Computer Test - Neurological system

Question 1

What is a nystagmus ?

Answer 1

Involuntary movement of eyeballs

Question 2

What are the characteristics of Horner’s syndrome ?

Answer 2

Lossof sympathetic innervation →
Myiosis
Ptosis
Enophtalmos
\+ prolapse of the 3rd eyelid

Question 3

Which is true about ataxia ?

• Incoordination
• Muscle weakness
• Vestibular malfunction

Answer 3

Incoordination

CNS is involved, not the peripheral nerves

Question 4

Signs of UMN disease ?

Answer 4

Hyperactive reflexes, increased tone

Question 5

What are proprioception tests ?

Answer 5

Complex responses involving spinal reflexes and central coordination for normal movement and posture

• Wheel barrow
• Hopping
• Hemi-hopping
• Correction / Knuckling over
• Crossing over
• Tactile and optical placing reactions
• Reflex stepping

Question 6

Symptoms of a generalized seizure ?

Answer 6

Diffused origin within cortex, thalamus, brainstem → so all muscles effected and general symptoms seen → excitation or loss of consciousness

Question 7

What is the procedure of the nervous system exam ?

Answer 7

Ask
Watch
Touch
Pain

Question 8

Slap test explanation ?

Answer 8

,Hit the wither of the horse -> slap test on arytenoïds → N; vagus recurrens

Question 9

Is auto-mutilation a pathological behaviour ?

Answer 9

Yes

Question 10

What indicates consciouness ?

• Ability to learn
• Eat
• Sleep
• Walk
• Ability to remember
• Make noise

Answer 10

• Ability to learn
• Eat
• Walk
• Ability to remember

Question 11

What is incorrect concerning spinal cord sampling ?

• Biopsy
• Blood sample
• US of abdominal cavity
• FNA

Answer 11

• Biopsy
• Blood sample
• US of abdominal cavity

Question 12

Which nerve(s) is/are responsible for panniculus reflex ?

Answer 12

Afferent : spinal segments, center = C7-T1

Efferent : m. cutaneous trunci

Question 13

Symptoms of vestibular ataxia ?

• Head tilt
• Nystagmus
• Animal lean and fall to affected side
• Muscle weakness
• Goose stepping
• Circling

Answer 13

• Head tilt
• Nystagmus
• Animal lean and fall to affected side

Question 14

What do you examine with the “swinging light test” ?

Answer 14

N. opticus + N. oculomotor

Question 15

Nerves involved in the perineal and anal reflexes ?

Answer 15

N. pudenlus (afferent and efferent)

N. rectalis caud. (efferent)

Question 16

Signs of damaged trigeminal nerve ?

Answer 16

Sagging lower jaw
Trismus
Tic

Question 17

LMN lesion signs ?

Answer 17

Diminished or absent reflexes

Decreased or absent tone

Question 18

Rhythmic oscillating muscle twitch :

• tremor
• tic
• tetany

Answer 18

Tremor

Question 19

Instruments needed for neurological eReflex hammer
Penlight
Arterial clamp
Needle
Stethoscope
Glovesxams ?

Answer 19

Reflex hammer
Penlight
Arterial clamp
Needle

Question 20

What is anisocoria ?

Answer 20

Unequal pupil size

Question 21

Which are methods of neurological - X-ray

• EEG
• CT
• MRI
• MIR
• CBC
• Pathogen detection
• Cerebrospinal fluid analysisexamination ?

Answer 21

• X-ray
• EEG
• CT
• MRI
• CBC
• Pathogen detection
• Cerebrospinal fluid analysis

Question 22

Signs of conscious pain perception in dog ?

• leg withdrawal
• leg extension
• crying
• bitting towards the hand
• lifting the head up

Answer 22

• crying

- bitting towards the hand

Question 23

What are the reduced mental states ?

• Dementia
• Stupor
• Indolentia
• Somnolentia
• Delirium
• Coma
• Furor
• Aggressive
• Excitatio

Answer 23

• Dementia
• Stupor
• Indolentia
• Somnolentia
• Delirium
• Coma

Question 24

What extra exams can ber ordered for a neurological patient ?

