REFLEX

STRIKE EXTENSOR CARPI

RADIALIS MUSCLE

JUST DISTAL TO ELBOW

NORMAL:

EXTENSION OF CARPUS

ABNORMAL: ABSENT / DECREASE

EXAGGERATED REFLEX (+3): LESION CRANIAL TO C-7

SPINAL

REFLEXESTRICEPS REFLEX

STRIKE AT TRICEPS BRACHII

JUST PROXIMAL TO

OLECRANON

NORMAL: SLIGHT EXTENSION

OF ELBOW OR VISIBLE

CONTRACTION OF TRICEPS

MUSCLE

LESION: RADIAL NERVE (LOSS OF MUSCLE TONE AND

INABILITY TO SUPPORT WEIGHT)

EXAGGERATED REFLEX (+3): LESION CRANIAL TO C-7

SPINAL

REFLEXESBICEPS REFLEX

BY PLACING INDEX FINGER

OVER DISTAL END OF

BICEPS AND BICIPITAL

TENDON AT THE ELBOW

TAPPING THE FINGER

NORMAL: SLIGHT FLEXION

OF ELBOW AND CONTRACTION

OF THE BICEPS MUSCLE

FLEXION OF THE ELBOW ON FLEXOR REFLEX: BETTER

ASSESSMENT OF MUSCULO CUTANEOUS NERVE

EXAGGERATED REFLEX (+3): LESION CRANIAL TO C-6

SPINAL

REFLEXESEXTENSOR THRUST

REFLEX

LATERAL RECUMBENCY OR

WITH ANIMAL SUSPENDED BY

SHOULDERS WITH THE PELVIC

LIMB HANGING FREE

TOE SPREAD, APPLY

PRESSURE BETWEEN PADS

NORMAL: RIGID EXTENSION

OF LIMB

DIFFICULT TO ELICIT (LATERAL RECUMBENCY)

EXAGGERATED REFLEX (+3): LESION CRANIAL TO L-4

SPINAL

REFLEXESPERINEAL REFLEX

ELICIT BY LIGHT STIMULATION

OF PERINEUM WITH FORCEP

NORMAL: CONTRACTION OF

ANAL SPHINCTER WITH

FLEXION OF TAIL

BEST TO CHECK INTEGRITY OF SACRAL S.CORD SEGMENT

IMPORTANT IN ANIMAL (URINARY BLADDER DYSFUNCTION)

ABNORMAL/ DEPRESSED: PUDENDAL NERVE LESION

BULBOCAVERNOSUS REFLEX

SPINAL

REFLEXESCROSSED EXTENSOR

REFLEX

OBSERVED WHEN FLEXOR

REFLEX IS ELICITED

NORMAL: EXTENSION OF

LIMB OPPOSITE TO

STIMULATED LIMB

SPINAL

REFLEXESBABINSKI REFLEX

EXTENSOR TOE REFLEX

FINGER / FORCEP IS USED

TO STRIKE THE LIMB

ON CAUDO-LATERAL

SURFACE FROM HOCK TO

DIGITS

SEEN IN DOG(PELVIC LIMB PARALYSIS ASSOCIATED WITH

EXTENSOR HYPERTONUS AND EXAGGERATED REFLEXES

NORMAL:NO RESPONSE

ABNORMAL: EXTENSION AND

FANNING OF DIGITS