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    Neurological Examination in Pets

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    Neurological Examination in Pets

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    The Neurologic Examination in Dogs & Cats

    Part 1: Performing the Examination


    Helena Rylander, DVM, Diplomate ACVIM (Neurology)

    CRANIAL NERVE ASSESSMENT


    There are 12 cranial nerves:
    • Cranial nerve (CN) I: Olfactory nerve*
    • CN II: Optic nerve
    • CN III: Oculomotor nerve
    • CN IV: Trochlear nerve
    • CN V: Trigeminal nerve
    • CN VI: Abducens nerve
    • CN VII: Facial nerve
    • CN VIII: Vestibulocochlear nerve 1 2
    • CN IX: Glossopharyngeal nerve Figure 1. Menace response: Move the hand slowly toward
    • CN X: Vagus nerve the eye in a menacing movement, without touching the face or
    • CN XI: Accessory nerve pushing air onto the cornea; dropping a cotton ball in front of the
    • CN XII: Hypoglossal nerve eye helps assess vision.
    * Rarely evaluated in clinical practice Figure 2. Palpebral reflex: Touch the medial canthus of the eye
    with a finger, cotton tip applicator, hemostat, or pen; the blink
    The following tests are done to assess cranial should be complete.
    nerves and nerves involved in the response or
    reflex; afferent (A) and efferent (E) nerves are
    listed.
    • Menace response (Figure 1): A: CN II (retina);
    E: CN VI, CN VII; in addition, the thalamus,
    cerebrum, and cerebellum are involved in the
    response and its pathway
    • Palpebral reflex (Figure 2): A: CN V; E: CN VII
    • Vibrissae (and maxilla) response (Figure
    3 4
    3): A: CN V (maxillary branch); E: CN VII; this
    response also involves the cerebrum Figure 3. Vibrissae response: Touch the upper lip; the patient
    • Mandibular touch: A: CN V (mandibular may move the lip only or turn the head away.
    branch); E: CN VII Figure 4. Auricular reflex: The inner pinna is innervated by
    • Auricular réflex (Figure 4): A: CN VII; E: CN CN VII; the response should be twitching of the ear, blinking, or
    VII shaking of the head.
    • Corneal reflex: A: CN V (ophthalmic branch);
    E: CN VI
    »» The cornea is touched lightly with a moist
    cotton tip applicator; the eye should retract.
    • Pupillary light reflex (PLR): A: CN II; E: CN III
    »» Performed in a dark room to assess
    anisocoria (unequal pupil size)
    »» Dark and light environments can help
    determine which pupil is miotic/mydriatic 5 6
    (constriction/dilation)
    »» Indirect PLR is usually not as strong as Figure 5: Oculocephalic reflex: Eye movement is easier to see if
    direct PLR the sclera is exposed. Movement should be steady with moderate
    speed; before turning the head the other direction, wait and look
    • Oculocephalic reflex, normal physiologic
    for any postrotational nystagmus
    nystagmus (Figure 5): A: CN VIII; E: CN III, IV,
    (more than a few beats is abnormal).
    & VI
    Figure 6: Gag reflex: Touch the
    »» Palpation of the head for symmetry: Muscles larynx with a finger to induce the
    of mastication are innervated by CN V reflex.
    (mandibular motor branch); muscles of facial
    expression are innervated by CN VII
    »» Assess for asymmetry, muscle atrophy, and
    droopy lips
    • Gag reflex (Figure 6): A: CN IX; E: CN X
    • Palpation of the neck to assess muscle
    atrophy: E: CN XI (difficult to assess) Figure 7. Inspect the tongue for asym-
    • Tongue movement & symmetry (Figure 7): metry or muscle atrophy, indicating a
    E: CN XII 7 lesion affecting the hypoglossal nerve.

    January/February 2013 Today’s Veterinary Practice 1

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