Feline Neurological Examination

And
Localization
How to perform in cat
The objectives of the neurological examination

 Confirmation and differentiation of neurological

and non-neurological abnormalities.
 Localization of the lesion in the central (CNS) or peripheral
(PNS) nervous system.
 Determination of the severity of the lesion
 Development of differential diagnosis and prognosis.
 Neurological Diagnosis
 Chief complaint

 Signalment

 History taking

 General physical examination

 Neurological examination
 Clinical signs Anatomic Diagnosis
Seziures Forebrain

Abnormal behavior Forebrain

Head pressing Forebrain

Head tilt,nystagmus,falling Vestibular apparatus

Depression,stupor,coma Brainstem or forebrain

Dropped jaw Bilateral CN V (trigeminal

nerve)
Paralysis of eye
lids,lips,nostrils and/or ears CN VII (facial nerve)

Circling
• With loss of balance Vestibular apparatus
• Without loss of balance Forebrain
Checklist for Differential Diagnosis

D Degenerative

A Anomalous

M Metabolic

N Neoplasia,Nutrition

I Inflammatory,Infection,Idiopathic

T Traumatic,Toxic

V Vascular
The onset should be defined as:

 Acute (onset over minutes to hours)

 Subacute (onset over days)

 Chronic (onset over several days,weeks or months)

 Episodic (animal returns to normal between episodes)

Onset and progression of neurological diseases of differing causes

Sign-time graph
Neurological examination

Part I : Observation
Part II: Palpation
Part III: Postural reactions
Part IV: Spinal reflexs
Part V: Cranial nerves
Part VI: Sensation
 Part – Hands-off Part – Hands-on
examination examination
• Mental status • Postural reactions

• Behaviour • Spinal reflexes

• Posture and body position • Cranial nerves

at rest
• Gait • Muscle tone and size

• Identification of abnormal • Sensory evaluation

involuntary movements
Neurological examination

Part I :Observation
o Mental status and behavior
o Posture and body position rest
o Evaluation of gait
o Identification of abnormal involuntary
movment
Mental status and behavior
Anatomy and function
 Limbic system

 Emotional and Behaviour

 Status Clinical signs
Normal Alert; normal response to environmental
stimuli

Depressed Drowsiness, inattention and less responsive

to environment stimuli
Confuse and disoriented Responding to environmental stimuli in an in
appropriate manner

Stupors State of unciousness with reduced responses

to external stimuli,but can be roused by
painful stimuli

Comatose State of unconciousness with absence of

responses to Environment stimuli,including
pain
Normal
 Alert; normal response to environmental stimuli
Depressed
 Drowsiness, inattention and less
responsive to environment stimuli
Confuse and disoriented
 Responding to environmental stimuli in an inappropriate
manner
Stupors
 State of unciousness with reduced responses to external
stimuli,but can be roused by painful stimuli
Comatose
 State of unciousness with absence
of responses to any environment
stimuli,including pain
Posture and body position at rest
o Head tilt
o Head turn
o Ventroflexion of the neck
o Spinal curvature
o Decerebrate rigidity
o Decerebellate rigidity
o Wide-base stance
Head tilte
 Abnormal head posture is characterized by a rotation of the median
plane of the head (one ear is held lower than the other)
Head turn
 In contrast to a head tilte,the median plane of the head remains
perpendicular to the ground but the nose is turned to one side
Ventroflexion of the neck
 • Ammonium chloride toxicity
• Hypernatraemia
• Hyperthyroidism
• Hyperthyroidism
ventroflexion • Hypicalemia
of neck in cat • Hypokalemia
• Thiamine deficiency
• Idiopathic Polymyositis
• Myasthenia gravis
• Organophosphate poisioning
• Portosystemic encephalopathy
 Spinal curvature

• Scoliosis ( lateral deviation of the spine )

• Lordosis ( ventral curvature of the spine )
• Kyphosis ( dorsal curvature of the spine )
• Torticollis (twisting of the neck)
Scoliosis

