THE NEUROLOGIC EXAM MADE EASY （神经系统考试很容易）.pdf

THE NEUROLOGIC EXAM MADE EASY Jared B. Galle, DVM, Diplomate ACVIM (Neurology) Dogwood Veterinary Referral Center 4920 Ann Arbor-Saline Road Ann Arbor, MI 48103 Introduction The neurologic exam is an essential component of the physical examination for patients suspected of having a neurologic disorder and is a tool to help confirm and localize nervous system problems. Evaluating all components of the neurologic exam will help answer the following questions: 1) Does the patient have a neurologic problem? 2) Where in the nervous system is the problem located? 3) What diseases could be causing the problem? 4) What tests should be performed? Often times, a neurologic exam is not performed because it can be intimidating for those not accustomed to performing it regularly or those who are not comfortable with the anatomical organization of the nervous system. However, with a general understanding of the components of the nervous system and how they work together, performing a neurologic exam will become easier with practice. The goal of this lecture is to review the parts of the neurologic exam. Neurologic Exam The neurologic exam starts as soon as the veterinarian meets the patient. There are several components to the neurologic exam which should be tested in the same order each time to enable the clinician to quickly go through the steps without skipping major parts of the exam. The parts of the neurologic exam include: History, Mentation/Behavior, Cranial Nerves, Posture/Gait/ Involuntary Movements, Postural Reactions, Spinal Reflexes, Spinal Pain, and Sensory/Pain Perception. 1. History Obtaining a thorough history is the first component of the neurologic exam. It can be the most important part of the neurologic exam because it may provide clues about the diagnosis. When dealing with a neurologic problem, the history should include the following: signalment, sign- time graph, neurologic signs observed, painful vs. nonpainful, and s