Page 76 - Canine Lameness

48 4 The Neurologic Examination

stimulation, information entering the spinal cord is either processed directly on LMNs to complete
a reflex arc (e.g. patellar reflex) or is projected to the brain (i.e. conscious and unconscious proprio-
ception). Clinically, it is difficult to accurately separate unconscious from conscious propriocep-
tion and as such, the term general proprioception is preferred and will be used in this text.

4.3 The Neurologic Examination

The neurologic examination is always performed in combination with a full history and physical
exam. This allows the clinician to first identify clues that are indicative of a neurologic problem
(e.g. worn toe nails indicating proprioceptive deficits; Figure 4.3 and Box 4.2) and then determine
the level and extent of the nervous system dysfunction. Doing so establishes the anatomical diag-
nosis, a critical step in the approach to a neurologic patient.

(A) (B)

Figure 4.3 Toe nail wear commonly seen on the weight-bearing toes in patients with (A) neurologic
disease (white arrow) and (B) normal digits for comparison.

Box 4.2 Clinical Findings Indicating Neurologic Causes of Lameness or Monoparesis

Unprovoked, intermittent, or sudden vocalization
●
Focal pain (e.g. nerve root signature)
●
Neurologic deficits:
●
○ Paresis or paralysis and ataxia (including knuckling)
○ Postural reaction deficits
○ Rapid muscle atrophy
Paresis that worsens with activity
●
Other neurologic signs (Horner syndrome with thoracic limb lameness)
●
Uneven nail wear
●
Hyper- or hypoesthesia
●
Lack of orthopedic examination abnormalities
●