Lordosis

Kyphosis
 Decerebrate rigidity

This posture is observed As a result of a rostral brainstem lesion

(between the colliculi of the midbrain).
 Decerebellate rigidity

The rostral part of the cerebellum inhibits the stretch reflex mechanism of
antigravity muscles.
Decerebrate VS Decerebellate
 Wide base stance

This posture is characteristic of

a balance disorder with
disease particularly affecting
the cerebellum .
 Evaluation of gait

 Ataxia
 Paresis
 Circling
 Lamness
Ataxia

Vestibular ataxia
Cerebellar ataxia
Proprioceptive ataxia
Ataxia

Vestibular ataxia
Tight circling
Bilateral vestibular
Falling
Rolling
Cerebellar ataxia
Proprioceptive ataxia
 Hypermetria (longer protraction
phase of gait)
 Hypometria(short protraction of
gait)
 Dysmetria (ability to control the
distance,power and
Speed of an action is impaired.
Hypermetria
Hypometria (Two machine walking)
 Evaluation of gait

 Ataxia
 Paresis
 Circling
 Lamness
 Evaluation of gait
 Paresis/-Plegia

 Paresis is a deficit of motor function

 The suffix-plegia is used by some to indicate

both motor and sensory loss/complete loss of
voluntary movment
Paresis

• Tetraparesis/tetraplegia
• Paraparesis/paraplegia
• Monoparesis/monoplegia
• Hemiparesis/hemiplegia
Tetraparesis/Tetraplegia

 T3 to brain
 Generalized LMN
disorder
Neuromuscular disease
Paraparesis/paraplegia

T2 to Caudal
Plantigrade stance
 Monoparesis/monoplegia

Lesion of the
LMN innervating
(C6-T2,L4-S3)
 Hemiparesis/Hemiplegia

 Cranial to T2
 Ipsilateral to a lesion
located between T2 and
caudal midbrain
 Contralateral cerebrum
 Circling

Vestibular system
Asymetrical/focal
forebrain lesions
Part I: Observation
Abnormal involuntary movements
 Seziure

 Partial seizure

 Intension tremor

 Head shaking
Part I: Observation
Abnormal involuntary movements
Generalized seizure

 Generalised seizure activity results from

a synchronized electrical discharge from
the whole of the forebrain

 Generalised tonic-clonic seziures

 Autonomic discharge is common

(e.g.salivation,urination,defecation)

(from Platt S & Garosi L. Small Animal Neuroemergency. Manson publishing,2012)

 Abnormal involuntary movements
Generalized seziure
Partial seizure/Focal seziure

Partial seizure activity results from an abnormal

Electrical discharge in a single area of the brain

 Simple Focal (partial motor) seziures

 Complex partial seziure

(from Platt S & Garosi L. Small Animal Neuroemergency. Manson publishing,2012)

Simple focal partial seziure
Complex Partial seziure
Intensional tremor
Head shaking
Part II: Palpation

 Head
 Neck
 Thoracic and lumbar spine
 Limbs
 Integument
Part II: Palpation

“Back pain”
Muscle tone

 Absent 0

 Reduced 1+

 Normal 2+

 Increased 3+

 Greatly increase 4+
Part III: Postural reaction testing
Proprioception means “sense of position”

General proprioceptor
Concious proprioception
 Joint angle receptors
 Tactile receptors
 Pressure receptors
Unconcious proprioception
 Muscle spindles
 Golgi tendon organs (GTO)
Special proprioceptor
Vestibular receptors (inner ear)
Propioceptive pathways (spinothalamic)
Part III: Postural reaction

o Propioception
o Hopping
o Wheel barrowing
o Extensor postural thrust
o Visual Placing
Grading Propioception

 Absent : 0

 Decreased : 1+

 Normal : 2+
Propioceptive placing
Hopping
Wheel barrowing and Extensor postural thrusting
Visual and tactile placing response
Part IV :Spinal reflex examination

 To categorize the weakness or paralysis of a limb

as either UMN or LMN in origin
 To localize the level of a spinal cord lesion
 To monitor progression of disease
Spinal cord segment

