{"id":1347,"date":"2013-03-01T17:07:30","date_gmt":"2013-03-01T17:07:30","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1347"},"modified":"2022-02-17T19:15:33","modified_gmt":"2022-02-17T19:15:33","slug":"the-neurologic-examination-in-companion-animals-part-2-interpreting-abnormal-findings","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-2-interpreting-abnormal-findings\/","title":{"rendered":"The Neurologic Examination In Companion Animals, Part 2: Interpreting Abnormal Findings"},"content":{"rendered":"<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/09\/T1303F04.pdf\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9886\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2011\/07\/pdf_button.png\" alt=\"pdf_button\" width=\"110\" height=\"27\" \/><\/a><\/p>\n<hr \/>\n<p class=\"p1\"><span class=\"s1\"><em>Helena Rylander, DVM, Diplomate ACVIM (Neurology)<\/em><\/span><\/p>\n<p class=\"p1\">Once a neurologic examination has been completed in a patient, the practitioner can use the abnormalities, or lack thereof, to help localize the lesion to the brain, spinal cord, peripheral nervous system, or cauda equine, which provides critical information on the patient&#8217;s condition.<\/p>\n<hr \/>\n<p class=\"p1\"><span class=\"s1\">A complete neurologic examination should be done in all animals presenting with suspected neurologic disease. Abnormalities found during the neurologic examination can reflect the location of the lesion, but not the cause, requiring further tests, such as blood analysis, electrodiagnostic tests, and advanced imaging, to determine a diagnosis.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The neurologic examination evaluates different parts of the nervous system; the findings from the examination help localize the lesion to the:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Brain <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Spinal cord <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Peripheral nervous system <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Cauda equine.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">A fundic examination is recommended, especially in patients with brain disorders. Repeat neurologic examinations are helpful to discover subtle abnormalities and assess progression of disease.<\/span><\/p>\n<blockquote><p>Read <strong><a href=\"https:\/\/todaysveterinarypractice.com\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/\" target=\"_blank\" rel=\"noopener noreferrer\">The Neurologic Examination in Companion Animals\u2014Part 1: Performing the Examination<\/a><\/strong> (January\/February 2013) at todaysveterinarypractice.com.<\/p><\/blockquote>\n<h2 class=\"p3\"><span class=\"s1\"><b>THE BRAIN<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Lesions in the brain can be localized to the:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Cerebrum and thalamus (ie, prosencephalon)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Brainstem <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Cerebellum.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">In order to localize the lesion to a specific part of the brain, an understanding of the anatomy and function of the brain is necessary (see <strong>Brain Anatomy &amp; Related Functions<\/strong>).<\/span><\/p>\n<div class=\"orange-box\">\n<h2>BRAIN ANATOMY &amp; RELATED FUNCTIONS<\/h2>\n<h3 class=\"p3\"><span class=\"s1\"><b>Cerebrum &amp; Thalamus<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The cerebrum <em>initiates<\/em> movements; the thalamus <em>executes<\/em> movements.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">A common finding in cats with a <strong>large meningioma<\/strong> compressing the cerebrum is difficulty initiating movements and continuous, aimless walking in large circles. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">A patient with a <strong>thalamic lesion<\/strong> may have a compulsive behavior: if restrained, the patient may struggle, vocalize, and try to keep walking.<\/span><\/li>\n<\/ul>\n<h3 class=\"p3\"><span class=\"s1\"><b>Brainstem<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The brainstem connects the cerebrum with the spinal cord and body. All information to and from the body (which is examined by postural reaction assessment) passes through the brainstem and thalamus to leave or reach the cerebrum.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The brainstem includes the midbrain (mesencephalon), pons, and medulla oblongata. Localizing to one specific part of the brainstem is often not possible; however, cranial nerve deficits may help pinpoint the lesion.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The <strong>brainstem<\/strong> contains the cranial nerve cell bodies (except CN I and II).<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">The <strong>midbrain<\/strong> contains the reflex center for vision and hearing (colliculi) and the nuclei of CN III and IV. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">The <strong>pons<\/strong> lies between the midbrain and medulla oblongata and contains the nucleus of CN V. In addition, some of the vestibular nuclei are partially in the pons. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">The <strong>medulla oblongata<\/strong>, the most caudal part of the brainstem, contains the respiratory and blood pressure regulation centers, nuclei of CN VI to XII, and the vestibular nuclei (4 vestibular nuclei on each side).<\/span><\/li>\n<\/ul>\n<h3 class=\"p3\"><span class=\"s1\"><b>Cerebellum<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The cerebellum <em>adjusts<\/em> and <em>moderates<\/em> all movements initiated by the cerebrum and executed by the thalamus. Clinical signs that may indicate a cerebellar lesion include:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Cerebellar ataxia <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Variable and intermittent loss of the menace response<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Ipsilateral postural reaction deficits and\/or hypermetria<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Intention tremor.<\/span><\/li>\n<\/ul>\n<div id=\"attachment_3250\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/brain_LisaWirth.jpg\"><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-3250\" class=\"wp-image-3250 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/brain_LisaWirth-300x183.jpg\" alt=\"brain_LisaWirth\" width=\"300\" height=\"183\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/brain_LisaWirth-300x183.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/brain_LisaWirth.jpg 493w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3250\" class=\"wp-caption-text\">Cross-section of cerebrum and thalamus and lateral aspect of brainstem<\/p><\/div>\n<\/div>\n<h3 class=\"p1\">Ataxia<\/h3>\n<p class=\"p1\"><span class=\"s1\">A patient with ataxia may have a lesion in the proprioceptive pathways (peripheral nerves, spinal cord, or cerebrum), vestibular system, or cerebellum. Ataxia can be described as an uncoordinated gait, with crossing of the limbs and, sometimes, listing or falling to 1 or both sides. Ataxia can be further characterized as:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><strong>Proprioceptive<\/strong>: Mild, usually bilateral ataxia<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\"><strong>Vestibular<\/strong>: Moderate, asymmetric ataxia<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\"><strong>Cerebellar<\/strong>: Symmetric, truncal ataxia.<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\"><span class=\"s1\"><b>Circling<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The direction of circling is usually toward the side with the lesion. The circles tend to be larger with lesions in the prosencephalon than with lesions in the vestibular system.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Cranial Nerve Abnormalities<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Cranial nerve abnormalities are signs of either a peripheral neuropathy or brainstem lesion. Brainstem lesions can be localized to the part of the brainstem where the cranial nerve nucleus is located. Peripheral neuropathy may affect only 1 nerve (eg, idiopathic facial paralysis) or be part of a polyneuropathy.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Decerebellate Posture<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">This rare posture is seen with a severe lesion in the cerebellum. Findings include:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">A mentally alert patient<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Opisthotonus (dorsiflexion of the head and neck)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Increased extensor tone in the thoracic limbs due to loss of inhibition from the cerebellum to the extensor muscles<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Pelvic limbs with reduced muscle tone that are usually flexed.<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\"><span class=\"s1\"><b>Decerebrate Posture<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">This rare posture is seen with a severe lesion in the midbrain or pons.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">The mentation in these patients is severely affected (stupor or coma).<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Opisthotonus may be present if the animal has a cerebellar lesion in addition to the brainstem lesion.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Increased extensor tone in all limbs is a result of loss of inhibitory function from the pontomedullary reticular formation (RF or RAS), which affects extensor tone of the limbs.<\/span><\/li>\n<\/ul>\n<div class=\"orange-box\">\n<p><span class=\"s1\"><b>Horner&#8217;s Syndrome &amp; Aniscoria<\/b><\/span><\/p>\n<p><span class=\"s1\"><b>Horner&#8217;s syndrome<\/b> is caused by a lack of sympathetic innervation to the eye. In patients with other neurologic dysfunction, it is most commonly seen with peripheral vestibular dysfunction, C6 to T2 myelopathy, or brachial plexus injury (ie, outside the spinal canal). Clinical signs include: <\/span><\/p>\n<ul>\n<li><span class=\"s1\">Miosis (constricted pupil)<\/span><\/li>\n<li><span class=\"s1\">Enophthalmia (sunken eye) <\/span><\/li>\n<li><span class=\"s1\">Ptosis (drooping eyelid) <\/span><\/li>\n<li><span class=\"s1\">Protrusion of the third eyelid.