Presenter – Victoria Doyle BVetMed DipECVN MRCVS RCVS Recognised Specialist in Veterinary Neurology, Animal Health Trust Centre for Small Animal Studies
As soon as I consider a case to be neurological my anxiety levels take a turn in the upwards direction. Firstly I have to work out if the case actually is neurological, and then I have to pinpoint the site of the problem. This can only be achieved by a full and thorough examination and a great memory for the copious number of tests required to localise a lesion. Sadly my memory isn’t that great and I don’t perform these tests on a regular basis so an updated overview is always useful.
This was delivered very successfully by ‘The Webinar Vet’ last week. Victoria Doyle, a European and RCVS specialist in Neurology led the veterinary webinar and discussed ‘how to unravel the mysteries of the neurological examination’. I want to share some little gems delivered by Victoria, starting with the importance of a good history and physical examination. Other conditions can often mimic neurological disease and it is really important to ascertain there are no other underlying causes. Victoria cited a case of a cat presenting to her with seizure like activity which on further examination was found to have an intermittent AV block.
Bilateral cruciate disease can also mimic spinal disease as well as urinary tract infections and prostate disease. A full and thorough clinical evaluation can help to exclude some of these problems prior to starting a full neurological examination.
Cranial nerve examination plays an important part of any neurological examination. Victoria suggested when performing the palpebral reflex to always tap the medial and lateral canthi as each of these positions are innervated by different nerves. When performing the menace response always cover one eye and ensure you neither touch nor waft air at them. Interestingly this is called the menace ‘response’ rather than reflex as it is a learned response and is often absent in animals less than 12 weeks of age.
Victoria also went into great depth discussing spinal reflexes and advised she is unlikely to perform these on thoracic limbs as they are often abnormal in normal animals. The patella reflex can also be difficult to stimulate in tense animals. It is worth getting patients to settle in lateral recumbancy over a few minutes before trying again. If the patella reflex is still negative, it is worth trying the recumbent limb. Also remember in dogs over 10 years old the patella reflex can start to degenerate and may not always be present. Lower motor neurone disease can also cause pseudohyper-reflexion of the patella reflex due to poor counteracting reflexes.
Victoria went through a number of elements of the neurological examination and recommended using a template available from the BSAVA manual ensuring no part of the examination is missed. She also included a number of tables which helped to localize lesions according to the findings of the neurological examination. This veterinary webinar not only provided practical advice on how to perform a neurological examination but also a really useful reference point for any future cases.
The Stethoscope (MRCVS)