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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History – (very important! - where technicians shine!)
Physical exam
Baseline diagnostics
CBC/Chem
Radiographs
BP
etc
THE BASICS
10/16/20182018 FALL CE | A VETERINARY TECHNICIAN"S DOGMA TO ASSESSING THE NEUROLOGIC PATIENT
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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?
10/16/20182018 FALL CE | A VETERINARY TECHNICIAN"S DOGMA TO ASSESSING THE NEUROLOGIC PATIENT
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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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Central vs peripheral
Brain
Spinal cord
Nerves - neuromuscular
THE NERVOUS SYSTEM IN A NUTSHELL
10/16/20182018 FALL CE | A VETERINARY TECHNICIAN"S DOGMA TO ASSESSING THE NEUROLOGIC PATIENT
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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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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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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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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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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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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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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
10/16/20182018 FALL CE | A VETERINARY TECHNICIAN"S DOGMA TO ASSESSING THE NEUROLOGIC PATIENT
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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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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
10/16/20182018 FALL CE | A VETERINARY TECHNICIAN"S DOGMA TO ASSESSING THE NEUROLOGIC PATIENT
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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
10/16/20182018 FALL CE | A VETERINARY TECHNICIAN"S DOGMA TO ASSESSING THE NEUROLOGIC PATIENT
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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
10/16/20182018 FALL CE | A VETERINARY TECHNICIAN"S DOGMA TO ASSESSING THE NEUROLOGIC PATIENT
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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