Nervous Dz’s

• Neurologic exam


  Complete exam performed to determine if a problem is neurologic in origin and where in the nervous system the problem is located
• Components of a complete neurologic exam

  • Assessing mentation
  • Assessing posture and gait
  • Assessing cranial nerves
  • Assessing postural reactions
  • Assessing spinal reflexes
  • Spinal palpation
  • Assessing pain perception
• Mentation


  General assessment of the patient's level of consciousness
• Levels of mentation

  • Normal/Alert (BAR)
  • Depressed - awake, but relatively unresponsive to environmental stimuli (QAR)
  • Stupor - Asleep except when aroused by strong stimulus
  • Coma - deep unconsciousness, the animal cannot be aroused even by painful stimulus
• Posture and Gait


  Evaluation of the animal's movement and positioning
• Terms used to describe gait

  • Ataxic - wobbly, stumbling, falling, and incoordination
  • Paresis - a condition of muscular weakness caused by nerve damage or disease, partial paralysis but still able to move
  • Hemiplegia - when the left or right side of the body is paralyzed
  • Paraplegia - when the back legs are paralyzed
  • Tetraplegia - when all four legs are paralyzed
  • Hypermetria - when a patient's voluntary movement appears as high stepping or over reaching the intended location
• Cranial Nerves


  Assessed individually to look for lesions in the brainstem or along the path of that nerve
• Postural Reactions


  Tests that assess the pathways that help a patient maintain a normal, upright position in space
• Common postural reaction tests

  • Paw Replacement Test
  • Hopping
• Spinal Reflexes

  Automatic responses designed to help protect an animal's body from injury or maintain homeostasis
• 1 Hyporeflexia (less than normal response)

  2. Normal response

  3. Hyperreflexia (greater than normal response

  4.Clonus (repetitive response)
• Patellar Reflex

  1. Animal is in lateral recumbency and the rear limb supported

  2. The patellar tendon is tapped with a pleximeter

  3. Should respond by quickly extending the knee
• Flexor Response (Withdrawal Reflex)

  1. Compress the foot pad to elicit pain

  2. Watch for withdrawal
• Panniculus Reflex


  1. Pinch the skin gently with forceps

  2. Should contract the SQ muscle at the point of stimulation
• Anal Reflex


  1. Stimulation of the perineal region

  2. Should elicit contraction of the external anal sphincter
• Corneal Reflex

  1. When the cornea is touched

  2. The eye should blink (primarily used during anesthesia)
• Spinal Palpation and Pain Perception

  1. Palpate along the spine

  2. Check the range of motion in the neck

  3. Look for signs of pain

  4. Check for muscle atrophy
• Checking for pain in patients unable to walk


  1. First check for superficial pain by pinching the web between the toes

  2. If no superficial pain, assess for deep pain by pinching the bone, often with hemostats
• Once the problem has been localized through the neurologic exam, the next step is to perform diagnostics tests to determine the underlying pathogenesis
• Bloodwork, imaging and special tests may be performed to get a diagnosis of spinal palpuation and pain perception
• Neurologic Disorders

  • Brain disorders
  • Spinal cord disorders
  • Peripheral nervous system disorders
• Traumatic brain injuries

  • Can be primary (from the initial injury) or secondary to swelling, bleeding or hypoxemia
  • Swelling increases the intracranial pressure (ICP)
  • Severe ICP can result in brainstem herniation and death
• Treatment for traumatic brain injury and cerebral edema

  1. Head is elevated

  2. Patient is treated with mannitol or other diuretics

  3. May also use anticonvulsants or steroids
• Idiopathic vestibular disease


  • Also called old dog vestibular disease
  • Acute disorder affecting the peripheral vestibular nerve in older dogs without an underlying etiology
  • Patients present with head tilt, nystagmus, ataxia, loss of balance and sometimes nausea
  • Typically resolves on its own with supportive care
• Brain and spinal tumors

  • Can be primary or secondary
  • Most common clinical sign is a seizure
  • Other signs include behavior changes, vision changes, circling/pacing, ataxia, neck/spinal pain
  • Diagnosed through imaging, often MRI
  • Treated with neurosurgery, radiation or chemotherapy but have a poor prognosis
• Seizure

  • A transient disturbance of brain function that is sudden in onset and ceases spontaneously
  • Involves loss of consciousness, involuntary muscle contractions, hypersalivation, temporary blindness
  • Can vary in severity from Petit Mal to Grand Mal
  • Focal seizures involve rhythmic motions in parts of the face or limb
• Managing a patient during a seizure

  1. Prevent the patient from injuring itself or others

  2. Do not move the patient

  3. If in hospital, diazepam is typically administered intravenously
• Causes of seizures


  • Toxin
  • Underlying metabolic disease
  • Neoplasia
  • Idiopathic epilepsy
• Anticonvulsants

  Used to decrease the frequency and severity of seizures, but do not cure the underlying disease
• When is a seizure an emergency vs not an emergency?

  • Emergency: Prolonged, generalized seizure (>5 mins) and/or status epilepticus; Cluster of seizures; Pet showing other abnormal symptoms
  • Non-emergency: Single episode <5 mins; Animal has history of seizures and is being managed by vet
• Long term care for epilepsy

  • Lifelong condition
  • Owners should have a plan for seizures, keep a seizure journal
  • Important to have yearly bloodwork to monitor medication side effects
• Intervertebral Disc Disease

  Disc material can mineralize and protrude or explode into the spinal canal, resulting in a pinching of the spinal cord
• Intervertebral Disc Disease

  • Most frequently affects chondrodystrophic breeds such as the Dachshund, Pekingese, Shih Tzu, Basset Hound or Cocker Spaniel
• Treatment for mild IVDD


  1. Anti-inflammatory medications (steroids or NSAIDs)

  2. Pain control

  3. Rest
• Treatment for severe IVDD causing paralysis


  1. Surgical hemilaminectomy to decompress the pressure on the spine

  2. Post-op physical therapy to regain normal function
• Atlantoaxial Subluxation


  Abnormal anatomy of the first two vertebra (atlas and axis) resulting in instability of this joint and compression of the spinal cord
• Atlantoaxial Subluxation


  • Occurs most commonly in toy breeds under a year of age
• Cervical Spondylomyelopathy (Wobblers)

  Malformation of the cervical vertebrae
• Cervical Spondylomyelopathy (Wobblers)


  • Primarily occurs in Doberman Pinchers or Great Danes
• Treatment for Cervical Spondylomyelopathy (Wobblers)


  1. Surgical stabilization

  2. Anti-inflammatories

  3. Cage rest