Answer 24

Xray, EEG, CT, cerebrospinal fluid analysis, CBC, detection of pathogens, MRI

Question 25

Pupillary light reactions nerves ?

Answer 25

N. opticus, and N. oculomotorus + vegetative system

Question 26

Examination order ?

Answer 26

``` AWTP = Ask Watch Touch (palpation/percussion/postural reactions and reflexes/sensitivity of skin & Mm) Pain(ful manipulations & percussion) ```

Question 27

Examination of the neurological system ?

Answer 27

Inspection Palpation Percussion * Extra exams : - X-ray – see e.g. disk space of vertebrae (Spondylosis), inflammation ossificiation of tympanic bulla (dog) - EEG (Electro encephalography) – but needs sedation. Lower significancy in vet medicine - CT – Computed Tomography : cross section imaging – X-ray takes rotational multiple images, but has higher resolution → computer reconstructs the image - MRI – Magnetic Resonance Imaging : cross-sectional imaging but uses no radiation (hydrogen atoms change in magnetic and radio frequency fields). Better for soft tissue : improved anatomic details - CSF = Cerebro-Spinal Fluid – via Occipital punctures (released under pressure → suggests high ICP (hydrocephalus...). Normal - “water-clear, transparent fluid”, liquid as water . EDTA sample (non-EDTA sample for PCR) - Blood count, blood chemistry - Detection of pathogens

Question 28

Abnormal head positions ?

Answer 28

* Opisthotonus – “stargazing” * Lateral head turning, +/- walk in circle * Head tilt – axis of head is NOT in a perpendicular angle (usually ipsilateral to lesion). Normal consciouness in most of cases, but huge inbalance * Paralysis of neck muscles

Question 29

Abnormal spine positions ?

Answer 29

* Kyphosis – permanent dorsal deviation vs pseudo-kyphosis (when back arched in pain) – * Lordosis – ventral deviation * Scoliosis – lateral deviation – rare in animals NOT primary neurological disorder

Question 30

Examination of head ?

Answer 30

* Shape of skull, symmetry * Mobility of head/neck/jaws * Ears (dropping/pointing) * Lips * Pain at palpation

Question 31

Examination of the face ?

Answer 31

Facial expression (eyelids, nostrils, ears : often pulled by muscles towards healthy side) * Uni/bilateral function of facial muscles * Detailed eye exam (eyeballs + pupils)

Question 32

Examination of vertebral column ?

Answer 32

Inspection (shape, position) | Palpation (careful bending if pain)

Question 33

Regulation of mental state ?

Answer 33

Regulated by thalamocortex, the brain influences the mental state → ARAS – ascending reticular activating system (activates cortex)

Question 34

Definition of consciousness ?

Answer 34

Aware of surroundings and has ability to learn and remember

Question 35

Decreased levels of consciousness ?

Answer 35

* Dementia – loss of intelligence, alert but inappropriate reactions * Start eating but forget hay is in mouth * Stupor – responds only to strong stimuli * Indolentia – uninterested in surroundings * Somnolentia – drowsy but can be woken * Delirium – uncoordinated, as if drunk * Coma – cannot be woken, loss of consciousness * Possible indications – Lead poisoning, hydrocephalus

Question 36

Increased levels of consciousness ?

Answer 36

Excitation, excitement Aggression, attacking Furor – rage

Question 37

Involuntary movements ?

Answer 37

Opisthotonus or “stargazing”, head tilt, lateral turn of the head o Circling, walking in circle clockwise or anticlockwise, compulsive walking (pacing) – usually cortical abnormality, and restless at night

Question 38

Special abnormalities ofconsciousness ?

Answer 38

Hallucinations: illusory perception; a common symptom of severe mental disorder Paraesthesia – psychogenic dermatitis – constant scratching of fur vigorously Automutilation or semitmutilation

Question 39

Seizure definition ?

Answer 39

“Sudden extreme change in muscle contraction and behaviour and muscle tone due to abnormal brain function” : a state with unvolutnary muscle contractions

Question 40

Does seizure have only neurological causes ?

Answer 40

NO | Can be hypo-calcaemia, hypo-glycaemia, hepatic encephalopathy (HE), severe renal failure causes uremic failure....

Question 41

Classification of neural seizures ?

Answer 41

* According to muscle function - Tonic – continuous contraction causes spasm (entire musculature) : spasm of a muscle group - Clonic – rapid contraction but then relaxation – rhythmic - Tonico-clonic – mixture of two * According to focus or centre of seizure - Generalised – diffuse origin within cortex, thalamus, brainstem – so all muscles affected and “general” symptoms seen so causes excitation or loss of consciousness - Focal – only smaller region of cerebro-cortex gets excited e.g. temporal or parietal lobe – so only a small portion of muscles affected – can cause tail chasing, fly catching etc

Question 42

Definition of epilepsy ?

Answer 42

= Recurring seizures with a certain time frame Animal between seizures is normal + common in dogs 

Question 43

Definition of status epilepticus ?

Answer 43

When seizure does not stop and becomes continuous (without or with minimal normal periods) – often causes more cerebral damage

Question 44

Definition of petit mal ?

Answer 44

Short-term loss of consciousness and increased muscle tone – rare in animals (e.g. Canine distemper)

Question 45

Definition of grand mal ?

Answer 45

Severe tonico-clonic convulsions of muscles with loss of consciousness

Question 46

Other involuntary changes of muscle tone NOT necessarily connected to CNS ?

Answer 46

* Tetanus – sustained tonic contraction with no twitching i.e. stiffness Usually due to Cl. tetani - Horses – tail biting in early stages, and raised tail, difficult to breath, wide stance - Cattle – episthotonus (extensor muscle stronger than flexors) - Dogs – spastic tetra-paresis –can affect puppies when shedding teeth and chewing wood – “flying dog stance” → Risus sardonicus facial expression, and locked jaw due to chewing muscle spasm (Trismus) * Tetany – violent muscle twitching of whole body Esp. due to hypo-calcaemia (+ panting, and high temp) *Tremor – mild form of tetany – oscillating muscle twitches : regular, rhythmic trembling (oscillation) of muscles . Shaking, shivering * Tic – repetitive non-rhythmic contraction of one muscle Often seen in distemper – can often feel temporal muscle tic by palms on top of head * Myoclonia – abrupt, rhythmic contractions of one muscle group E.g. just flexors of a limb * Fibrillation – non-coordinated of individual muscle fiber twitching Less severe form of tremor

Question 47

Postural reactions list ?

Answer 47

