{"id":1372,"date":"2013-01-01T17:25:44","date_gmt":"2013-01-01T17:25:44","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1372"},"modified":"2022-02-18T16:53:44","modified_gmt":"2022-02-18T16:53:44","slug":"the-neurologic-examination-in-companion-animals-part-1-performing-the-examination","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/","title":{"rendered":"How to Perform a Neurologic Examination in Companion Animals"},"content":{"rendered":"<p class=\"p1\">A complete neurologic examination should be completed in any patient with a suspected neurologic condition. <span class=\"s1\">In any patient with a suspected neurologic condition, a complete neurologic examination should follow the physical examination. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The purpose of the neurologic examination is to: <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>1. Confirm the existence of a neurologic condition<br \/>\n2. Localize the lesion (ie, make a neuroanatomical diagnosis).<\/b><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Repeat neurologic examinations are helpful to detect subtle changes or progression of signs.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">This article will discuss how to perform the neurologic examination<br \/>\n<img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone wp-image-4528 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Screen-Shot-2015-06-16-at-4.49.42-PM-e1458936499673.png\" alt=\"Screen Shot 2015-06-16 at 4.49.42 PM\" width=\"341\" height=\"418\" \/><br \/>\n<\/span><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>NEUROLOGIC EXAMINATION OVERVIEW<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">The neurologic examination can be divided by evaluation of:<\/span><\/p>\n<ol class=\"ol1\">\n<li class=\"li1\"><span class=\"s1\">Mentation<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Posture and gait<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Cranial nerves<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Postural reactions<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Spinal reflexes<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Pain on spinal palpation<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Pain perception.<\/span><\/li>\n<\/ol>\n<h2 class=\"p3\"><span class=\"s1\"><b>1. MENTATION<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">While taking the patient&#8217;s history (see <b>Taking a History: Questions to Ask<\/b>), allow the animal to explore the examination room, which provides an opportunity to perform a mentation evaluation. This evaluation requires some knowledge of the patient&#8217;s normal behavior.<\/span><\/p>\n<p class=\"p1\">Mentation can be described as follows:<\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\"><span class=\"s2\"><b>Normal:\u00a0<\/b><\/span><span class=\"s1\">Bright, alert, responsive or quiet<\/span><\/span><\/li>\n<li class=\"p1\"><span class=\"s2\"><b>Obtunded:<\/b><\/span><span class=\"s1\"> Reduced response to the environment<\/span>\n<ul>\n<li class=\"li1\"><span class=\"s1\"><strong>Mild<\/strong> obtundation may be mistaken for lethargy or systemic illness and only noticed by the owner (who is familiar with the pet&#8217;s normal behavior); a mild decrease in response to auditory stimulus is present.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\"><strong>Moderate<\/strong> obtundation results in an animal that is still responsive to voices (such as its name being called) and noises; however, stronger stimuli may be required and the animal&#8217;s response may not be normal. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\"><strong>Severe<\/strong> obtundation usually causes the patient to become nonambulatory but the animal is still responsive to loud noises and hand clapping.<\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><span class=\"s2\"><b>Comatose:<\/b><\/span><span class=\"s1\"> Unconscious; patient cannot be aroused despite stimulus<\/span><\/li>\n<li class=\"li1\"><span class=\"s2\">Other <\/span><span class=\"s3\">changes may<\/span><span class=\"s1\"> be described, including compulsive behavior, agitation, aggression, and dementia.<\/span><\/li>\n<\/ul>\n<div class=\"orange-box\">\n<h2 class=\"p4\"><span class=\"s1\"><b>Taking a History: Questions to Ask<\/b><\/span><\/h2>\n<ul>\n<li class=\"p4\"><span class=\"s1\">How did the clinical signs occur (acute versus insidious onset)?<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Have the signs progressed and how have they done so?<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Has the patient been treated previously?<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">If so, what was the response to treatment?<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Does the patient seem to be in pain?<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">What behavior\/signs are believed to indicate this pain?