VETgirl July 2025 BEAT e-Magazine

QUARTERLY BEAT / JULY 2025

HANDS-ON NEUROLOGIC ASSESSMENT Based on the information you have gathered above, you likely have a good idea of where you would neurolocalize your patient. The hands-on evaluation helps you to confirm your suspicion/solidifies you are down the right track. CRANIAL NERVE EVALUATION First up is the cranial nerve evaluation. Below is a chart that goes through the cranial nerve reflexes, responses, and other evaluations of the head, as well as the cranial nerves that are involved in these tests.

As my technicians are going through the above history with me, I am observing the patient. How is their mentation and attitude? Do they have a low head carriage, do they look painful, are they kyphotic, is there pronounced muscle atrophy, do they have a head tilt or turn? This not only provides me with more information, but it also allows me to modify my evaluation if needed. If I have a patient with a low head carriage and is clearly exhibiting signs of cervical hyperesthesia, there is no need to assess the dog for neck pain – we don’t need to make them hurt any more than they already do. And on this subject, you should NEVER do range-of-motion of a dog’s cervical spine. Lateral palpation is all you need if you are assessing for neck pain. You never know when an atlantoaxial luxation is lurking, and you don’t want to find out during your neurologic examination. GAIT EVALUATION The more cases you see the more you will be able to identify “classic” gaits. Below are descriptions of some of the classic gaits. Remember, a normal gait doesn’t rule out neurologic disease. Also, these gaits are in the context that these patients are ambulatory, but a lot of these dogs will present non- ambulatory. If the patient is non-ambulatory, you should still be performing a gait evaluation and classifying the motor function of the patients (i.e., paretic or -plegic). Forebrain: Pacing, wide circles with lateralization if there is a focal forebrain lesion (always circling in one direction TOWARDS the side of the lesion), head pressing, proprioceptive ataxia or proprioceptive deficits that are CONTRALATERAL to the side of the lesion. Cerebellar: Hypermetria, wide based stance, fine oscillating head tremors, truncal sway, menace deficit with normal vision. Vestibular: Head tilt, rolling or falling to one side, nystagmus, strabismus, if central vestibular other cranial nerve deficits or proprioceptive +/- proprioceptive ataxia and paresis (+ if central). Bilateral Peripheral Vestibular: Wide based head excursions with a low body carriage (decreased extensor tone). C1-C5 Myelopathy: Tetraparesis and proprioceptive ataxia with a FLOATING thoracic limb gait and a spastic pelvic limb gait. C6-T2 Myelopathy: A two-engine gait, which is characterized by a tetraparesis with a SHORT, CHOPPY thoracic limb gait and a spastic pelvic limb gait. Proprioceptive ataxia also present. T3-L3 Myelopathy: Paraparesis and proprioceptive ataxia with a spastic pelvic limb gait. • Some of these cases may present with a Shiff-Sherrington posture. If they present with a Shiff-Sherrington posture, then they are either going to be non-ambulatory paraparetic or paraplegic. They will have increased extensor tone of the thoracic limbs, but they have normal movement and proprioception of the thoracic limbs when you support them in a normal standing position. It is important to know that this can occur, because these patients can be confused with cervical myelopathies. L4-S3 Myelopathy: Paraparesis and proprioceptive ataxia with a floppy pelvic limb gait. Lower Motor Neuron: Walking on eggshells, short-strided gait, holding the limbs directly beneath the body (think of a circus dog standing on a ball).

NEUROLOCALIZATION

Menace Response

Optic (2), Facial (7)

DOGS AND CATS

Pupillary Light Reflex

Optic (2), Oculomotor (3)

Palpebral Reflex

Wondering how to trace back your patient’s abnormal gait to where the root problem is? We’ve got you covered! In this VETgirl article, Dr. Missy Carpentier, DACVIM (Neurology) provides a comprehensive review of small animal neurolocalization. Read on to refresh your knowledge of how to read the map of central nervous system signs in cats and dogs!

Trigeminal (5), Facial (7)

Missy Carpentier, DVM, DACVIM (Neurology) Minnesota Veterinary Neurology, Columbus, MN The main goal of the neurologic examination is to identify if the patient is truly neurologic, and if so, further identify the specific area of the nervous system that is affected, known as neurolocalization. Neurolocalizing your patient is the only way that you can make an appropriate list of differentials and come up with the best recommendations for your patient. I am not going to go through the step-by-step neurologic examination – you can open any textbook and find this information – but I am going to review the main points of the neurologic examination and discuss how you use this information to neurolocalize your patient. IS YOUR PATIENT NEUROLOGIC? The first goal of the neurologic examination is to identify if your patient’s signs are neurologic in origin – this can sometimes be the hardest part! Below are the bullet points for a good neurologic examination. To me, the most important part of the neurologic examination is the hands-off evaluation. Don’t worry if you don’t know what muscle belly you are supposed to be hitting and what the reflex is called - you can neurolocalize most patients based on their signalment, history, and gait evaluation. This doesn’t mean that you shouldn’t be performing a hands-on neurologic examination to the best of your abilities but think of the hands-on part of the exam as further solidifying what part of the nervous system is affected.

Nasal Sensation

Trigeminal (5), Forebrain

Physiological Nystagmus aka Vestibulo-Ocular Reflex

Vestibulocochlear (8), Oculomotor (3), Trochlear (4), Abducens (6)

Gag Reflex

Glossopharyngeal (9), Vagus (10)

Medial – Abducens (6), Ventrolateral, not positional – Oculomotor (3) Dorsolateral – Trochlear (4)

HANDS-OFF NEUROLOGIC ASSESSMENT SIGNALMENT Many neurologic disorders have an age and breed predilection that is helpful when forming your list of differentials. HISTORY/PRESENTING COMPLAINT The first question that I have my technicians ask when they go into the room is what brought the owners in to be evaluated. We encourage the owners to give as much descriptive information as they can about their concerns. If they start to use medical terminology and they are not in the medical field, we will ask them to clarify what they mean (i.e., if they come in saying their dog had a tonic clonic seizure with loss of consciousness and autonomic dysfunction, ask for an actual description to be sure they didn’t just pull this information from Google and that truly is what occurred). Allowing the owners to describe abnormal events in detail also allows us to pick up additional information about the event or clinical signs that the owner may not know are important to the history. You should be able to gather the following information from the owners:

Strabismus

Facial Symmetry – Position of the Ears, Lip Commissure, and Palpebral Fissure

Facial (7)

Masticatory Muscles

Trigeminal (5)

Tongue Symmetry and Movement

Hypoglossal (12)

NEUROLOCALIZATION REGIONS 1. Brain

• Onset • Duration • Progression • +/- Lateralization • Presence of hyperesthesia • Presence or absence of improvement with medications

• You can get more specific but just figuring out if the brain is involved or not is a great place to start. Below you will find information regarding cerebellar signs that can allow you to be more precise.

2. C1-C5 myelopathy 3. C6-T2 myelopathy 4. T3-L3 myelopathy 5. L4-S3 myelopathy 6. Diffuse lower motor neuron 7. Multifocal

Other important information to obtain from the owners includes how long they have had the pet, vaccine status, travel history, use of preventative medications, access to toxins, any history of trauma, if any other animals or littermates are affected, diet, current medications, and any pertinent prior medical history.

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