Neurology

Spinal cord

The extracranial part of the CNS

Spinal column

Encases + protects the spinal cord

Neurolocalisation

Identification of what part of the spinal cord is being affected

Upper motor neurons

Neurons between the cerebral cortex + spinal cord

* Loss of motor function
* Paresis
* Increased reflexes
* Increased extensor muscle tone
* Chronic atrophy

Lower motor neurons

Neurons connecting the CNS to the effector organ

* Flaccid paralysis
* Reduced reflexes
* Loss of muscle tone
* Muscle atrophy

Ataxia

Uncoordinated gait

Paresis

Weakness, with decreased voluntary movement

Paralysis

No voluntary movement

Mono-

One side affected

Hemi-

Both limbs on one side affected

Para-

Both pelvic limbs affected

Quadra/tetra-

All 4 limbs affected

(very rare as this also compromises respiratory function!)

Head tilt

One ear below the other

Head turn

Nose turned towards the body

Ventroflexion of the neck

Low head carriage

Scoliosis

Lateral spine curvature

Lordosis

Ventral deviation of the spine

Kyphotic

Spine arching dorsally

Decerebrate rigidity

Extension of the limbs, head, and neck

Decerebellate rigidity

Extension of thoracic limbs, head, and neck

Wide based stance

Feet and legs wider apart than normal when standing

Proprioceptive positioning

Reaction to moving their paw

Hopping

Lifting one limb, and getting them to hop

Visual placing

Getting them to put their paw on a table. They should reach out when moving towards a table

Tactile placing

Covering their eyes and moving their paw to touch a table. They should replace their paw to its natural position

Hemi-walking

Supporting their limbs on one side and getting them to walk

Wheelbarrowing

Lifting their hind limbs and getting them to walk

Withdrawal reflex

Pinching between the toes. They should withdraw

Extensor carpi radialis reflex

Tapping the extensor carpi radialis and checking for a response

Perineal reflex

Stroke or pinch skin in the anal region to check for contraction

Panniculus reflex

Pinching skin either side of the spinal column. The skin should twitch

Deep pain negative

Inability to feel any pain in the toes.

We check for this by pinching the nail bed on digits of each limb, checking for any turning, vocalising, or biting

Upper motor neuron bladder

* Increased urethral resistance
* Detrusor + urethral sphincter muscle contraction at the same time
* Urinary retention
* Kidney damage
* Difficult to manually express - Requires catheterisation

Lower motor neuron bladder

* Flaccid bladder than doesn’t contract spontaneously
* Continues to fill = Overflow leakage
* Overstretched bladder muscle
* Easy to express manually

Neuromuscular disease

Disease particularly affecting lower motor neurons that innervate skeletal muscle.

This causes a reduction in muscle function

Polyradiculoneuritis

Immune mediated neuromuscular disease affecting the myelin of axons.

* Short-strided gate (tetraparesis)
* Autonomic function remains

Once stabilised, recovery is within 1-4 months

Myasthenia gravis

Disease of neuromuscular transmission, affecting the neuromuscular junction.

Can be congenital, or immune mediated

* Muscle weakness (esp. during exercise)
* Regurgitation (oesophageal dilation)

Can be focal, generalised, or acute fulminating

Focal myasthenia gravis

Localised myasthenia gravis, affecting just 1 muscle group

Generalised myasthenia gravis

Myasthenia gravis affecting 2 or more muscle groups

Acute fulminating myasthenia gravis

Most severe myasthenia gravis type

Polymyostitis

Immune-mediated inflammatory myopathy (neuromuscular disease) where there is an infiltration of inflammatory cells into skeletal muscle

* Exercise intollerance
* Stiff gait
* Muscle weakness + atrophy
* Dysphonia, dysphagia, regurgitation

Focal polymyostitis

Polymyostitis affecting just 1 muscle

Diffuse polymyostitis

Polymyostitis affecting a large group of muscles

Muscle contracture

The adaptive shortening of soft tissue + muscle as a result of recumbency + immobilisation.

Treated with intensive physiotherapy

Intracranial disease

Disease or injury affecting the brain

Skull vault

A closed, inelastic compartment that doesn’t allow room for inflammation + swelling.

This contains:

* Parenchymal tissue (brain)
* Blood
* Cerebrospinal fluid

Cushings reflex

A reflex triggered by severe, acute increase in ICP.

* Hypertension
* Reflex bradycardia

This is an emergency - Treat ASAP

Anisocoria

Asymmetric pupils

Mydriasis

Dilated pupils

This indicates neurological deterioration (likely brain dead) if no pupillary light reflex!

Glasgow coma score

Assessment of:

* Motor activity
* Brainstem reflexes
* Level of consciousness

Lower score = More severe neurological deficit

Mannitol

First line medication infusion for raised ICP

Hydrocephalicus

Excessive accumulation of CSF within the ventricular system

Meningoencephalitits

Non-infectious inflammatory disorder of the CNS causing brain and spinal cord changes

* Seizures
* Muscle tremors
* Blindness
* Head tilt
* Altered balance/posture
* Circline

Decubital ulcer

An open skin wound caused by continued pressure of skin on a firm surface, which eventually causes tissue ischemia.

Most common on bony prominences + can develop rapidly

Effleurage

Physio technique: Gentle contact w/ the palm of the hand. Like a warm up before exercise.

Stroke towards the heart if oedema present

Petrissage

Physio technique: Roll, squeeze, compress + kneed the skin + muscles to inc circulation

Percussion

Physio technique: Gentle tapping of the skin with the palm or side of hand.

This increases blood supply to aid muscle relaxation

Vibration

Physio technique: Gently shaking limbs to stimulate the whole limb.

Can be good at the end of a massage

Coupage

Respiratory physio technique for recumbent animals, or those with pulmonary disease.

This loosens secretions + assists coughing for airway clearance

* **Never use with fractured ribs/throacic trauma!**
* **Never use with those lacking a gag or cough reflex**

Passive range of motion

Physio technique: Stretching and mobilising the joint within its normal capacity, with no active muscle contraction.

Start with the toes (flex + extend 10 times) then move up joint by joint

Three-legged standing

Assisted exercise technique: Lift 1 leg to build strength in other limbs

Weight-shifting

Assisted exercise technique: Gently shift weight back and forth

E stim

Electrical stimulation using a neuromuscular electrical nerve stimulation device.

This:

* Stimulates muscle contraction
* Increases tissue perfusion
* Minimises muscle atrophy