Taber Korosec, LVT Neurology Department The lecture is intended to "fur”ther your knowledge with guidelines for a thorough history, visual assessment, and diagnostic options to help aid in the diagnosis and treatment of the neurologic patient.

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NEUROLOGIC PATIENT

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 History – (very important! - where technicians shine!)
 Physical exam
 Baseline diagnostics
 CBC/Chem
 Radiographs
 BP
 etc
THE BASICS
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 Because of Annie –
 11y golden retriever
 Acute onset of blindness and weakness (over barely 2 days)
 Whimpering and needed assistance onto the bed
 Knuckling of hind limbs
 Bumping into objects
 Inappropriate urination (in the living room)
 Reluctance to walk, stiff in all 4 limbs
 Abnormal eye position the day of exam
WHY BASELINE DIAGNOSTICS?
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 Annie’s PE
 Bumping into objects
 Abnormal behaviors (inappropriate urination, lethargy,
whimpering)
 Reluctant to walk, stiff gait
 Ventral lateral strabismus & negative menace OS
 Slight L head tilt
 Horizontal nystagmus
 Delayed hopping and proprioceptive placing with left pelvic limb
ANNIE
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ANNIE’S RADIOGRAPHS
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 Central vs peripheral
 Brain
 Spinal cord
 Nerves - neuromuscular
THE NERVOUS SYSTEM IN A NUTSHELL
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Altered mentation/behavior changes
Near normal gait
Circling (usually wide and toward the side of the lesion)
Head press (get stuck in between furniture/corners)
CP and hopping deficits contralateral to the lesion
Generalized or focal seizures
Increased ICP (intra cranial pressure) can cause patients to become
stuporous, comatose and altered respiration and papilledema can develop
papilledema – ICP causes swelling of part of the optic nerve
FOREBRAIN SYNDROME
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 Cataracts with no menace OS
 Recent onset seizures for 1 month
 Circling Left
 Bumping into objects at home
 Ambulating normally
 Hx of 2/6 heart murmur
COOPER – 15Y MN MINIATURE DACHSHUND
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COOPER’S MRI – CYSTIC MENINGIOMA
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COOPER’S RECOVERY
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 Midbrain, pons, medulla
 Maintains consciousness - if affected dullness, stupor, or coma
 Motor inputs from forebrain cross thru midbrain
- gait deficits more apparent - ipsilateral (same side) to lesion
Cranial Nerve deficits –
dysphagia – difficulty swallowing, decreased gag reflex, laryngeal paralysis
absent menace
ear/lip droop
poor jaw tone, atrophy of mastication muscles
ptosis – drooping of upper eyelid
negative PLR
BRAINSTEM SYNDROME
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 Behavior changes – aggression
 Staring off into space
 Vocalizing
 ”hugging” walls on the right side
 Circling L
IVY – 5.5Y F STANDARD POODLE
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IVY’S MRI
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 Meningoencephalitis – most commonly in small breeds
 Meningioma, lymphoma, glioma
 Trauma
 Metronidazole toxicity
 Infectious – Cryptococcus, protozoal, distemper, tick
bourne
BRAINSTEM R/O’S
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 Patients are BAR
 Increased muscle tone, normal to increased reflexes
 Hypermetric (high/goose) stepping gait
 Intention tremors - rhythmic; involuntary movement
 Delayed menace response
 Vestibular signs (head tilt, nystagmus, strabismus)
 Dysmetria – inability to regulate rate, range, force of movement
 Mydriasis – dilation of pupil w/out change in light (contralateral
to lesion)
CEREBELLAR SYNDROME
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 Previous R sided vestibular episode
 Drooling/vomiting
 Rapid progression of tetraparesis
 R head tilt with no nystagmus/strabismus
 Delayed menace OS
 Increased muscle tone
 Left sided dysmetria
MOJACK – 9Y MN GREYHOUND
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MOJACK’S MRI
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 Stroke
 Hypoplasia
 Degeneration
 GME
 Neoplasia
 Metronidazole toxicity
 Infectious – distemper, parasitic, toxoplasma, neospora,
ehrlichiosis, FIP, rocky mountain spotted fever
CEREBELLAR SYNDROME
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head tilt (usually ipsilateral to lesion)
Vestibular ataxia
Tight circling, falling, or rolling
Nystagmus
Nausea
Strabismus (usually ipsilateral to lesion)
Horner’s syndrome (peripheral)
VESTIBULAR SYNDROME
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VESTIBULAR – CENTRAL VS PERIPHERAL
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 10y MN Cockapoo
 Circling with vestibular signs
 What questions would you ask?
