Skills Laboratory, Part 1: Performing a neurologic examination - Veterinary Medicine
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Skills Laboratory, Part 1: Performing a neurologic examination
Take your time and be thorough, advises this author-neurologist, who tells you step by step how to examine a patient with a possible neurologic problem.


VETERINARY MEDICINE


Have the patient walk freely (i.e. unleashed and on the floor) in the room while you take the history. This allows you to evaluate its gait without restraint as well as its behavior, mental status, and interaction with the surroundings and its owner. While the animal walks freely in the room, you may identify pacing, circling, bumping into things, or falling asleep in the middle of the room. Allow cats to jump if possible since this is a good way to evaluate their balance and strength. Perform a more complete gait evaluation during the neurologic examination.

NEUROLOGIC EXAMINATION


Neurologic Examination Form
like to divide the neurologic examination into six sections: mental status, gait and posture, cranial nerves, spinal reflexes, conscious proprioception reactions, and other factors (e.g. evaluation of pain, tremors, seizures). (See the sample Neurologic Examination Form.)

Mental status

Evaluate a patient's mental status while taking the history and making your initial observations. Take note of the client's evaluation, but also make your own assessment. A bright and alert pet with normal responsiveness has a normal mental status. A poorly responsive animal that is difficult to arouse but has a normal reaction to different stimuli (e.g. looks at owner and wags its tail when the owner calls its name) is lethargic or mentally depressed. The mental depression secondary to a brain lesion might be hard to differentiate from the lethargy secondary to a variety of other medical problems. The physical examination and the rest of the neurologic examination will help you differentiate between neurologic and other causes. A pet that can only be aroused by a strong stimulus such as pain is characterized as stuporous, whereas a pet that cannot be aroused at all is characterized as comatose.1 An animal with an improper reaction to stimuli is mentally confused.

Gait and posture

Evaluate the gait and posture on a nonslippery surface. A carpeted room or a hallway with a large rug is ideal. If needed, take the patient outside. Many neurologic abnormalities are more obvious when a patient walks slowly. So have the client walk the patient at different paces and in circles to improve your chance of defining the problem. Allow cats to jump on chairs or other furnishings while in the exam room. Also, do not assume that a pet is paralyzed because the client says so. Unless there is a possibility of spinal fracture, try to support the patient with a sling or a towel under the abdomen or even with a sling for the back and a harness for the front. Have the client step back and call for the pet to see if it wags its tail or moves its limbs voluntarily. You will gain important information by doing this with and without supporting the animal, since some pets will be inhibited by sling support.


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Source: VETERINARY MEDICINE,
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