Skills Laboratory, Part 2: Interpreting the results of a neurologic examination - Veterinary Medicine
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Skills Laboratory, Part 2: Interpreting the results of a neurologic examination
Now that you've compiled all your findings from the neurologic examination, it's time to identify the origin of the problem. Here are some tips to help you locate the lesion.


VETERINARY MEDICINE


For spinal cord disease, obtain survey radiographs since they may show a malformation (hemivertebrae, atlantoaxial instability), evidence of trauma (luxation, fracture), signs of an infectious process (chronic diskospondylitis, osteomyelitis), or a tumor. If the survey radiographs are unremarkable, further imaging of the spine is usually necessary (myelogram, computed tomography, magnetic resonance imaging). In cases of diffuse neuromuscular diseases, a metabolic or endocrine problem should be ruled out (see above). Then, depending on the differential diagnoses, creatine kinase activity measurement, a thyroid profile, or tests to detect acetylcholine receptor antibodies or antibodies against the type 2M fibers could be performed. If a polyneuropathy or a polymyopathy is suspected, muscle and nerve biopsies are recommended. Electrodiagnostic testing can also be performed but usually requires referral to a neurologist.

Cases of focal brain disease usually require advanced imaging of the brain, such as computed tomography or magnetic resonance imaging. But a proper minimum database is always recommended before these advanced procedures.

CONCLUSION

A complete neurologic examination should lead to accurate lesion localization. Once you've localized a lesion, you can compile a proper list of differential diagnoses and propose a list of diagnostic procedures to the client. Also, a proper list of differential diagnoses will allow you to discuss the treatments and prognoses of the diverse possible conditions with the client. Although referral to a neurologist may sometimes be warranted, many diagnostic procedures and treatments can be performed by primary care veterinarians.

Veronique Sammut, DVM, MS, DACVIM (neurology)
California Animal Hospital
1736 S. Sepulveda Blvd.
Los Angeles, CA 90025

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