<\/span><\/li>\n<\/ul>\n<p><span class=\"s1\"><b>Anisocoria<\/b> refers to pupils of unequal size. <\/span><\/p>\n<ul>\n<li><span class=\"s1\">Loss of sympathetic tone (ie, Horner&#8217;s syndrome) results in one pupil failing to dilate (remaining constricted) in darkness. <\/span><\/li>\n<li><span class=\"s1\">A parasympathetic lesion (ie, deficit of the oculomotor nerve CNIII) results in one pupil failing to constrict (remaining dilated) when exposed to light. <\/span><\/li>\n<li><span class=\"s1\">Brain edema and brain herniation may cause compression of the CNIII nucleus in the midbrain, resulting in anisocoria, pinpoint pupils that do not dilate in the dark or respond to light, or fixed and dilated pupils. In these patients mental status is also altered (stuporous or comatose). This is a serious finding that requires immediate attention and treatment.<\/span><\/li>\n<\/ul>\n<\/div>\n<h3 class=\"p4\"><span class=\"s1\"><strong>Hemineglect (Hemiinattention)<\/strong><\/span><\/h3>\n<p class=\"p4\"><span class=\"s1\">Hemineglect is a reduced reaction to a stimulus (body or head) contralateral to a lesion in the cerebrum. To test for hemineglect observe the patient&#8217;s reaction (turning the head around, whining, trying to bite) while pinching the side of the trunk with hemostats. Compare reactions when pinching the other side.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Mental Status<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">A change in mental status is caused by a lesion in the prosencephalon or brainstem (the reticular activating system is diffusely spread in the brainstem and responsible for our awareness and arousability).<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Owner&#8217;s knowledge of his or her pet&#8217;s personality plus observations at home are essential to assess the patient&#8217;s mental status, especially when there are subtle mentation changes. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Repeat examinations and observation of the animal over a longer time period and in different surroundings are also helpful.<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\"><span class=\"s1\"><b>Paresis<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">A patient with a cerebral lesion usually has mild, almost unnoticeable paresis. Patients with brainstem lesions have more pronounced paresis and ataxia ipsilateral to the lesion.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Seizures<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">If there is a history of seizures, the lesion can be localized to the prosencephalon, even if the neurologic examination is normal.<\/span><\/p>\n<blockquote>\n<p class=\"p1\">For more information, see <a href=\"https:\/\/todaysveterinarypractice.com\/lesion-location-organized-by-neurologic-assessment-findings\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Lesion Location Organized by Neurologic Assessment &amp; Findings<\/strong><\/a>.<\/p>\n<\/blockquote>\n<h2 class=\"p3\"><span class=\"s1\"><b>THE SPINAL CORD<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Patients with spinal cord lesions have normal mental status and cranial nerves. Spinal cord lesions can be localized based on:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Gait abnormalities<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Postural reaction deficits<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Spinal reflex abnormalities.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">The spinal cord is divided into 4 functional regions: (1) <strong>C1 to C5<\/strong>, (2) <strong>C6 to T2<\/strong>, (3) <strong>T3 to L3<\/strong>, and (4) <strong>L4 to S3<\/strong>.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">A lesion in the C1 to C5 or C6 to T2 spinal cord segment results in tetraparesis and often postural reaction deficits in all limbs. Sometimes the pelvic limbs are more affected than the thoracic limbs. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">A lesion in the T3 to L3 or L4 to S3 spinal cord segment results in paraparesis and postural reaction deficits in the pelvic limbs.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">The C6 to T2 and L4 to S3 spinal cord segments are anatomically enlarged (thus, cervical and lumbar intumescences) because they contain the nerve cell bodies of the peripheral nerves to the limbs and tail. It is important to understand that these enlarged spinal cord segments are normal anatomy when evaluating images of the spinal cord.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">In addition to postural reaction assessment, these areas are also evaluated by testing the spinal reflexes (<b>Figure 1<\/b>).