Other Aspects of Physical Examination of the Patient With Neurologic Disease
Diagnosis of a neurologic disease can often be facilitated by the observation of physical abnormalities in other systems. When one examines animals with limb ataxia or tetraparesis, the head, neck, and back should be gently manipulated while the spine is palpated for pain, crepitation, or swelling.
These findings could indicate the presence of a fracture, malformation, or luxation of one or more cervical vertebrae, vertebral osteomyelitis, diskospondylitis, or osteoarthritis of intervertebral joints. Do not manipulate the neck when there is evidence of acute cervical vertebral trauma. Swelling, bruising, or hair loss on the skin around the head or bleeding from the ears or nose could signify cranial trauma. Hair loss and dermatitis around the perineum and medial thigh may indicate urinary incontinence. In neonates a hairless patch over the dorsum of the spine or skull could indicate a meningomyelocele or meningoencephalocele. Crepitation over coxofemoral or stifle joints of recumbent cattle could indicate a luxation or fracture. The pelvic limb and pelvis should be examined in all recumbent large animals to detect displacement of the hip joint into the obturator foramen or fractures through the shaft of the ilium. All joints should be passively manipulated to detect dislocations or fractures. The heart should be auscultated for murmurs that could suggest left-sided endocarditis because such lesions can shower bacteria into the meninges. Odors on the breath such as ammonia, ketones, or petroleum distillates could provide clues about possible toxic causes. The ocular fundus should be examined ophthalmoscopically to detect retinal hemorrhages (trauma), papilledema (increased intracranial pressure), or vasculitis.
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