 Cranial cervical (C1-C5)

 Cervicothoracic (C6-T2)

 Thoracolumbar (T3-L3)

 Lumbosacral (L4-S3)
 Site of lesion Thoracic limbs Pelvic limbs

Brain UMN UMN

C1-C5 UMN UMN

C6-T2 UMN UMN

T3-L3 Normal UMN

L4-S3 Normal LMN

Polyradiculopat LMN LMN

hy
polyneuropathy
 Characteristics of the motor supply

UMN lesions LMN lesions

Paresis or paralysis Yes YES

Spinal reflexes Normal to increased Decreased or absent

Muscle tone Normal to increased Decreased or absent

Atropy Gradual (disuse) Rapid (Denervation)

 Grading reflexs

Absent,Areflexia = 0
Reduced,Hyporeflexia = 1+
Normal,Normoreflexia = 2+
Increased,Hyperreflexia = 3+
Clonus,Clonic = 4
Evaluation of the pelvic limbs

 Withdrawal (Flexor) reflex (L4-S2)

 Patellar reflex (L4-L6)
Withdrawal (Flexor) reflex (L4-S2)

Patellar reflex (L4-L6)

Evaluation of the thoracic limbs

 Withdrawal (Flexor) reflex (C6-T2)

 Extensor carpi radialis reflex (C7-T2)
Withdrawal (Flexor) reflex (C6-T2)
Extensor carpi radialis reflex (C7-T2)
Hyporeflexia
Areflexia
Hyperreflexia
Increased, hyperreflexic
 Evaluation of the tail and anus

 Perineal reflex (S1-Cd5)

 Perineal reflex (S1-Cd5)
Part V :Cranial nerve assessment

CN I : Olfactory nerve
CN II : Optic nerve
CN III: Oculomotor nerve
CN IV: Trochlear nerve
CN V: Trigeminal nerve
CN VI: Abducent nerve
CN VII: Facial nerve
CN VIII: Vestibulocochlear nerve
CN IX: Glossopharyngeal nerve
CN X: Vagus nerve
CN XI: Accessory nerve
CN XII: Hypoglossal nerve
CN III,IV CN VI-XII

CN V
CN I-Olfactory nerve
CN II-Optic nerve

Afferent pathway :
Retina--->optic nerve--->contralateral obtic tract
--->visual cortex

Efferent pathway:
Contralateral motor cortex--->the ipsilateral
cerebellar cortex--->the facial nerve
CN II-Obtic nerve

Menace Response
(CN II,CN VII)
Interpretation
Menace deficit and may occur from a lesion in either the afferent
or efferent pathway.

 Retina , optic nerve lesion and optic chiasma

 Unilateral cerebral function---->Contralateral menace deficit

 Facial paralysis (CN VII)

 Unilateral cerebellar lesion----->Ipsilateral menace deficit

Diffuse cerebellar lesion----->Bilateral menace deficit

Menace deficit and facial paralysis
Cotton ball reflex
 Dazzle reflex

 Subcortical reflex blink associated

with a bright light stimulalus

 The efferent pathway of the dazzle

reflex is mediated via the facial
nerve
CN III-Oculomotor nerve
Anisocoria
 CN III-Oculomotor nerve
 Parasympathetic function
CN III-Oculomotor nerve

Parasympathetic function
Sympathetic function
Horner’s syndrome

Miosis

Third eyelid protrusion

Enopthalmia and ptosis of the

upper eyelid.
 Extraocular muscle
CN III,CN IV and CN VI
(eye position and movement)
Eye position

Deviation of the visual axis is called “strabismus”

 Resting (spontaneous) strabismus

 Positional (inducible) strabismus

Ventrolateral strabismus
CN IV-Trochlear nerve
 Dorsolateral strabismus of the
contralateral eye
CN V-Trigeminal nerve
Ophthalmic branch
sensory
Maxillary branch

Mandibular branch Sensory & motor

Opthalmic branch
 Sensory to the eye,cornea,medial canthus and nostril,skin
on the dorsum of the nose.