<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">A lesion in the C1 to C5 or T3 to L3 spinal cord segment results in normal (sometimes increased) spinal reflexes (upper motor neuron signs) (<b>Figures 2 and 3<\/b>). <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">A lesion in the C6 to T2 or L4 to S3 spinal cord segment results in reduced muscle tone and reduced spinal reflexes in the thoracic limbs (C6\u2013T2) or pelvic limbs (L4\u2013S3) (lower motor neuron signs) (<b>Figures 4 and 5<\/b>).<\/span><\/li>\n<\/ul>\n<div id=\"attachment_3253\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-1.jpg\"><img decoding=\"async\" aria-describedby=\"caption-attachment-3253\" class=\"wp-image-3253 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-1-300x225.jpg\" alt=\"Neuro_Figure 1\" width=\"300\" height=\"225\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-1-300x225.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-1.jpg 400w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3253\" class=\"wp-caption-text\">Figure 1. Myotatic and withdrawal reflex pathways; thoracic and pelvic limbs<\/p><\/div>\n<div id=\"attachment_3254\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-2.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3254\" class=\"wp-image-3254 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-2-300x225.jpg\" alt=\"Neuro_Figure 2\" width=\"300\" height=\"225\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-2-300x225.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-2.jpg 400w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3254\" class=\"wp-caption-text\">Figure 2. C1 to C5 myelopathy: Postural reactions are delayed or absent in all limbs (red lines); spinal reflexes are normal or increased (green lines)<\/p><\/div>\n<div id=\"attachment_3255\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-3.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3255\" class=\"wp-image-3255 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-3-300x225.jpg\" alt=\"Neuro_Figure 3\" width=\"300\" height=\"225\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-3-300x225.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-3.jpg 400w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3255\" class=\"wp-caption-text\">Figure 3. T3 to L3 myelopathy: Postural reactions and spinal reflexes in thoracic limbs are normal; postural reactions are delayed or absent (red lines) but spinal reflexes are normal or increased (green lines) in pelvic limbs<\/p><\/div>\n<div id=\"attachment_3256\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-4.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3256\" class=\"wp-image-3256 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-4-300x225.jpg\" alt=\"Neuro_Figure 4\" width=\"300\" height=\"225\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-4-300x225.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-4.jpg 400w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3256\" class=\"wp-caption-text\">Figure 4. C6 to T2 myelopathy: Postural reactions are delayed or absent in all limbs; spinal reflexes are reduced or absent in thoracic limbs (red lines) and normal or increased in pelvic limbs (green lines)<\/p><\/div>\n<div id=\"attachment_3257\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-5.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3257\" class=\"wp-image-3257 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-5-300x225.jpg\" alt=\"Neuro_Figure 5\" width=\"300\" height=\"225\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-5-300x225.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro_Figure-5.jpg 400w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3257\" class=\"wp-caption-text\">Figure 5. L4 to S3 myelopathy: Postural reactions and spinal reflexes in thoracic limbs are normal (green lines); postural reactions are delayed or absent and spinal reflexes are reduced or absent in pelvic limbs (red lines)<\/p><\/div>\n<h3><b>Paresis<\/b><\/h3>\n<p class=\"p1\"><span class=\"s1\">Tetraparesis without cranial nerve deficits or other brainstem signs suggests a cervical myelopathy; paraparesis is suggestive of a thoracolumbar myelopathy.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Schiff-Sherrington Posture<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">This posture is seen with severe spinal cord injury between the T3 and L4 spinal cord segments. There is increased tone in the thoracic limbs, and normal or reduced tone with paralysis of the pelvic limbs; the prognosis is guarded but not hopeless.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The posture results from loss of normal inhibition of the thoracic limb extensor muscle tone, which is normally controlled by the border cells in the lumbar spinal cord. Axons of these cells ascend the spinal cord to reach the cervical intumescence, where they inhibit the thoracic limb extensor motor neurons.