NIKO
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 Head tilt?
 Abnormal eye positions?
 Acute vs progressive?
 Balance loss, incoordination, ataxia?
 Listing, leaning, falling, or rolling (which direction?)
 Nausea, drooling, vomiting, anorexia?
QUESTIONS FOR NIKO
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 One month history of circling to the left (adopted 3
months ago)
 Possible hind limb ataxia
 Horizontal nystagmus (FP right) and L strabismus
 Is alert and responsive, wags tail when you call his
name
 Slight Left head tilt and turn
NIKO’S HISTORY AND SYMPTOMS
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NIKO VIDEOS
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 Otitis media/interna
 Idiopathic
 Metronidazole toxicity
 Endocrinologic (ie hypothyroidism,
hyperadrenocorticism)
 Infarct
 neoplasia
VESTIBULAR DISEASES
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ANAYA MRI – BILATERAL FACIAL PARALYSIS
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THE SPINAL CORD
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 Upper (spinal cord) vs lower (neuromuscular)
UPPER MOTOR NEURON VS LOWER MOTOR NEURON
UMN LMN
Normal to exaggerated reflexes Reduced/absent reflexes
Increased muscle tone Decreased muscle tone
Diffuse (late onset) muscle atrophy Earl/rapid onset muscle atrophy
No fasciculations Fasciculation may be present
Weakness present Weakness present
Spastic paresis Flaccid paralysis
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 Pain/discomfort
 Hunched/arched back posture
 Knuckling/scuffing/dragging/crossing – gait abnormalities
 Muscle tremors/fasciculations
 Paresis (weakness)
 Paralysis
 Low head or hind end carriage
 Reluctance or inability to jump, climb, use stairs
 Fecal/urinary incontinence
 Inability to use tail, decreased/loss of anal tone
SPINAL CORD SIGNS AND SYMPTOMS
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DOTTIE
7 y FS Beagle mix
PC: hind limb paresis
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 3 week history of HL weakness (L>R)
 Fecal and urinary incontinence
 Can longer jump, dragging LH, ataxia, not wagging her
tail
 decreased anal tone
 Lumbosacral pain noted
 Previous hemilaminectomy at L3/4
DOTTIE’S HISTORY AND SYMPTOMS
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 Dottie went to a closer referral hospital initially
 Started on Deramaxx and Gabapentin
 improvement noted with medications
 Was wagging her tail again, first play bow in weeks
 No further dragging, knuckling, scuffing noted by owners
 Still semi-incontinent (dribbling urine)
 Anal tone was present
 Still had some mild to moderate lumbosacral pain
DOTTIE HISTORY CONTINUED …
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DOTTIE MRI
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 7.5 year old MN golden retriever
 Presented to ER progressive weakness in all 4 limbs
SIR COSMO
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 Flaccid weakness x 4
 Decreased reflexes
 Decreased muscle tone
 Decreased gag reflex
SIR COSMO’S SYMPTOMS AND PE FINDINGS
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 Myasthenia gravis – acetylcholine
 Polyradiculoneuritis
 Tick paralysis
 Botulism
 polymyositis
R/O’S
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 Myasthenia gravis – tensilon test - negative
 Botulism - usually has dysphagia and not present
 Tick paralysis – had tick infestation – was clipped and
given tick bath and seresto collar applied
 Started on Doxy and Clinda for infectious r/o
(toxo/neospora)
SIR COSMO
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 Suspected Polyradiculoneuritis (coon hound paralysis)
takes 1- 2 months of recovery
- possibly associated with rabies vaccines or raw
chicken consumption
- classically described after contact with raccoon saliva
- supportive care and intensive PT!!!
SIR COSMO
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SIR COSMO’S RECOVERY
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 The basics: history, PE, baseline diagnostics
 Is the patient neurologic?
 Is it brain, spinal cord, or nerves?
 Get a thorough history and assessment
 Keys to localizing where the problem is with
Neurologic patients
TAKE HOME MESSAGE
10/16/20182018 FALL CE | A VETERINARY TECHNICIAN"S DOGMA TO ASSESSING THE NEUROLOGIC PATIENT