``` Wheel barrowing test Hopping test Correction test Crossing over test Tactile and optical placing reactions Extensor postural thrust reaction ```

Question 48

Wheel barrowing test description ?

Answer 48

Elevate hind legs of patient, it should be able to do steps without falling over With or without vision

Question 49

Hopping test description ?

Answer 49

Evaluate every foot one by one by lifting the remaining three legs, shift centre of gravity to lateral reaction, animal should be able to follow this movement One leg Hemi-walking

Question 50

Correction test description ?

Answer 50

Bend over foot and place it on the ground | → should replace it immediatly

Question 51

Crossing-over test description ?

Answer 51

Cross limbs in front of each other | → Should replace it immediatly

Question 52

Tactile and optical placing reactions description ?

Answer 52

Tactile: shield patient’s eyes and place animal close to table so it touches the table with skin → Should place foot on it Optical: approach table without covering the eyes → animal should put legs on table before it touches it

Question 53

Extensor postural thrust reaction description ?

Answer 53

Take the dog behing the armpits, lift him totally from the floor, and then put him down on his hindlimbs → Should step back and rebalance himself

Question 54

Define ataxia ?

Answer 54

Lack of coordination in muscle function without muscular weakness The CNS is involved, not the peripheral nerves.

Question 55

Classification of ataxia ?

