THE NEUROLOGICAL EXAMINATION AND LOCALISATION
HOW TO DESCRIBE WHAT YOU SEE AND KNOW IF IT IS NORMAL OR ABNORMAL
The neurological examination is one of the most important and cost-effective tools in clinical neurology.
The two aims of a neurological examination are:
- To determine if the nervous system is affected in a disease process (to detect the presence of a neurological abnormality)
- To establish an accurate anatomical diagnosis, to localise the lesion (to determine its location)
The neurological examination is the most important step in identifying if a patient’s condition is neurological (versus medical or orthopedic) and where in the nervous system the pathology is located.
A veterinarian must establish a routine standard procedure for examining an animal. This will provide the experience and confidence necessary to make an accurate neuroanatomical diagnosis.
A full physical examination including an orthopedic and musculoskeletal examination should be performed prior to a neurological examination. It is also important to assess a patient’s general health, as many of the neurological diagnostic tests will require general anesthesia.
The neurological examination should enable an anatomical diagnosis to be established and determine where the lesion is:
Peripheral nerve and muscle
It is important to consider if one lesion can explain all deficits, or if the disease is more diffuse or multifocal.
After the neurological examination has been completed, and the location(s) of a neurological abnormality determined, the next step is to investigate the area involved using ancillary diagnostic procedures, common tests and diagnostics: laboratory analysis, diagnostic imaging, electrodiagnostics and tissue biopsy.
Differential Diagnosis List – “DAMN IT V” or “VITAMIN D” systems may be used to ensure that all possible etiological categories of disease are considered. Ranking of differential diagnoses is based on information collected in the history regarding signalment, nature of onset and progression of signs, and on results of the physical and neurological examinations.
Note on client education: A client should be completely informed regarding the problem list and list of differential diagnoses. The diagnostic plan should be explained and an owner should be informed regarding costs and risks.