<\/span><\/li>\n<\/ul>\n<\/div>\n<h2 class=\"p3\"><span class=\"s1\"><b>2. POSTURE &amp; GAIT<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\"><strong>Posture<\/strong> describes the animal at rest; the following conditions may be noted:<\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s2\"><b>Kyphosis<\/b><\/span><span class=\"s1\"> (dorsal curvature of the spine)<\/span><\/li>\n<li class=\"p1\"><span class=\"s2\"><b>Lordosis<\/b><\/span><span class=\"s1\"> (ventral curvature of the spine)<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\"><b>Head tilt<\/b><\/span><\/li>\n<li class=\"p1\"><span class=\"s1\"><b>Head and neck turn<\/b><\/span><\/li>\n<li class=\"p1\"><span class=\"s1\"><b>Wide-based stance. <\/b><\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">The following postures are rare but can help in lesion localization:<\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s2\"><b>Decerebrate posture:<\/b><\/span><span class=\"s1\"> Extension of all limbs<\/span><\/li>\n<li class=\"p1\"><span class=\"s2\"><b>Decerebellate posture<\/b><\/span><span class=\"s1\">: Extension of thoracic limbs; flexion of pelvic limbs<\/span><\/li>\n<li class=\"p1\"><span class=\"s2\"><b>Opisthotonus:<\/b><\/span><span class=\"s1\"> Dorsoflexion of head and neck<\/span><\/li>\n<li class=\"p1\"><span class=\"s2\"><b>Schiff-Sherrington posture:<\/b><\/span><span class=\"s1\"> Increased tone in forelimbs; paralysis in hindlimbs <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><strong>Gait<\/strong> is assessed both in the examination room and in an area where the patient can be walked; stairs may be useful for detection of subtle gait abnormalities. Gait abnormalities are often a mix of weakness, paresis, and ataxia. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The following key words should be used to describe gait:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li5\"><b><\/b><span class=\"s1\"><b>Ambulatory\/Nonambulatory:<\/b><\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">An <i>ambulatory<\/i> <i>patient<\/i> should be able to walk on all 4 limbs, supporting its body weight and advancing without assistance. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">A <i>nonambulatory patient<\/i> is not able to support its weight or walk; nonambulatory can refer to all limbs or only the pelvic limbs. See <b>Motor Function Assessment<\/b> for information on evaluating nonambulatory patients.<\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li5\"><b><\/b><span class=\"s1\"><b>Ataxia:<\/b><\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Proprioceptive ataxia<\/i>: Symmetric; lack of coordination can be mild.<\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Vestibular ataxia<\/i>: Asymmetric; patient tends to drift or fall to one side of mid line. Note: Metronidazole toxicity may manifest in a mix of vestibular and cerebellar signs, including ataxia.<\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Cerebellar ataxia<\/i>: Symmetric; no loss of strength in the limbs; a &#8220;bouncy&#8221; gait with hypermetria (overreaching the intended object or goal) of the limbs is present.<\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li5\"><b><\/b><span class=\"s1\"><b>Paresis &amp; Plegia:<\/b><\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Paresis<\/i> describes reduced voluntary motor function. <\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Plegia<\/i> describes loss of motor function. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Patients may be <i>mono-, hemi-, para-, <\/i>or<i> tetra<\/i>&#8211; paretic or plegic, depending on how many and which limbs are involved.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">With paresis, there is often a certain degree of weakness as well. Weakness can be <i>neurogenic<\/i>, if the lesion is located in the central nervous system or peripheral nerves, or true <i>muscular<\/i> <em>weakness<\/em>.<\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><b><\/b><span class=\"s2\"><b>Lameness<\/b><\/span><span class=\"s1\"> can be neurologic or orthopedic in origin.<\/span><\/li>\n<\/ul>\n<p>Other abnormalities that provide a more precise description of the quality and degree of the paresis include:<\/p>\n<ul>\n<li><span class=\"s1\"><span class=\"s2\"><b>Discombobulate or 2-engine gait:<\/b><\/span> Short choppy gait in the thoracic limbs with a long stride in the pelvic limbs<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\"><b>Knuckling, stumbling, or falling<\/b><\/span><span class=\"s5\"> when walking.<\/span><\/li>\n<\/ul>\n<div class=\"orange-box\">\n<h3 class=\"p1\"><span class=\"s1\"><b>Paresis versus Weakness<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\"><strong>Paresis<\/strong> describes reduced <em>voluntary motor function<\/em>, while <strong>weakness<\/strong> describes a <em>loss of muscle strength<\/em>.<\/span><\/p>\n<\/div>\n<h2 class=\"p3\"><span class=\"s1\">3. CRANIAL NERVE EXAMINATION<br \/>\n<\/span><\/h2>\n<p class=\"p3\"><span class=\"s1\">Cranial nerve evaluations are either reflexes or reactions:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><b><\/b><span class=\"s2\"><b>Reflexes<\/b><\/span><span class=\"s1\"> include cranial nerve reflexes and spinal reflexes. These reflexes involve the: <\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Sensory, afferent peripheral nerves or cranial nerves<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Interneurons in the spinal cord or brainstem (<em>Note<\/em>: While some monosynaptic reflexes do not rely on any interneurons, very few fall into this category.) <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Efferent motor neurons.