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).
Menace Response
Optic (2), Facial (7)
Pupillary Light Reflex
Optic (2), Oculomotor (3)
Palpebral Reflex
Trigeminal (5), Facial (7)
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)
Strabismus
Facial Symmetry – Position of the Ears, Lip Commissure, and Palpebral Fissure
Facial (7)
Masticatory Muscles
Trigeminal (5)
Tongue Symmetry and Movement
Hypoglossal (12)
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