Answer 55

* By signs : - Static: signs are also seen in animals that are not moving - Locomotive: Signs seen during movement - Intentional: Tremor of head when fine adjustment of position is demanded) – rare * By anatomical origin: - Cortical/Cerebral (proprioceptive): Less common (except old animals) Occurs together with behavioural changes Circling May be muscular weakness ``` - Brain stem: Swaying from side to side Rolling Involuntary movements Wide-based stance ``` - Cerebellar: Exaggerated steps (wide based stance: Hypermetria, dysmetria) Nystagmus (involuntary movement of eyeballs) No muscular weakness - Vestibular: Ipsilateral head tilt (towards side of lesion) Nystagmus Tendency to fall on ipsilateral side → cortex and behaviour are not effected! Bilateral vestibular ataxia – rare (cats) - Spinal (uni-/bilateral): As the peripheral reflex arch is involved, paresis, paralysis is often seen Hind limbs are always affected.

Question 56

Paresis/lysis/plegia definition ?

Answer 56

Abnormal posture of movement due to reduced (or increased) muscular strength without incoordination. Extra-neural forms are frequent.

Question 57

How to diagnose a paresis/lysis/plegia ?

Answer 57

Inspection, palpation, evaluation of muscle tone: Atony, Hypotony (reduced muscular tone) Hypertony Schiff. Sherrington phenomenon: present in acute spinal trauma between T2 and L3; the rear limbs will be paralyzed and the thoracic limbs are stiff and extended

Question 58

Classification of paresis/lysis/plegia ?

Answer 58

* By severity - Paresis and paralysis/plegia (partial or complete loss of strength) * By the affected limbs of the body - Monoparalysis/plegia/paresis (only one limb affected; peripheral nerve damaged) - Tetra- (all limbs are affected) - Para- (both limbs are affected) → Paraplegia anterior → Paraplegia posterior - Hemiparalysis (limbs on one side of body are affected) * By the quality - Rigid, spastic - Atonic, flaccid * By origin - UMN (upper motor neuron): injury is above spinal reflex centre (spinal nerve nucleus). The UMN regulates/decreases the activity of the LMN → muscle tone will be increased -LMN (lower motor neuron disease): injury is in spinal centre or below it UMN is regulating "too much" because the LMN is damaged → decresed muscle tone

Question 59

LMN disease signs ?

Answer 59

Diminshed/absent reflexes | Decreased/absent tone

Question 60

UMN disease signs ?

Answer 60

Hyperactive reflexes | Increased tone

Question 61

List of 12 cranial nerves ?