<\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><b><\/b><span class=\"s2\"><b>Responses<\/b><\/span><span class=\"s1\"> involve the:<\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Afferent sensory pathways <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Efferent motor pathways <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Cerebrum.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span class=\"s1\">Several of the tests to assess cranial nerve function rely on responses; for example, when the patient moves its head away when sensation of the face is tested. See <a href=\"https:\/\/todaysveterinarypractice.com\/clinical-resources\/\" target=\"_blank\" rel=\"noopener noreferrer\"><b>Cranial Nerve Assessment<\/b> <\/a>for a description of cranial nerve assessment tests, available at todaysveterinarypractice.com (Resources).<\/span><\/p>\n<div class=\"orange-box\">\n<h2 class=\"p4\"><span class=\"s1\"><b>MOTOR FUNCTION ASSESSMENT<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">To assess motor function in a nonambulatory patient:<\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Support the patient under the pelvis (or under the pelvis and chest for tetraparetic\/plegic patients)<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Encourage the patient to move forward.<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">This momentum sometimes helps the practitioner see voluntary movement.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Motor function can also be assessed by: <\/span><\/p>\n<p class=\"p1\" style=\"padding-left: 30px\"><span class=\"s1\">\u2022 Calling the patient. <\/span><\/p>\n<p class=\"p1\" style=\"padding-left: 30px\"><span class=\"s1\">\u2022 Then encouraging the patient to walk with you. <\/span><\/p>\n<p class=\"p1\" style=\"padding-left: 30px\"><span class=\"s1\">\u2022Voluntary movement may be seen as the patient tries to sit up and move forward. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><i><strong>Note<\/strong>:<\/i> Movements elicited when touching the patient may be reflex movements rather than actual voluntary movement.<\/span><\/p>\n<\/div>\n<blockquote>\n<p class=\"p3\"><span class=\"s2\"><b>AFFERENT NERVES:<\/b><\/span><span class=\"s1\"> Carry impulses from receptors to the central nervous system<\/span><\/p>\n<p class=\"p1\"><span class=\"s2\"><b>EFFERENT NERVES<\/b><\/span><span class=\"s1\">: Carry impulses away from the central nervous system to effectors<\/span><\/p>\n<\/blockquote>\n<h2 class=\"p1\"><span class=\"s1\"><b>4. POSTURAL REACTIONS<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Postural reactions are complex responses that maintain an animal in its normal, upright position. An abnormality indicates a lesion anywhere along the ascending or descending pathways in the peripheral or central nervous systems. A lesion in the cerebral cortex may cause marked abnormalities in postural reactions without any change in gait.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Postural reaction tests are challenging to perform well and require good technique and a cooperative patient. The paw replacement test (previously called conscious proprioception) and hopping test are the assessments most frequently performed.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">If results are equivocal due to poor technique or an uncooperative patient, other tests can be performed to confirm findings. In patients that are weak from systemic illness or sedated with drugs, the paw replacement test may be delayed or absent.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">See <b>Postural Reaction Assessment<\/b> for a list of tests and descriptions on how to perform them.<\/span><\/p>\n<h2 class=\"p1\"><b>POSTURAL REACTION ASSESSMENT<\/b><\/h2>\n<h3 class=\"p4\"><span class=\"s1\"><b>Paw Replacement (Figures 1 and 2)<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">\u2022 Flex the paw so the dorsum of the paw is on the floor; do not let the patient put weight on the paw. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 The patient should return the paw to a normal position. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 A nonslippery surface and good support of the animal are essential to detect subtle deficits.<\/span><\/p>\n<div id=\"attachment_3346\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-1A.jpg\"><img decoding=\"async\" aria-describedby=\"caption-attachment-3346\" class=\"wp-image-3346 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-1A-300x208.jpg\" alt=\"Figure 1A\" width=\"300\" height=\"208\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-1A-300x208.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-1A.jpg 433w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3346\" class=\"wp-caption-text\">Figure 1A<\/p><\/div>\n<div id=\"attachment_3347\" style=\"width: 275px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-1B.jpg\"><img decoding=\"async\" aria-describedby=\"caption-attachment-3347\" class=\"wp-image-3347 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-1B-265x300.jpg\" alt=\"Figure 1B\" width=\"265\" height=\"300\" \/><\/a><p id=\"caption-attachment-3347\" class=\"wp-caption-text\">Figure 1B<\/p><\/div>\n<p><em><strong>Figure 1.