Veterinary Hospital

Special

NEUROLOGICAL EXAMINATION

and Neurologic Consult Form

EVALUATION OF THE HEAD:

1. History of Seizures: Yes or No

2. Personality & Mentation 

3. Head Posture 

4. Head Coordination 

EVALUATION OF CRANIAL NERVES:
 
LEFT RIGHT LEFT RIGHT
Olfaction abn or nrm abn or nrm Spontaneous Nystagmus Y or N Y or N
Menace 0 1+ 2+ 0 1+ 2+ Type
Pupil Size sm med lrg sm med lrg Hearing 0 1+ 2+ 0 1+ 2+
Pupil Reflex (Direct) 0 1+ 2+ 0 1+ 2+ Ear, Eye, Lip Reflexes 0 1+ 2+ 0 1+ 2+
(Consensual) 0 1+ 2+ 0 1+ 2+ Temporal & Masseter Muscles abn or nrm abn or nrm
Doll's Eye abn or nrm abn or nrm Swallow 0 1+ 2+ 0 1+ 2+
Strabismus Y or N Y or N Trapezius Muscle abn or nrm abn or nrm
Type Tongue abn or nrm abn or nrm
Vestibular Nystagmus 0 1+ 2+ 0 1+ 2+

EVALUATION OF LIMB RESPONSES:
 
FRONT: LEFT RIGHT REAR: LEFT RIGHT
Wheelbarrow 0 1 2 3 4 0 1 2 3 4 Wheelbarrow 0 1 2 3 4 0 1 2 3 4
Hopping 0 1 2 3 4 0 1 2 3 4 Hopping 0 1 2 3 4 0 1 2 3 4
Propriocept. 0 1 2 3 4 0 1 2 3 4 Propriocept. 0 1 2 3 4 0 1 2 3 4
Triceps R. 0 1+ 2+ 3+ 4+ 0 1+ 2+ 3+ 4+ Patellar R. 0 1+ 2+ 3+ 4+ 0 1+ 2+ 3+ 4+
Bicepts R. 0 1+ 2+ 3+ 4+ 0 1+ 2+ 3+ 4+ Ant. Tibial R. 0 1+ 2+ 3+ 4+ 0 1+ 2+ 3+ 4+
Ex. Carpi R. 0 1+ 2+ 3+ 4+ 0 1+ 2+ 3+ 4+ Gastroc. R. 0 1+ 2+ 3+ 4+ 0 1+ 2+ 3+ 4+
Flexor R. 0 1+ 2+ 3+ 4+ 0 1+ 2+ 3+ 4+ Flexor R. 0 1+ 2+ 3+ 4+ 0 1+ 2+ 3+ 4+
X extensor Y or N Y or N X extensor Y or N Y or N
Babinski Y or N Y or N Babinski Y or N Y or N
Deep Pain Y or N Y or N Deep Pain Y or N Y or N
Neck Pain Y or N Y or N Back Pain Y or N Y or N
Muscle Atr. Y or N Y or N Muscle Atr Y or N Y or N
Location Location
Panniculus Y or N Y or N Anal R. 0   1+ 2+ 3+ 4+ 0 1+ 2+ 3+ 4+

EVALUATION OF GAIT & STRENGTH: (WALK, TROT, & HEMIWALK)      0    1    2    3    4

LOCATION OF LESION:

SEVERITY OF LESION:

PROGNOSIS:

DIFFERENTIAL DIAGNOSIS:

DIAGNOSTIC PLAN:

RECOMMENDATION:

DATE:

SIGNATURE:

Return to the Neurologic Examination

Last updated 27 August 2002