Abnormal Neuro Exam Part 2

Question 1

Spinal reflexes will increase or stay the same with ….

Answer 1

UMN disease

Question 2

spinal reflexes will decrease with …

Answer 2

LMN disease

Question 3

Type of muscle atrophy associated with UMN disease?

Answer 3

disuse atrophy

Question 4

Type of muscle atrophy associated with LMN disease

Answer 4

neurogenic atrophy (rapid)

Question 5

Regarding the cutaneous trunci reflex - if there is a cut off….

Answer 5

lesion is 1-2 spinal cord

segments cranial to cutoff

Question 6

Regarding the cutaneous trunci reflex - If absent on one side
regardless where you
pinch ….

Answer 6

there is an efferent problem on that
side (C8-T1 spinal cord
segments and nerve
roots, lateral thoracic
nerve, or cutaneous
trunci mm)

Question 7

Optic Nerve Dysfunction (CN2) (3 signs)

Answer 7

- Menace deficit -
avisual
- Absent / decreased
PLR
- Mydriasis

Question 8

Occulomotor Nerve Problem

CN3) (3 signs

Answer 8

-ptosis, ventrolateral resting strabismus, mydriasis (parasympathetic dysfunction)

Question 9

4 cardinal signs of Horner’s syndrome

Answer 9

Ptosis
Elevated 3rd eyelid
Enopthlamos
Miosis (anisocoria)

Question 10

Neural pathway associated with Horner’s syndrome

Answer 10

• 1st order neuron: hypothalamus 􀃆 down brain
  stem 􀃆 down spinal cord
• 2nd order neuron: T1-2 spinal cord segments
  􀃆 travels cranially with vagosympathetic trunk
  up the neck
• 3rd order neuron: cranial cervical ganglion 􀃆􀃆
  thru the tympano-occipital fissure into the inner
  ear 􀃆 travels into the ventral floor of the brain
  􀃆 exit skull thru orbital fissure 􀃆
  1. dilator muscles of the pupil
  2. periorbital smooth muscles
  3. third eyelid
  4. eyelid (muller’s muscle)
  5. blood vessels within and around the eyes

Question 11

Causes of miosis

constricted pupil

Answer 11

-Primary ocular
- corneal ulcer
- uveitis
-Spastic pupil syndrome – -FeLV / FIV
Increased parasympathetic - pilocarpine, cerebrocortical disease
decreased sympathetic - Horner’s syndrome

Question 12

Causes of mydriasis

Answer 12

Decreased parasympathetic - atropine, CN3 dysfunction
Increased sympathetic - phenylephrine
- Primary ocular
   - blindness
   - glaucoma
   - iris atrophy
-- Cerebellar disease

Question 13

Trochlear Nerve Dysfunction

(CN4) - often seen with what clinical sign?

Answer 13

Contralateral
ventromedial resting
strabismus

Question 14

Contralateral ventromedial resting strabismus is seen in the dog in what part of the eye

Answer 14

fundus of the eye

Question 15

Contralateral ventromedial resting strabismus is seen in the cat in what part of the eye

Answer 15

slit pupils

Question 16

What cranial nerves are affected when you see resting stabismus

Answer 16

CNs 3, 4, 6
dysfunction cause
resting strabismus

Question 17

What cranial nerve causes positional but not resting strabismus

Answer 17

CN8

Question 18

Structures affected with decreased facial sensations

Answer 18

• CN 5
• CN 7
• Contralateral Cortex

Question 19

Why Neurotropic Keratitis with

CN5 dysfunction?

Answer 19

Lack of eyeball and eyelid sensation due
to ophthalmic and maxillary dysfunction –>
reduce blinking –> corneal drying

Lack of proper corneal nutrition due to
ophthalmic branch dysfunction –> corneal
necrosis

Question 20

Differentials for facial nerve paralysis

Answer 20

• Idiopathic*
• Inner/middle ear disease*
• Hypothyroidism
• Trauma
• Neoplasia – brainstem level or in the
  nerve peripherally
• Polyneuropathy

Question 21

Hemifacial Spasm (CN7) - two causes

Answer 21

1. Irritated CN7 (overactivity)

2. Result of chronic CN7 paralysis (fibrosis of muscles)

Question 22

Nystagmus - slow phase is ___

Answer 22

towards the side of the lesion

Question 23

Positional Strabismus with no

resting strabismus indicates what

Answer 23

CN 8

vestibular dysfunction

Question 24

Positional Strabismus
Abnormalities with the occulovestibular
pathway:

Answer 24

CN 8 – vestibular component
 MLF – medial longitudinal fasciculus
 CN 3 – occulomotor nerve
 CN 4 – trochlear nerve
 CN 6 – abducent nerve
Can happen with both central or peripheral vestibular
disease

Question 25

Peripheral Causes of vestibular disease

Answer 25

􀂄􀂄 Ear infection
􀂄􀂄 Foreign body
􀂄􀂄 Polyp
􀂄􀂄 Trauma / hemorrhage
􀂄􀂄 Tumor
􀂄􀂄 Hypothyroidism
􀂄􀂄 Drugs – aminoglycosides.
flurosemide, ear cleaning
agents
􀂄􀂄 Congenital
􀂄􀂄 Idiopathic - geriatric
vestibular disease

Question 26

Signalment of dogs with old dog vestibular disease

Answer 26

Older dogs

Question 27

Clinical signs and history of dogs with old dog vestibular disease

Answer 27

􀂄􀂄 Acute onset of peripheral vestibular signs
􀂄􀂄 Mild head tilt to severe imbalance / rolling
􀂄􀂄 Usually unilateral signs
􀂄􀂄 No treatments
􀂄􀂄 Improve rapidly, although can take 2-3 wks for complete
recovery
􀂄􀂄 Can have residual head tilt
􀂄􀂄 Can be relapsing