<\/strong> Paw replacement (thoracic limb): The patient is supported under the chest (<strong>A<\/strong>) to prevent loss of balance when the paw is knuckled over (<strong>B<\/strong>). Place a hand above the paw and only use a few fingers to flex the toes; then the patient will be less likely to pull the foot away when touched.<\/em><\/p>\n<div id=\"attachment_3348\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-2.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3348\" class=\"wp-image-3348 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-2-300x243.jpg\" alt=\"Figure 2\" width=\"300\" height=\"243\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-2-300x243.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-2.jpg 370w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3348\" class=\"wp-caption-text\">Figure 2. Paw replacement (pelvic limb): Support the patient under the pelvis or caudal abdomen; then place the hand above the paw.<\/p><\/div>\n<h3 class=\"p1\"><span class=\"s1\"><b>Visual &amp; Tactile Placing<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">\u2022 With the patient in your arms, slowly (so not to induce a vestibular response) approach a table or other surface and let the dorsum of the paw touch the table; the paw &#8220;away&#8221; from your body is tested. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 In visual placing, the patient is allowed to see the table; in tactile placing, the patient&#8217;s eyes are covered.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Hopping (Figures 3 and 4)<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">\u2022 Push the patient over toward the foot that is on the ground. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 Poor initiation of the hopping reaction suggests sensory (proprioceptive) deficits; poor follow-through suggests a motor system abnormality (paresis).<\/span><\/p>\n<div id=\"attachment_3350\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-4.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3350\" class=\"wp-image-3350 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-4-300x253.jpg\" alt=\"Figure 4\" width=\"300\" height=\"253\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-4-300x253.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-4.jpg 356w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3350\" class=\"wp-caption-text\">Figure 3. Hopping (thoracic limb): Place one hand under the abdomen to life the pelvic limbs from the ground; the other hand folds a thoracic limb back along the chest while pushing the animal toward the standing limb.<\/p><\/div>\n<div id=\"attachment_3349\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-3.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3349\" class=\"wp-image-3349 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-3-300x251.jpg\" alt=\"Figure 3\" width=\"300\" height=\"251\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-3-300x251.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-3.jpg 358w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3349\" class=\"wp-caption-text\">Figure 4. Hopping (pelvic limb): One hand under the chest lifts the thoracic limbs off the ground; the other hand, placed by the femur, lifts one pelvic limb off the ground and pushes the patient toward the standing limb.<\/p><\/div>\n<h3 class=\"p1\"><span class=\"s1\"><b>Wheel Barrowing (Figure 5)<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">\u2022 Wheel barrowing can be done with or without extending the neck. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 By extending the neck and elevating the head, visual compensation is removed, making the test more challenging and allowing detection of subtle abnormalities.<\/span><\/p>\n<div id=\"attachment_3351\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-5.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3351\" class=\"wp-image-3351 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-5-300x270.jpg\" alt=\"Figure 5\" width=\"300\" height=\"270\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-5-300x270.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-5.jpg 333w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3351\" class=\"wp-caption-text\">Figure 5. Wheelbarrow: Lift the pelvic limbs from the ground and move the patient forward, just as you would push a wheelbarrow.<\/p><\/div>\n<h3 class=\"p1\"><span class=\"s1\"><b>Extensor Postural Thrust (Figure 6)<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">\u2022 The patient is lifted straight up; then lowered to the ground. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 As the pelvic limb paws touch the ground, the patient extends the hocks and takes a few steps backwards to find its balance. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 The patient should not be walked backwards (ie, reverse wheel barrowing).