Answer 61

``` I. N. Olfactorius II. N. Opticus III. N. Oculomotorious IV. N. Trochlearis V. N. Trigeminus VI. N. Abducens VII. N. Facialis VIII. N. Vestibulocochlearis IX. N. Glossopharyngealis X. N. Vagus XI. N. Accessories XII. N. Hypoglossus ```

Question 62

Evaluation of the CN n°1

Answer 62

I. Olfactorius Smelling → Methods: * Using strongly stimulatory compounds or food * Substance should not irritate the nasal mucosa (involvment of the N. Trigeminus V.) * Hyposomia/anosomia = partial or complete loss of smell

Question 63

Evaluation of the CN n°2

Answer 63

II. Opticus Vision = importance of the history !! * Examination of the vision: falling cotton test (tracking, leading the animals to objects * Pupillary nerve is involved in the development of: - Pupillary (light) reaction (direct and consensual) Cover eyes before testing Evaluation of pupil constriction Efferent nerve/motor part: N. oculomotorius - Threat/menace reflex (response) Response: blinking Efferent part: facial nerve - Optical placing test

Question 64

Evaluation of the position and movement of the eyeballs

Answer 64

III. Oculomotorius IV. Trochlearis V. Abducens * Physiological nystagmus: Turning the head from side to side and up and down elicits involuntary eye movements * Pathological nystagmus: could be horizontal, vertical or rotatory * Strabismus: uni- or bilateral abnormal position of the eyeball (they’re not parallel) - N. Oculomotorius paralysis: Str. Divergens (ventrolateral strabismus) - N. Trochlearis paralysis: medioventral strabismus - N. Abducens paralysis: Str. Convergens (medial strabismus) and exophthalmos

Question 65

If the animal presents a medial strabismus, which nerve is damaged ?

Answer 65

IV. Trochlearis | = Strabismus medioventralis

Question 66

If the animal presents a ventrolateral strabismus, which nerve is damaged ?

Answer 66

III. Oculomotorius | = Strabismus divergens

Question 67

If the animal presents a convergent strabismus, which nerve is damaged ?

Answer 67

VI. Abducens | = Strabismus convergens

Question 68

Evaluation of the pupils

Answer 68

Anisocoria: Uneven size of pupils Mydriasis: Dilation of pupils Myosis: Constriction of pupils (Claude Bernard) Horner’s syndrome: Loss of sympathetic innervation results in - Myosis - Ptosis (Drooping or falling of upper eye lid) - Enophthalmos (and prolapse of the third eyelid)

Question 69

Evaluation of the CN n°5

Answer 69

V. Trigeminus = Mixed nerve having sensory and motor fibres * Sensory part: involved in the development of - Eyelid (palpebral) reflex (efferent/motor nerve: facial) along with VII. nerve - Corneal reflex (efferent nerve: facial) * Motor part - Tic (repeated contractions of chewing muscles) - Sagging lower jaw (paralysis – caused by central/peripheral injury of the nerve) - Trismus (Tonic spasm of chewing muscles – might also be caused by myositis) - Further tests of motor function: Prehension of food, drinking and chewing processes

Question 70

Evaluation of the CN n°7

Answer 70

VII. Facialis * Mixed nerve (mainly motor function) Uni-/Bilateral paralysis of the nerve is known * Nerve is involved in: - Eyelid reflex - Threat (menace) reflex - Corneal reflex * Investigations to diagnose facial paralysis: - Position of the ears (drooping on affected side) - Position of the upper eyelids (Ptosis, following paralysis of the orbicular eye muscles) - Moving of the nostrils (away from the affected side) - Sagging of lips on affected side * Forms of facial paralysis: - Severe (intracranial, intrapetroseal lesion): Drooping ear, lip, the nose pulled toward the normal side (most obvious in horse) - Mild (peripheral lesion): Pointing ear, ptosis, sagging lips

Question 71

Evaluation of the CN n°8

Answer 71

VIII. Vestibulotrochlearis Two-division nerve, involved in hearing (trochearis) and postural (vestibulo) reactions * Examination of hearing (cochlear division of the nerve) - Hearing ability tested by speaking, whistling, clapping - Deafness (congenital, acquired) * Examination of dysfunctions of the peripheral vestibular system (vestibular division of the nerve) - The mental status and the postural reactions are regularly normal - Inspection: o Position of the head (ipsilateral head tilt) o Falling towards the affected side o Nystagmus (usually horizontal, the slow phase is toward the lesion) o (Strabismus) o (Horner’s syndrome) * Examination of dysfunctions of the central vestibular system (cerebellar and brain stem lesion) - Severe asymmetric ataxia (circling, Hypermetria)

Question 72

Evaluation of the CN n° 9 & 10

Answer 72

IX. Glossopharyngeus X. Vagus Malfunctions cause dysphagia, weak/absent gag (swallowing reflex), laryngeal paralysis * To study: - Swallowing/gag reflex (sensory part: glossopharyngeal nerve, efferent nerve: n.vagus). A cranial reflex can be stimulated by fingers (in SA) or with a nasogastric tube (in LA). Alternative: little amount of water from syringe - Laryngeal paralysis (recurrent laryngeal nerve of n.vagus) important in horses, dogs - Consider rabies! * Bilateral paralysis : very severe dyspnoe, stridor, exaggerated breathing * Unilateral paralysis : change in voice, unsuccessful barking

Question 73

Evaluation of the CN n° 11

Answer 73

Deficit from an injury to this nerve are not frequently recognized in animals. → Palpate m.trapezius, sternocephalicus and brachiocephalicus for atrophy Sagging of head

Question 74

Evaluation of the CN n°12

Answer 74

Responsible for protruding and retracting the tongue (after feeding, usually dogs lick their nose. Possibility to offer food on the floor so the dog needs to lick it up * Bilateral lesion: Protrusion of the tongue with weak retraction * Unilateral lesion: ipsilateral deviation of the tongue (towards the healthy side : because of muscle tone to this side !!)

Question 75

Definition of a reflex

Answer 75

An involuntary movement or other immediate response of an organ to an appropriate stimulus, without the aid of the will or without even entering consciousness.

Question 76

5 scales to evaluate a reflex ?

Answer 76