Maxillary branch
 Sensory to the eye,lateral canthus and nostril,skin of the
cheek, side of the nose,muzzle,palates,mucous membrane
of the nasopharynx,teeth,and gingival of the upper jaw.

Mandibular branch
 Motor to muscle of mastication and sensory to the
mandible
 CN V-Trigeminal nerve

Palpebral Reflex
( CN V,CN VII)

ophthalmic and maxillary branch

Palpebral Reflex
(Rt.CN VII deficits)
Corneal reflex
(CN V ,CN VII)
Ophthalmic branch
Nasal stimulation
(CN V ,Forebrain)
Ophthalmic branch
Palpebral reflex deficit and normal nasal stimulation
Mandibular branch
 CN VI-Abducent nerve

Medial strabismus
CN VII Facial nerve
CN VII Facial nerve
Motor function
Facial expression

Sensory function
The test buds of the rostral 2/3 of the tongue

Parasympathetic function
The lacrimal glands and the submaxillary and
sublingual salivary glands.
CN VII-Facial nerve
Facial paralysis

• Wide palpebral fissure

• Ipsilateral drooping
• Absent nostril abduction
• Dysfunction of the
parasympathetic supply
of the lacrimal gland
Parasympathetic function
CN VIII-Vestibulocochlear nerve
Hearing function
 Sensory receptor organ (organ of corti) within the cochlea
of inner ear.

Vestibular function
Adaptation of the position of the eye and body
with respect to the position and movement of the head.
Clinical signs of vestibular dysfunction
Head tilt
 Falling
 Leaning
 Rolling
 Circling
 Abnormal and/or positional nystagmus
 Positional strabismus
 Asymetrical ataxia
Head tilt
Positional strabismus
Nystagmus
 CN VIII-Vestibulocochlear nerve

Physiological nystagmus
Oculocephalic reflex
Pathological nystagmus
Horizontal nystagmus
Rotatory nystagmus
Vertical nystagmus
CN IX Glossopharyngeal nerves

 Motor function of the pharynx and palatine

structures

 Sensory function of the caudal third of tongue

and pharyngeal mucosa (sense of taste)

 Parasympathetic component innervates the

parotid and zygomatic salivaly glands.
 CN X Vagus nerves

 Motor function of the larynx,pharynx and

oesophagus

 Sensory function of the larynx,pharynx and

thoracic and abdominal viscera.

 Parasympathetic component provide innervation

to all thoracic and abdominal viscera
CN IX and CN X- Glossopharyngeal and Vagus nerves
CN XI – Accessory nerves

Trapezius muscle atrophy

CN XII – Hypoglossal nerve
Part VI:Sensory evaluation
Spinal pain
Mening

Nerve root

Annulus of the intervertebral discs

Vertebral periosteum

Joint capsules (especially articular joint )

Epaxial musculature

Ligamentous structures
 Part VI:Sensory evaluation

Hyperesthesia
Evaluation of the cutaneous trunci (paniculus) reflex
Evaluation of the cutaneous trunci (paniculus) reflex
Nociception testing
Self-mutilation
 Micturation

Urinary bladder size

(Empty/Distend)

Expression
(Easy to void/Resistance)
 Clinical signs of micturition dysfunction
Lesion Conscious Bladder Residual urine Perineal reflex
localization voiding expression/siz volume
attempts e
Cerebral Absent Difficult/small Small Present
cortex to
brainstem
Cerebellum Normal;increa Difficult/small Small Present
sed frequency
Brainstem to L7 Absent;dyssyn Difficult/large Moderate to Present
ergia large
Sacral spinal Absent;may Easy;leakage large Reduced to
cord attempt but absent
limited success
 GRADE OF PARESIS

0 NORMAL
1 PAINFUL
2 AMBULATORY PARESIS
3 NON AMBULATORY PARESIS
4 NON AMBULATORY PARESIS, URINARY INCONT.
5 NON AMBULATORY PARESIS, URINARY INCONT., DEEP PAIN -
Progression of signs in spinal cord compression