<\/span><\/p>\n<div id=\"attachment_3352\" style=\"width: 258px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-6.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3352\" class=\"wp-image-3352 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-6-248x300.jpg\" alt=\"Figure 6\" width=\"248\" height=\"300\" \/><\/a><p id=\"caption-attachment-3352\" class=\"wp-caption-text\">Figure 6. Extensor postural thrust: Elevate the patient from the ground by wrapping arms around chest; then lower animal until pelvic limbs touch the ground.<\/p><\/div>\n<h3 class=\"p1\"><span class=\"s1\"><b>Hemiwalking (Figure 7)<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">\u2022 Hemiwalking is similar to hopping, but 2 ipsilateral (same side) limbs remain on the ground. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 In severely affected patients, hopping and hemiwalking should either be done carefully or not at all, as these patients can fall, which may result in injury.<\/span><\/p>\n<div id=\"attachment_3353\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-7.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3353\" class=\"wp-image-3353 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-7-300x290.jpg\" alt=\"Figure 7\" width=\"300\" height=\"290\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-7-300x290.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-7.jpg 310w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3353\" class=\"wp-caption-text\">Figure 7. Hemiwalking: Lift the limbs on the same side from the ground and push the patient toward the other side, which forces the animal to hop with the limbs on the ground.<\/p><\/div>\n<h2 class=\"p1\"><b>5. SPINAL REFLEXES<\/b><\/h2>\n<p class=\"p1\"><span class=\"s1\">Examination of spinal reflexes assesses the: <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Integrity of the sensory and motor components of the reflex arch <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Influence of descending motor pathways on the reflex. <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">The reflex hammer (percussion hammer) is used to hit the tendon of the muscle tested. Keep the muscle and tendon slightly stretched. Repositioning of the limb may be required several times to find a reflex.<\/span><\/p>\n<h3 class=\"p1\"><span class=\"s1\"><b>Myotatic reflexes for the thoracic limbs:<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">\u2022 Biceps reflex evaluates C6 to C8 spinal nerves and, peripherally, the musculocutaneous nerve (<b>Figure 8<\/b>).<\/span><\/p>\n<div id=\"attachment_3354\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-8.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3354\" class=\"wp-image-3354 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-8-300x195.jpg\" alt=\"Figure 8\" width=\"300\" height=\"195\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-8-300x195.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-8.jpg 461w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3354\" class=\"wp-caption-text\">Figure 8. Biceps reflex: While pulling the limb slightly caudally, place a finger over the tendon and tap the finger with the pleximeter. In large-breed dogs, the reflex is easier to see if the limb is held parallel to the floor.<\/p><\/div>\n<p class=\"p1\"><span class=\"s1\">\u2022 Triceps reflex evaluates C7 to T1 spinal nerves and, peripherally, the radial nerve (<b>Figure 9<\/b>).<\/span><\/p>\n<div id=\"attachment_3355\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-9.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3355\" class=\"wp-image-3355 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-9-300x175.jpg\" alt=\"Figure 9\" width=\"300\" height=\"175\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-9-300x175.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-9.jpg 514w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3355\" class=\"wp-caption-text\">Figure 9. Triceps reflex: Flex and abduct the elbow by holding the limb over the radius\/ulna. Tap the triceps tendon with the hammer.<\/p><\/div>\n<h3 class=\"p1\"><span class=\"s1\"><b>Myotatic reflexes for the pelvic limbs: <\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">\u2022 Patellar reflex evaluates L4 to L6 spinal nerves and the femoral nerve (<b>Figure 10<\/b>).<\/span><\/p>\n<div id=\"attachment_3356\" style=\"width: 284px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-10.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3356\" class=\"wp-image-3356 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-10-274x300.jpg\" alt=\"Figure 10\" width=\"274\" height=\"300\" \/><\/a><p id=\"caption-attachment-3356\" class=\"wp-caption-text\">Figure 10. Patella reflex: Slightly flex the stifle and tap the patella tendon with the pleximeter. A normal response is forward movement of the tibia and extension of the stifle.<\/p><\/div>\n<p class=\"p1\"><span class=\"s1\">\u2022 Gastrocnemius reflex evalutes L7 to S1 spinal nerves and, peripherally, the tibial branch of sciatic nerve (<b>Figure 11<\/b>).<\/span><\/p>\n<div id=\"attachment_3357\" style=\"width: 301px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-11.