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The Neurologic Examination

Alexander de Lahunta, DVM, PhD, DACVIM (Neurology), DACVP

College of Veterinary Medicine, Cornell University, Ithaca, NY, USA

Anatomic Diagnosis making an appropriate anatomic diagnosis. The first‐year
student is readily able to handle this. Now, in the 21st cen-
What is the most important first step in evaluating a tury, when the need for teaching time is so critical, it should
patient presented for a neurologic disorder? It is making be recognized that the most effective teaching of neuro-
the anatomic diagnosis based on the results of your anatomy and clinical neurology is as a vertically integrated
neurologic examination. Did you ever think about who course taught by a board‐certified veterinary neurologist
first made these correlations between the neurologic ideally in the first year of the curriculum. Most veterinary
signs exhibited by a patient and the location of the lesions neuroanatomy courses are taught by nonveterinarians and
responsible for these clinical signs? Based on textbook as a result there is no correlation to clinical disorders.
publications that were available to me, you have to credit As an example of how far we have come, consider this.
the keen observations of two veterinary pathologists for Prior to the mid‐1960s, there was no understanding of
this: Jack McGrath at the University of Pennsylvania the pathogenesis of what was known as coonhound
School of Veterinary Medicine and Anthony Palmer at paralysis then and is now known as polyradiculoneuritis.
the Cambridge University School of Veterinary Medicine. There had been a few case studies published that sug-
These two astute veterinarians both published a textbook gested that these dogs became paralyzed following the
in 1956 and 1965 respectively that recorded their obser- trauma to their cervical spinal cord caused by their con-
vations of the location and character of nervous system tinual jumping up on the trees where they had followed a
lesions with the clinical observations supplied to them by raccoon. Now, you should recognize the fallacy of this
the clinicians that examined the patient prior to its death. observation because you understand that a cervical spinal
Thus began the concept of an anatomic diagnosis. cord lesion cannot cause the diffuse lower motor neuron
I was a veterinary student at the College of Veterinary disorder that is present in these paralyzed dogs. Hopefully,
Medicine at Cornell University from 1954 to 1958. The your education has taught you how to distinguish tetra-
majority of my clinical neurology education took place in a plegia caused by a lower motor neuron disorder from one
course in Applied Anatomy in my third year of college. caused by an upper motor neuron disorder.
This course taught the clinical signs associated with cranial Fifty years ago, we were just learning the importance of
nerve abnormalities and the effects of specific nerve dys- making an anatomic diagnosis and how to do it. Now, we
function on the gait of the animal. I joined the faculty of the are faced with how to select the most useful diagnostic
Department of Anatomy at this college in 1963 and was procedure to support our most presumptive clinical
given the responsibility of teaching the new course in neu- diagnosis from a plethora of diagnostic instruments.
roanatomy to first‐year veterinary students in their second Issues of expense and patient safety are most prevalent.
semester. As a rule, veterinary students have a need to However, all of these ancillary procedures are meaning-
understand the reason why they must study a subject. less without an accurate anatomic diagnosis.
When a course in clinical neurology does not exist or is a I was asked to write about the approach to a neurologic
brief exposure in the third year, most students will find it patient. This must be a compassionate hands‐on approach
difficult to concentrate on neuroanatomy in their first year. that requires your utmost patience as well as that of your
If you agree with this, then you will understand that patient so that a thorough physical neurologic examina-
combining the teaching of neuroanatomy and clinical neu- tion can be performed. An accurate anatomic diagnosis
rology in one course is the solution and the foundation for will be dependent on this cooperation between you and

Clinical Small Animal Internal Medicine Volume I, First Edition. Edited by David S. Bruyette.
© 2020 John Wiley & Sons, Inc. Published 2020 by John Wiley & Sons, Inc.
Companion website: www.wiley.com/go/bruyette/clinical