Page 79 - Canine Lameness

4.3 The Neurologic Examination 51

Box 4.3 Key Components of the Neurologic Examination that Should Be Performed
in a Given Patient
All patients:
●
○ Gait and posture evaluation
○ Postural reactions: Proprioceptive placement and hopping
○ Sensory palpation
○ Muscle mass and tone
Patients with thoracic limb lameness:
●
○ Assess for Horner syndrome
○ Assess for neck pain
○ Withdrawal reflexes (thoracic and pelvic limb)
○ Cutaneous trunci reflex
Patients with pelvic limb lameness:
●
○ Tail lift
○ Paraspinal palpation
○ Withdrawal reflexes (thoracic and pelvic limb), patellar reflexes, and anal tone
○ Perineal reflex
○ Cutaneous trunci reflex

and behavior should be unaffected unless multiple lesions (e.g. vehicular trauma causing brachial
plexus avulsion and traumatic brain injury) are present.

4.3.2 Posture

The neural organization of gait and posture is complex and involves all levels of the nervous system.
Posture evaluation is a subjective assessment of the position of the head, neck, trunk, and limbs. An
example of an abnormal posture that may be associated with a lameness includes neck guarding.
This term refers to a patient where the head and neck are held in a fixed position, even when walk-
ing around a turn. When thoracic limb paresis accompanies cervical pain, the back may be arched
(kyphosis), and the nose kept close to the ground in an effort to off‐weight the thoracic limbs.
Spontaneous knuckling of a foot (i.e. without an observer flipping the paw), causing the dog to
stand on the dorsum of the paw, is generally caused by proprioceptive deficits, indicating neuro-
logic origin, not orthopedic. Off‐weighting a single limb can be seen with nerve pain (i.e. nerve root
signature), but it can also be seen in orthopedic conditions.

4.3.3 Gait
Initial gait assessment allows the clinician to determine which limb(s) is/are affected and to get an
impression of the nature (i.e. orthopedic versus neurologic), location, extent, and severity of the
lesion. Please refer to Chapter 1 for further details regarding subjective gait analysis.
Specific to the patient with neurologic disease, abnormal gait patterns can be grouped into six
components: (1, 2) two qualities of paresis (UMN and LMN), (3) neurogenic lameness, and (4–6)
three qualities of ataxia (cerebellar, vestibular, and GP). Understanding the difference between
paresis and ataxia is very important to establish a neuroanatomic diagnosis. While ataxia is not