JAVMA, Vol 226, No. 5, March 1, 2005 Vet Med Today: What Is Your Neurologic Diagnosis? 699 Coma Stupor Disoriented Depressed Falling Tremor Head tilt Circling All 4 X Pelvic limbs Ataxia Mono Hemi Tetra No paresis; intermittent, shifting, linb-carrying lameness Key: 4=exaggerated, clonus; 3=exaggerated; 2=normal; 1=diminished; 0=none; NE=not evaluated Alert X Normal X Normal Pelvic limbs LF RF LR RR 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 LF RF LR RR 2 2 2 2 2 2 2 2 0 0 0 0 L R 2 2 2 2 2 2 2 2 2 2 2 2 2 2 L R 2 2 2 2 2 2 2 2 2 2 2 2 2 3 2 2 2 Pain elicited during palpation of hind limb muscles 2 2 2 Comments CN NE NE NE NE Mental Posture Gait Paresis Other Wheelbarrow Hopping Ext postural thrust Proprioceptive pos Hemistand/walk Placing–tactile Placing–visual Postural reactions Spinal reflexes Cranial nerves Sensation (Locate and describe abnormal) Quadriceps Extensor carpi Flexion Crossed extensor Perineal VIII–Nystagmus, resting VIII–Nystagmus, change V–Sensation VII–Facial mm V, VII–Palpebral flex IX, X–Gag XII–Tongue II, VII–Vision menace II, III–Pupils resting Stim L Stim R II–Fundus III, IV, VI–Strabismus, resting III, IV, VI, VIII–Strabismus, position Hyperesthesia Superficial pain Cutaneous reflex Deep pain What is the problem? Where is the lesion? What are the most probable causes of this problem? What is your plan to establish a diagnosis? Please turn the page. What Is Your Neurologic Diagnosis? Signalment: 11-year-old castrated male mixed-breed dog. History: The owners had noticed intermittent lameness of acute onset involving the dog’s hind limbs 2 days prior to evaluation. The dog also appeared to have occasional tremors when rising and episodic facial muscle twitching while alert. There was no apparent progression or resolution of clinical signs. The dog was kept outdoors and was current on vaccines and heartworm preventative; flea and tick control status was unknown. Physical examination: Findings were within normal limits. No orthopedic abnormalities were detected and no signs of pain were elicited during joint palpation. Neurologic examination Observation In cooperation with