Difference between revisions of "Neuro Exam of The Horse - Pathology"

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[[Neurological Examination of Horses Overview]]
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#redirect[[:Category:Neurological Examination - Horse]]
 
 
 
 
[[Neurological Examination Initial Observation - Horse]]
 
 
 
==[[Cranial Nerve Examination - Horse]]==
 
 
 
 
 
==[[Body, Spinal Cord and Limb Neurological Examination - Horse]]==
 
 
 
 
 
 
 
==[[Site of Spinal Lesions Determination - Horse]]==
 
 
 
* If there are no brain or brainstem signs, an animal with ataxia or weakness is most likely to have a lesion in the spinal cord.
 
* The spinal reflexes used in small animals to assess specific segments are not very useful in adult horses.
 
** However, withdrawal reflexes are useful in recumbent horses with severe lesions.
 
*** A stimulus is applied to the distal limb and the reflex results in limb withdrawal.
 
 
 
===Cervical Lesions===
 
 
 
* Cervical lesions occur from C1 to C5
 
** C6 and C7 may also be included.
 
* Horses with defects in all four legs are most likely to have a cervical lesion.
 
* The pelvic limbs tend to be more severely affected than the thoracic limbs.
 
** This is due to the topographical arrangement of the white matter tracts in the spinal cord.
 
 
 
====Effects on Reflexes====
 
 
 
* Cervicofacial reflex
 
** The cervicofacial reflex is tested by lightly stimulating the skin of the lateral neck.
 
*** In an intact reflex movement of the lips should be observed.
 
*** This reflex varies widely between individual horses.
 
*** This is not intact in cervical lesions.
 
* Withdrawal reflexes
 
** Only of use in recumbent horses.
 
** In cervical lesions, reflexes in both thoracic and pelvic limbs may be exaggerated.
 
*** This is due to a loss of upper motor neuron inhibition.
 
 
 
===Brachial Lesions===
 
 
 
* Brachial lesions occur from C6 to T2.
 
* Signs of a spinal lesion at this level differ in the thoracic and pelvic limbs.
 
** Thoracic limbs
 
*** Lower motor neuron signs
 
**** Weakness
 
***** May be mild
 
***** May manifest  unwillingness to take the weight on the other thoracic limb when one is picked up.
 
**** Muscle atrophy
 
*** Withdrawal reflex in recumbent animals may be reduced.
 
** Pelvic limbs
 
*** Ataxia
 
*** Upper motor neuon weakness
 
**** For example, swaying and stumbling.
 
*** Withdrawal reflex in recumbent animals may be exaggerated.
 
 
 
===Thoraco-lumbar Lesions===
 
 
 
* Thoraco-lumbar lesions occur in the segments T3 to L3 of the spinal cord.
 
* In an animal that has pelvic limb ataxia and weakness but no thoracic limb involvement, the lesion will be between T2 and L3.
 
** I.e. caudal to the brachial plexus.
 
** The animal should be closely examined for symmetry over the gluteals and pelvic limbs.
 
*** If there is symmetry, the lesion is likely to be at this level.
 
*** If there is no symmetry, the lesion is likely to be more caudal, and involve the pelvic outflow.
 
* Asymmetry may be detected in the cutaneous trunic reflex.
 
** This is tested by lightly stimulating the skin of the lateral thorax.
 
* The withdrawal reflex in the pelvic limb may be exaggerated.
 
*  Flexibility of the thoracolumbar spine may be assessed.
 
** The skin of the longissimus musculature is firmly stimulated, and observed for:
 
*** A lordotic movement over the thorax and cranial lumbar region, and
 
*** A kyphotic movement over the caudal lumbar region and gluteals.
 
 
 
===Lumbosacral Lesions===
 
 
 
* Lumbosacral lesions occur between the segments L4 and S3.
 
* Horses with such lesions may:
 
** Exhibit atrophy of one or more muscles of the pelvic region, and so
 
** Be easy to pull over when standing, and
 
** Be unwilling or unable to take weight on the affected side when the other limb is lifted.
 
* More caudal lesions may:
 
** Affect the anal and perineal reflexes.
 
*** These are tested by lightly stimulating the skin surrounding the anus and observing for a reflex contraction of the anal sphincter.
 
** Cause paresis of the tail.
 
* The withdrawal reflex may be reduced or absent in the pelvic limb.
 
 
 
===Sacral Lesions===
 
 
 
* Damage to the savral spinal cord can affect bladder function and control of defaecation.
 
 
 
====Bladder Incontinence====
 
 
 
* The bladder is reflexely controlled, via higher order neurones in the caudal brainstem and cerebrum, by the:
 
** Pelvic nerve
 
*** Parasympathetic fibres leave the spinal cord in the sacral segments and combine to form the pelvic nerve.
 
**** These fibres innervate the smooth detrusor muscle of the bladder wall.
 
** Pudendal nerve
 
*** The pudendal nerve innervates the striated muscle of the bladder neck.
 
* During micturition, the bladder is evacuated as:
 
** The striated muscle is relaxed.
 
** Stimulation of the pelvic nerve causes the detrusor smooth muscle to contract.
 
 
 
====Faecal Incompetence====
 
 
 
* Lesions in the sacral region may also be manifest as faecal incompetence.
 
** In horses, problems are usually caused by defects in the lower motor neurons in the pelvic nerve.
 
*** Faeces is retained.
 
 
 
 
 
[[Category:Neurological Examination - Horse]]
 

Latest revision as of 12:52, 10 March 2011