An accurate history and thorough physical and neurological examination are necessary to evaluate a problem involving the nervous system. Based on initial assessment, several questions can be answered. Is the problem:
- focal, multifocal or diffuse?
- symmetric or asymmetric?
- painful or nonpainful?
- static, regressive or progressive?
- mild, moderate or severe?
- what is the anatomic location of the lesion?
- what are possible causes for the disease?
From these findings, diagnostic tests may be recommended to determine the exact disease process and how to treat the disorder.
History
Prior to the neurological examination, the neurologist gains information about the history of the patient’s problem by reviewing the referring veterinarian’s findings (submitted on the Referral Form) and the information the owner provides (submitted on the Patient Registration Form). Neurological diseases tend to have a species, age, breed, and occasionally sex predilection. These details, along with information about the onset, course and duration of the primary complaint, not only help describe the type of condition and possible causes of the problem, but also help confirm that the problem is indeed a neurological disorder.
Examination
1. Observation During the physical examination, the neurologist will first observe the patient’s mental status, posture and movement. 2. Palpation Careful examination of the skin, skeleton and muscles helps to determine the integrity and symmetry of the body and possible lesions and/or deficits that may provide indications of neurological disease. 3. Postural Reactions The complex responses that maintain a patient’s normal upright position are known as postural reactions. Assessing deficits, however minimal, through certain physical tests (e.g. wheelbarrowing) will help later in localizing the problem. 4. Spinal Reflexes A variety of reflex tests are used to determine if there is a disruption of the communication along the spinal cord to/from different parts of the body. 5. Cranial Nerves There are 12 pairs of cranial nerves that leave the brain and provide motor and sensory functions to different parts of the head and neck. From cranial nerve 1, olfactory, to cranial nerve 12, hypoglossal, examination of these nerves using a variety of tests helps to localize problems in the brain and brainstem. 6. Sensation Examining how the patient perceives different types of touch in different areas reveals if there is pain involved. This provides information relative to anatomic location and the severity of the lesion. This information is meant to be a guide and not a substitute for veterinary care. Always follow the instructions provided by your veterinarian.