Working up a neurologic patient can be challenging and confusing.  The first step to narrowing down the list of possibilities is a full neurologic examination.  The complete examination involves 30 different sets of observations ranging from the simple to the complex, such as assessing thoracic limb weakness in a cat.  Peter Brofman, our neurologist, performs thousands of exams each year thereby increasing the chance of obtaining clinically significant information.

In this photo Dr. Peter Brofman examines an older dog who presented with seizures.  He is looking for positional nystagmus, checking for eye position within the orbit, and looking for a doll’s eye reflex as the head is moved from side to side.  Each pair of cranial nerves is assessed when trying to determine if central nervous system disease is present.

When an abnormal myotactic reflex is seen during the neurologic examination, causes must include not only a disease state but also iatrogenic reasons, eg. drug therapy (analgesics) or fear.

Neurodiagnostics can be performed in animals where peripheral nervous disease is suspected.  We can do electromyography, nerve conduction velocity, and repetitive nerve stimulation as well as measure spinal cord evoked potentials.  In some cases the disease is muscular rather than nervous in origin and biopsy of the muscle or nerve is indicated.

Hematology and blood chemistries are routinely performed on neurology patients as a minimum data base and to rule out other body systems affecting the neurologic system secondarily.  More specific laboratory testing involves spinal fluid collection and analysis.  Cells degrade quickly in CSF and we are fortunate that our samples can be analyzed within minutes at the Antech laboratory in our building.

The Iams imaging center downloads MR images to VSH while the patient is still at the center.  This allows us the opportunity to work with the radiologists to correlate any radiologic diagnosis to the clinical signs.  Just as with ultrasound the challenge of a CT or MR image is being able to take the radiologic diagnosis and determine whether or how any findings correlate with the clinical picture. This cat had masses within the brain which were due to Cryptococcus infection. 
The diagnosis was confirmed on the basis of a positive titer.  Because of prompt diagnosis and treatment, the patient continues to do well one year after this image was made.

For animals with acute paresis or paralysis secondary to intervertebral disk disease, a CT image can help diagnose lesions at multiple disk spaces or show if the protruded disk is lateralized.  The CT image shows a cross section through the lumbar region of a dog. The bright white vertebrae should surround a spinal column that is oval and uniformly dark grey in appearance.  Radiodense, calcified, disk material has protruded into the left side of the cord of this pa(right side of the image).
 Dr. Brofman has training in both medical and surgical neurology, and he shares neurosurgical on-call responsibilities with our surgeons.

Many animals with disk disease can be managed with medical rather than surgical treatment.  One novel method of treating chronic IVDD is epidural injection of steroids.  Epidural administration decreases the side effects associated with long term oral therapy.