Neuro exam overview
When presented with a patient that might have neurologic dysfunction, it is important to obtain a thorough account of the patient’s recent and past medical history, perform a full general physical examination to look for evidence of clinical signs related to non-neurologic disease, and then a complete neurologic exam. Keep an open mind until all parts of the physical and neurologic exams have been completed.
As my intern director used to tell us, “No examination is complete without a fundic and a rectal.” Veterinarians are often time-constrained, stressed, and have a lot of patients on their minds. Try to remember to take the time with every patient for a thorough exam. With practice, the neurologic exam can be performed within a few minutes.
There are many ways to physically perform the neurologic exam. This author tends to start with evaluation of mental status while taking the history, followed by gait analysis, and then working from head to tail, simultaneously performing the neurologic and physical exams. An orthopedic exam should also be performed if the patient displays lameness, paresis, or pain. Never forget that cardiovascular and orthopedic conditions, such as syncope, aortic thromboembolism, cruciate ligament tears, or polyarthropathy, frequently mimic neurologic disorders.
Most importantly, find a method that works for you and then be consistent with your method. It helps to have copies of blank neurologic exam forms handy to be sure that you don’t forget any portion of the exam and can quickly record your findings.
There are 5 major portions of the neurologic exam:
- Mental status
- Gait and body posture
- Cranial nerve examination
- Postural reactions
- Spinal nerve reflexes
There are also several other important tests that need to be performed:
- Cutaneus trunci reflex
- Paravertebral palpation to evaluate the patient for neck or back discomfort
- Nociception testing in the extremities and tail
- Evaluation of muscle tone
- Palpating for muscle atrophy
- Determination of anal tone