Many veterinarians are uncomfortable when facing a patient with a neurologic problem. However, by taking the time to obtain a good, detailed history and by doing a methodical and thorough neurologic examination, these cases can be both challenging and interesting. In this article, I review the neurologic examination step by step and provide tips to help you better understand the significance of the abnormalities found. The next article describes how to interpret the results of the neurologic examination.
A good history is always important, but it is crucial when dealing with a neurologic case. In everyday practice, appointments are often booked every 10 to 20 minutes, so we tend to jump to the physical examination as quickly as possible. For a patient with a neurologic disorder, most of this time should ideally be spent collecting the history. If needed, do not hesitate to hospitalize the patient so you can do a complete neurologic examination and assessment later. Most clients will understand and appreciate that you are taking the time to listen to them and thoroughly evaluate their pets.
When listening to the history, try to separate the facts from the client's interpretation of the problems (Table 1). For example, many owners assume that their pets are in pain if their pets are having difficulty walking. However, an abnormal gait might be the result of a nonpainful condition that causes ataxia or weakness rather than pain. Most clients can readily identify problems or changes in their pets' behavior because they know their companions so well. However, their assessment of the problem's cause is not necessarily correct.
Table1. Clinical Signs and Possible Client Misconceptions
When questioning a client, be suspicious when, for example, he tells you that his 6-year-old golden retriever suddenly seems to be getting old. A middle-aged dog should not suddenly exhibit signs of old age; it could be mentally depressed or lethargic. Ask about the onset of the clinical signs (overnight or gradual over the past few days or weeks), the progression (better, worse, or stable), and the response to any treatment. Also ask clients about any change in behavior (hiding, sleeping more, pacing, confusion) and about their pets' activity (difficulty going up or down the stairs or jumping, shaking their heads). Difficulty going down the stairs or jumping off something is most likely associated with a problem of the neck, forelimb, or both, whereas a problem jumping on something or climbing the stairs is most often associated with a back or hindlimb problem (i.e. pain, weakness). A pet that is reluctant to shake its head or that refuses to flex its head to eat but will happily take food that is handed to it directly most likely has neck pain. You may need to ask the same question many times in different ways to obtain or validate the information. Also, don't push for a specific answer and always give the client the opportunity to answer "I don't know" without feeling negligent or guilty.
While taking the history, look at the pet's behavior and attitude in the room. Most normal patients will hide or timidly explore the room. Try to determine what the normal behavior of that specific pet should be. For example, a puppy should move around and explore everything, whereas most cats will try to find a place to hide.