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3357\" class=\"wp-image-3357 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-11-291x300.jpg\" alt=\"Figure 11\" width=\"291\" height=\"300\" \/><\/a><p id=\"caption-attachment-3357\" class=\"wp-caption-text\">Figure 11. Gastrocnemius reflex: Flex and abduct the hock by holding the limb over the metatarsus; keep the hock flexed, which keeps the tendon tense.<\/p><\/div>\n<h3 class=\"p1\"><span class=\"s1\"><b>Withdrawal reflex:<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">\u2022 The withdrawal reflex engages all nerves in the thoracic (C6\u2013T2) and lumbar (L4\u2013S3) intumescences, respectively (<b>Figures 12 and 13<\/b>).<\/span><\/p>\n<div id=\"attachment_3358\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-12.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3358\" class=\"wp-image-3358 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-12-300x262.jpg\" alt=\"Figure 12\" width=\"300\" height=\"262\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-12-300x262.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-12.jpg 344w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3358\" class=\"wp-caption-text\">Figure 12. Withdrawal reflex (thoracic limb): Watch for flexion of all joints; the reduced reflex often is best seen in the shoulder joint.<\/p><\/div>\n<div id=\"attachment_3359\" style=\"width: 238px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-13.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3359\" class=\"wp-image-3359 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-13-228x300.jpg\" alt=\"Figure 13\" width=\"228\" height=\"300\" \/><\/a><p id=\"caption-attachment-3359\" class=\"wp-caption-text\">Figure 13. Withdrawal reflex (pelvic limb): Watch for flexion of all joints; the reduced reflex often is best seen in the hock.<\/p><\/div>\n<p class=\"p1\"><span class=\"s1\">\u2022 This reflex is induced by touching or pinching the skin of the toe web. A stronger stimulus may be required in a tense patient with increased muscle tone. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 It is important to assess the quality of the entire reflex and watch for full flexion of all joints.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Perineal reflex:<\/b> Evaluates S1 to S3 spinal nerves and, peripherally, the pudendal nerve.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Cutaneous trunci reflex:<\/b> The sensory pathway from the skin enters the spinal cord and ascends bilaterally to the C8 to T1 spinal cord segment, where it synapses with the lateral thoracic nerve, resulting in a contraction of the cutaneous trunci muscles bilaterally (<b>Figure 14<\/b>).<\/span><\/p>\n<div id=\"attachment_3360\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-14.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3360\" class=\"wp-image-3360 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-14-300x198.jpg\" alt=\"Figure 14\" width=\"300\" height=\"198\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-14-300x198.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-14.jpg 454w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3360\" class=\"wp-caption-text\">Figure 14. Cutaneous trunci reflex: This reflex is present cranial to the L4 spinal cord segment, which approximately correlates to the wings of the ilium.<\/p><\/div>\n<h2 class=\"p1\"><span class=\"s1\"><b>6. PALPATION<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">The last step in the neurologic examination is palpation along the spine and muscles for pain; muscle tone and atrophy can also be evaluated. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 Assess whether the neck is painful and check range of motion (in all directions).<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 Neck flexion is usually not performed postoperatively or if an atlantoaxial subluxation (instability between C1 and C2) or fracture is suspected (<b>Figures 15 and 16<\/b>).<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 Avoid aggravating pain in limb joints by palpating the patient in lateral recumbency.<\/span><\/p>\n<div id=\"attachment_3361\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-15.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3361\" class=\"wp-image-3361 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-15-300x229.jpg\" alt=\"Figure 15\" width=\"300\" height=\"229\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-15-300x229.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-15.jpg 393w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3361\" class=\"wp-caption-text\">Figure 15. Palpation: When palpating the spine, use the free hand to support the area being palpated and prevent the patient from falling or sitting down.<\/p><\/div>\n<div id=\"attachment_3362\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-16.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3362\" class=\"wp-image-3362 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-16-300x249.jpg\" alt=\"Figure 16\" width=\"300\" height=\"249\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-16-300x249.