<\/span><\/p>\n<div class=\"orange-box\">\n<h2 class=\"p1\"><b>Postural Reaction Assessment<\/b><\/h2>\n<p class=\"p1\"><span class=\"s1\">All postural reaction tests assess the <strong>sensory pathway<\/strong> from the paw to the brain stem and contralateral cerebrum (through the limb and spinal cord) and the <strong>motor pathway<\/strong> that returns the same way to the paw (<strong>Figures A and B<\/strong>).<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Conscious recognition is required from the cerebrum in order for the patient to replace the paw correctly; a slow or absent response indicates a problem somewhere along the pathway. The pathways to and from the cerebellum contribute to the response and, in patients with cerebellar lesions, cause altered postural reactions.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Other findings help pinpoint the lesion to a specific area.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">In patients with brain disorders, postural reaction deficits are <strong>ipsilateral<\/strong> (both thoracic and pelvic limbs) to a lesion in the brainstem and <strong>contralateral<\/strong> to a lesion in the cerebrum and thalamus (<strong>Figure C<\/strong>). <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">A patient with a cervical myelopathy (<strong>C1\u2013C5 or C6\u2013T2<\/strong>) has postural reaction deficits in all limbs; a patient with a thoracolumbar myelopathy (<strong>T3\u2013L3 or L4\u2013S3<\/strong>) or cauda equina syndrome has postural reaction deficits only in the pelvic limbs.<\/span><\/li>\n<\/ul>\n<div id=\"attachment_3258\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureA.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3258\" class=\"wp-image-3258 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureA-300x108.jpg\" alt=\"Neuro2_FigureA\" width=\"300\" height=\"108\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureA-300x108.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureA-768x275.jpg 768w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureA.jpg 837w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3258\" class=\"wp-caption-text\">Figure A. Thoracic limb left (black) and right (blue) postural reaction pathways<\/p><\/div>\n<div id=\"attachment_3259\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureB.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3259\" class=\"wp-image-3259 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureB-300x108.jpg\" alt=\"Neuro2_FigureB\" width=\"300\" height=\"108\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureB-300x108.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureB-768x275.jpg 768w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureB.jpg 837w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3259\" class=\"wp-caption-text\">Figure B. Pelvic limb left (black) and right (blue) postural reaction pathways<\/p><\/div>\n<div id=\"attachment_3260\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureC.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3260\" class=\"wp-image-3260 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureC-300x108.jpg\" alt=\"Neuro2_FigureC\" width=\"300\" height=\"108\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureC-300x108.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureC-768x275.jpg 768w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Neuro2_FigureC.jpg 837w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3260\" class=\"wp-caption-text\">Figure C. With a left-sided brainstem lesion or right-sided cerebral lesion, postural reactions are affected in the left thoracic and pelvic limbs (red lines) but normal on the right side (green lines)<\/p><\/div>\n<\/div>\n<h2 class=\"p1\"><b style=\"line-height: 1.5\">THE PERIPHERAL NERVOUS SYSTEM<\/b><\/h2>\n<p class=\"p1\"><span class=\"s1\">The peripheral nervous system includes the: <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Neuromuscular system (peripheral motor nerves, muscles, and neuromuscular junctions)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Sensory nervous system <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Autonomic nervous system.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Peripheral nervous system diseases can be difficult to diagnose, with signs of neurologic dysfunction being vague or nonexistent. The following information does not pertain to diseases of the autonomic nervous system.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Patients with neuromuscular disease can have both paresis and muscular weakness as well as exercise intolerance.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Sometimes muscle pain is present.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Postural reaction deficits and reduced spinal reflexes may be present. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">The history may reveal signs of neuromuscular disease, such as exercise intolerance, generalized weakness, voice change, and neurogenic muscle atrophy; these signs may be intermittent.