``` 0 = areflexia 1 = hyporeflexia 2 = normoreflexia 3 = hyperreflexia 4 = hyperreflexia with clonus ( a series of rapid contractions of a muscle in response to one stimulus) ```

Question 77

Abnormal reflexes ?

Answer 77

Areflexia , hyporeflexia, hyperreflexia, hyperreflexia with clonus Reflex irradiation: a reflex elicited in a larger area / muscle group than expected Contralateral (crossed) reflex: a reflex elicited in response to a stimulus applied to the other side of the body

Question 78

2 types of normal reflexes ?

Answer 78

Proprioceptive (a reflex that is initiated by a stimulus to a proprioceptor (mechanoreceptor) Nociceptive

Question 79

Define & describe proprioceptive reflexes

Answer 79

A reflex that is initiated by a stimulus to a proprioceptor (mechanoreceptor) * Thoracic limb reflexes - Extensor carpi radiali reflex (important!): n.radialis (afferent + efferent) - Triceps reflex: n.musculocutaneus (afferent + efferent) - Biceps reflex : place your finger on the tendons of biceps brachii muscle, cranial and proximal to the elbow. The finger is struck ! Or tendons are directly strucl * Pelvic limb reflexes - Patellar (quadriceps) reflex (most important!): femoral centre L4-L6 - Achilles (gastrocnemius) reflex: n.ischiadicus (afferent + efferent) * Evaluate the tail tone

Question 80

Define & describe nociceptive reflexes

Answer 80

* Anal/perianal reflexes (movement of the tail/perineal region if touched) - Afferent: n.pudendalis - Efferent: n.pudendalis, n.rectalis caudalis * Panniculus reflex - Afferent: spinal segments, centre: C7-T1 - Efferent: m. cutaneus trunci - Touch the skin along the neck and trunk with a pointy tool. There can be hypersensitivity or hyposensitivity * Flexor (withdrawal) reflexes of limbs: - Not conscious pain sensation (but can show behavioral reaction if the information is integrated in the brain) - Forelimb: Centre C6-T1 - Hindlimb: L (4)6-S1

Question 81

Examination of pain perception

Answer 81

The last step in neurological examination. Mostly spinal reflexes belong here, but pain sensation should be studied on all parts of the body. 1. Superficial/cutaneous pain perception 2.

Question 82

Evaluate the superficial pain perception

Answer 82

Assessed mainly by pinching/pricking with a pencil/needle or light pressure of skin (as in panniculus and flexor reflex) * Normal response: - Local (skin twitch, leg withdrawal) via spinal reflex arch only - Behavioural (crying, biting, turning to the direction of pain) via long pathways: receptor-spinal ganglion-thalamus-cortex and back * Evaluation : - Normaesthesia - Hyperaesthesia - Anaesthesia - Paraaesthesia Sensitivity of the mucous membranes, anal skin and the fingers can be similarly analysed during reflex studies.

Question 83

Deep pain perception evaluation ?

Answer 83

Testing is not necessary if superficial pain perception is present. Assessed by squeezing a digit or the rim of a tail with a haemostat (arterial clamp) or with a strong pressure in large animals. Horse: step on the rim of the hoof

Question 84

Evaluation of the vertebral column

Answer 84

Palpation & percussion of the spine Cervical pain by passive movements of the head and neck Back pain evaluation by caudal to cranial palpation of the transverse processes, supporting the belly to avoid putting weight on limb joints History is also important