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Figure-16.jpg 361w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3362\" class=\"wp-caption-text\">Figure 16. Palpation: When palpating the neck, palpate over the transverse processes of the vertebrae.<\/p><\/div>\n<h2><span class=\"s1\"><b>7. PAIN PERCEPTION<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">In general, pain perception is only assessed in patients with loss of motor function; however, young patients presenting with signs of a sensory neuropathy are an exception. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 Evaluate <strong>superficial pain perception<\/strong> by pinching the toe web; evaluate <strong>deep pain perception<\/strong> by pinching the periosteum of the toe. Use a hemostat for pinching. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 A conscious response from the animal indicates pain (ie, vocalizing, trying to bite, turning the head, whining, dilating pupils, increased respiratory rate). <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 Lack of deep pain perception carries a guarded to poor prognosis.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2022 <i>Note<\/i> that a withdrawal reflex can be elicited in animals with loss of pain perception; this reflex should not be mistaken for <i>voluntary motor function or pain perception<\/i>. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Once the neurologic examination has been completed, a neuroanatomic diagnosis can be made. Read <a href=\"https:\/\/todaysveterinarypractice.com\/the-neurologic-examination-in-companion-animals-part-2-interpreting-abnormal-findings\/\" target=\"_blank\" rel=\"noopener noreferrer\"><b>Part 2<\/b> of <b>The Neurologic Examination in Companion Animals<\/b><\/a>, which discusses localizing lesions and making a diagnosis, in the March\/April 2013 issue of <i>Today&#8217;s Veterinary Practice<\/i>.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>How to perform a complete neurologic examination on dogs and cats with a suspected neurologic condition.<\/p>\n","protected":false},"author":1,"featured_media":2695,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":33406,"footnotes":""},"categories":[376],"tags":[13],"class_list":["post-1372","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-january-february-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>How to Perform a Neurologic Examination in Companion Animals | Today&#039;s Veterinary Practice<\/title>\n<meta name=\"description\" content=\"How to perform a complete neurologic examination on dogs and cats with a suspected neurologic condition.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"How to Perform a Neurologic Examination in Companion Animals\" \/>\n<meta property=\"og:description\" content=\"How to perform a complete neurologic examination on dogs and cats with a suspected neurologic condition.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/\" \/>\n<meta property=\"og:site_name\" content=\"Today&#039;s Veterinary Practice\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/todaysveterinarypractice\" \/>\n<meta property=\"article:published_time\" content=\"2013-01-01T17:25:44+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2022-02-18T16:53:44+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Cover-Art-Figure-1B_blur.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"800\" \/>\n\t<meta property=\"og:image:height\" content=\"540\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"12 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"How to Perform a Neurologic Examination in Companion Animals\",\"datePublished\":\"2013-01-01T17:25:44+00:00\",\"dateModified\":\"2022-02-18T16:53:44+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/\"},\"wordCount\":2424,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2013\\\/01\\\/Cover-Art-Figure-1B_blur.jpg\",\"keywords\":[\"Peer Reviewed\"],\"articleSection\":[\"January\\\/February 2013\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/#respond\"]}]},{\"@type\":[\"WebPage\",\"MedicalWebPage\"],\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/\",\"name\":\"How to Perform a Neurologic Examination in Companion Animals | Today&#039;s Veterinary Practice\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2013\\\/01\\\/Cover-Art-Figure-1B_blur.jpg\",\"datePublished\":\"2013-01-01T17:25:44+00:00\",\"dateModified\":\"2022-02-18T16:53:44+00:00\",\"description\":\"How to perform a complete neurologic examination on dogs and cats with a suspected neurologic condition.