<\/span><\/li>\n<\/ul>\n<div class=\"orange-box\">\n<h2 class=\"p3\"><span class=\"s1\"><b>Signs of Vestibular System Dysfunction<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Spontaneous nystagmus, vestibular ataxia, positional strabismus, head tilt, and circling are all signs of vestibular system dysfunction. The lesion may be in the inner ear or eighth cranial nerve (peripheral vestibular system) or in the brainstem or cerebellum (central vestibular system). Additional signs of brainstem dysfunction that are used to localize the lesion to the central vestibular system include:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Ipsilateral postural reaction deficits<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Changes in mental status<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Deficits in other cranial nerves.<\/span><\/li>\n<\/ul>\n<\/div>\n<h2 class=\"p3\"><span class=\"s1\"><b>THE CAUDA EQUINA<\/b><\/span><\/h2>\n<p><span class=\"s1\">The cauda equina are the spinal nerves (<strong>L6\u2013L7, S1\u2013S3, and Cd1\u2013Cd5<\/strong>) caudal to the spinal cord in the lumbar vertebral canal.<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Compression of the cauda equina initially results in pain, followed by paraparesis and postural reaction deficits. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Later in the disease, reduced spinal reflexes to the pelvic limbs, anus, and urinary sphincter are present.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">A history that includes slowly progressive paraparesis (over many months) and pain on palpation of the lumbosacral area can help localize a lesion to the cauda equina.<\/span><\/li>\n<\/ul>\n<h2 class=\"p3\"><span class=\"s1\"><b>FURTHER DIAGNOSIS<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Once the lesion is localized to a specific area of the nervous system, a list of differential diagnoses can be made. Based on lesion localization and differential diagnoses, appropriate diagnostic tests can be chosen.<\/span><\/p>\n<p class=\"p7\"><span class=\"s1\"><b>Suggested Reading<\/b><\/span><\/p>\n<ul>\n<li class=\"p7\"><span class=\"s1\">DeLahunta A, Glass E (ed). <em>The neurologic examination. Veterinary Neuroanatomy and Clinical Neurology<\/em>, 3rd ed. Philadelphia: WB Saunders, 2009, pp 487-501.<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Dewey C. Functional and dysfunctional neuroanatomy: The key to lesion localization. In Dewey C (ed): <em>A Practical Guide to Canine and Feline Neurology<\/em>, 2nd ed. Ames, IA: Blackwell Publishing, 2003, pp 17-52.<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Garosi L. Lesion localization and differential diagnosis. In Platt SR, Olby NJ (ed): <em>BSAVA Manual of Canine and Feline Neurology<\/em>, 3rd ed. Quedgeley, Gloucestershire, UK: BSAVA, 2004, pp 24-34.<\/span><\/li>\n<li class=\"p7\"><span class=\"s1\">Lorenz MD, Kornegay JN. Localization of lesions in the nervous system. <em>Handbook of Veterinary Neurology<\/em>, 4th ed. Philadelphia: WB Saunders, 2004, pp 45-74.<\/span><\/li>\n<\/ul>\n<p class=\"p7\"><span class=\"author-bio\"><strong><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Helena-Rylander.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-9302\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/03\/Helena-Rylander.png\" alt=\"Helena Rylander\" width=\"100\" height=\"127\" \/><\/a>Helena Rylander<\/strong>, DVM, Diplomate ACVIM (Neurology), is a clinical assistant professor in the Department of Medical Sciences at University of Wisconsin\u2013Madison&#8217;s School of Veterinary Medicine. Her clinical interests include spinal surgery, electrophysiology, and diagnostic imaging. Dr. Rylander has published several articles and a book chapter as well as presented at national and international meetings. She received her veterinary degree from University of Agricultural Sciences in Uppsala, Sweden. After 10 years in private practice in Sweden, Dr. Rylander completed a residency in neurology\/neurosurgery at University of California\u2013Davis. She also completed the Educational Commission for Foreign Veterinary Graduates (ECFVG) certification program and received her DVM.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Helena Rylander, DVM, Diplomate ACVIM (Neurology) Once a neurologic examination has been completed in a patient, the practitioner can use the abnormalities, or lack thereof, to help localize the lesion to the brain, spinal cord, peripheral nervous system, or cauda equine, which provides critical information on the patient&#8217;s condition.<\/p>\n","protected":false},"author":1,"featured_media":2739,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":8513,"footnotes":""},"categories":[375],"tags":[13],"class_list":["post-1347","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-march-april-2013","tag-peer-reviewed","column-features","clinical_topics-neurology"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>The Neurologic Examination In Companion Animals, Part 2: Interpreting Abnormal Findings | Today&#039;s Veterinary Practice<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" 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