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/#primaryimage\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2013\\\/01\\\/Cover-Art-Figure-1B_blur.jpg\",\"contentUrl\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2013\\\/01\\\/Cover-Art-Figure-1B_blur.jpg\",\"width\":800,\"height\":540},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/neurology\\\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"How to Perform a Neurologic Examination in Companion Animals\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#website\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\",\"name\":\"Today's Veterinary Practice\",\"description\":\"Peer-Reviewed Veterinary Journal\",\"publisher\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\",\"name\":\"Today's Veterinary Practice\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2022\\\/01\\\/tvp-logo.png\",\"contentUrl\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2022\\\/01\\\/tvp-logo.png\",\"width\":179,\"height\":89,\"caption\":\"Today's Veterinary Practice\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/todaysveterinarypractice\",\"https:\\\/\\\/www.youtube.com\\\/thenavc\"],\"email\":\"info@navc.com\"},{\"@type\":\"Person\",\"@id\":\"\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/author\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"How to Perform a Neurologic Examination in Companion Animals | Today&#039;s Veterinary Practice","description":"How to perform a complete neurologic examination on dogs and cats with a suspected neurologic condition.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"How to Perform a Neurologic Examination in Companion Animals","og_description":"How to perform a complete neurologic examination on dogs and cats with a suspected neurologic condition.","og_url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/","og_site_name":"Today&#039;s Veterinary Practice","article_publisher":"https:\/\/www.facebook.com\/todaysveterinarypractice","article_published_time":"2013-01-01T17:25:44+00:00","article_modified_time":"2022-02-18T16:53:44+00:00","og_image":[{"width":800,"height":540,"url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Cover-Art-Figure-1B_blur.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","twitter_misc":{"Written by":"","Est. reading time":"12 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/#article","isPartOf":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/"},"author":{"name":"","@id":""},"headline":"How to Perform a Neurologic Examination in Companion Animals","datePublished":"2013-01-01T17:25:44+00:00","dateModified":"2022-02-18T16:53:44+00:00","mainEntityOfPage":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/"},"wordCount":2424,"commentCount":0,"publisher":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/#primaryimage"},"thumbnailUrl":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Cover-Art-Figure-1B_blur.jpg","keywords":["Peer Reviewed"],"articleSection":["January\/February 2013"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/#respond"]}]},{"@type":["WebPage","MedicalWebPage"],"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/","name":"How to Perform a Neurologic Examination in Companion Animals | Today&#039;s Veterinary Practice","isPartOf":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/#primaryimage"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/#primaryimage"},"thumbnailUrl":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Cover-Art-Figure-1B_blur.jpg","datePublished":"2013-01-01T17:25:44+00:00","dateModified":"2022-02-18T16:53:44+00:00","description":"How to perform a complete neurologic examination on dogs and cats with a suspected neurologic condition.","breadcrumb":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/#primaryimage","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Cover-Art-Figure-1B_blur.jpg","contentUrl":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/Cover-Art-Figure-1B_blur.jpg","width":800,"height":540},{"@type":"BreadcrumbList","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/neurology\/the-neurologic-examination-in-companion-animals-part-1-performing-the-examination\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/"},{"@type":"ListItem","position":2,"name":"How to Perform a Neurologic Examination in Companion Animals"}]},{"@type":"WebSite","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#website","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/","name":"Today's Veterinary Practice","description":"Peer-Reviewed Veterinary Journal","publisher":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization","name":"Today's Veterinary Practice","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#\/schema\/logo\/image\/","url":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2022\/01\/tvp-logo.png","contentUrl":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2022\/01\/tvp-logo.png","width":179,"height":89,"caption":"Today's Veterinary Practice"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/todaysveterinarypractice","https:\/\/www.youtube.com\/thenavc"],"email":"info@navc.com"},{"@type":"Person","@id":"","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/author\/"}]}},"_links":{"self":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/1372","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/comments?post=1372"}],"version-history":[{"count":1,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/1372\/revisions"}],"predecessor-version":[{"id":28379,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/1372\/revisions\/28379"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/media\/2695"}],"wp:attachment":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/media?parent=1372"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/categories?post=1372"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/tags?post=1372"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}