Semiotic Approach to Nervous Symptoms & Sense Organs PDF

Semiotic approach to nervous symptons IntegratedClinicalReasoningI Inês Dias F. Cabral, DVM [email protected] 2024/2025 M a s t e r ’s D...

Semiotic approach to nervous symptons IntegratedClinicalReasoningI Inês Dias F. Cabral, DVM [email protected] 2024/2025 M a s t e r ’s D e g r e e i n Ve t e r i n a r y M e d i c i n e - 3 t h y e a r RCI I Nervous symptons 1  Introduction CENTRAL NERVOUS SYSTEM Forebrain Brainstem Brain Cerebelum Spinal cord PERIPHERAL NERVOUS SYSTEM Composed of: Cranial nerves Spinal nerves Neurologic exam: Peripheral nerves Identify and localize Contains: neurological disfunction Sensory neurons Motor neurons RCI I Nervous symptons 2  Introduction Injury classification: UMN (↑) LMN (↓) RCI I Nervous symptons 3  Introduction Mental status Posture 1. Observation Gait Skin Skeletal system knukling 2. Palpation hopping Muscular system wheelbarrowing Extensor Postural Thrust 3. Postural reactions Hemi-walking Semiotic approach placing reaction to nervous symptons Patellar reflex 4. Spinal reflexes Gastrocnemius reflex Cranial tibial reflex Olfactory (I) Vestibulocochlear Triceps reflex Optic (II) (VIII) Biceps reflex Oculomotor (III) Glossopharyngeal Withrawal reflex 5. Cranial nerves Trochlear (IV) (IX) Cutaneous trunci reflex Trigeminal (V) Vagus (X) Perineal reflex Abducens (VI) Accessory (XI) Facial (VII) Hypoglossal (XII) 6. Pain perception Superficial and deep pain RCI I Nervous symptons 4  Semiotic approach to nervous symptons RCI I Nervous symptons 5  Semiotic approach to nervous symptons 1. Observation 2. Palpation 3. Postural reactions 4. Spinal reflexes best performed in a quiet environment with 5. Cranial nerves a non-slippery surface 6. Sensation or Pain perception RCI I Nervous symptons 6  Semiotic approach to nervous symptons 1. Observation – Mental status ▪ Consciousness is a function of the cerebral cortex and brainstem. ▪ Sensory stimuli such as touch, temperature, pain, light, sounds or smells provide input to the reticular formation. Consciousness is maintained thanks to diffuse projections from the reticular formation to the cerebral cortex. ▪ This system is carried out through the ascending reticular activating system (ARAS). The affectation of ARAS is a typical cause of decreased levels of consciousness. A change in mental state is indicative of CNS disorders RCI I Nervous symptons 7  Semiotic approach to nervous symptons 1. Observation – Mental status ▪ Normal: Bright, alert, responsive or quiet → patient responds appropriately to stimulation ▪ Depression or Obtundation: Conscious but inactive. Reduced response to the environment. Tends to sleep when undisturbed ▪ Stupor: Sleps when undisturbed. Awakes with painful stimuli ▪ Coma: Unconscious; patient cannot be aroused despite stimulus ▪ Other changes may be described, including compulsive behaviour, agitation, aggression, and dementia. RCI I Nervous symptons 8  Semiotic approach to nervous symptons 1. Observation – Posture Sensory information is processed through the brainstem, cerebrum and cerebellum. ▪ Head: head tilt, head and neck turn. If the head tilt is intermittent, it may be associated with otitis. (external or middle). If the head tilt is continuous and resists repositioning, it is usually indicative of vestibular dysfunction. ▪ Trunk: abnormal postures of the trunk may be associated with acquired injuries or congenital deformities. - Kyphosis: dorsal deviation of the spine, typical of animals with pain. - Lordosis: ventral deviation. - Scoliosis: lateral deviation. RCI I Nervous symptons 9  Semiotic approach to nervous symptons 1. Observation – Posture RCI I Nervous symptons 10  Semiotic approach to nervous symptons 1. Observation – Posture ▪ Limbs: - Wide-based stance: common in all forms of ataxia and in cases of diffuse muscle weakness. - knukling: proprioceptive or motor deficits. - Muscular hypo/hypertonia: hypotonia is usually associated with lower motor neuron lesions. Hypertonia of the extensor muscles is a sign of upper motor neuron injury. RCI I Nervous symptons 11  Semiotic approach to nervous symptons 1. Observation – Posture ▪ Limbs: - Decerebration posture: extension of all four limbs and the trunk, with or without opisthotonus. Mental status is decreased. - Decerebellation posture: the forelimbs are extended, but the posteriors are flexed. Mental status is normal. - Schiff-sherrington posture: in severe lesions of the spinal cord between T2 and L4. It manifests with increased extensor tone in the thoracic extremities and flaccidity of the pelvic extremities. The animal will be paraplegic. RCI I Nervous symptons 12  Semiotic approach to nervous symptons 1. Observation – Posture Decerebration posture Decerebellation posture RCI I Nervous symptons 13  Semiotic approach to nervous symptons 1. Observation – Gait: - Poor placement of one or more members, continuous or discontinuous Mono (one limb) - Paresia → partial deficit of voluntary movement WITH sensitivity Para (pelvic limbs) Hemi (ipsilateral limbs) - Plegia → total absence of voluntary motricity WITHOUT sensitivity (+++ severity) Tetra (4 limbs) - Circling → Wide: forebrain Tight: vestibular, caudal brainstem (vestibular nuclei) RCI I Nervous symptons 14  Semiotic approach to nervous symptons 1. Observation – Gait: RCI I Nervous symptons 15  Semiotic approach to nervous symptons 1. Observation – Gait - Ataxia → incoordination of movements caused by a problem with the nervous system. Proprioceptive ataxia: symmetric; lack of coordination can be mild Vestibular ataxia: asymmetric; patient tends to drift or fall to one side of midline. Cerebellar ataxia: symmetric; no loss of strenght in the limbs; a “bouncy” gait with hypermetria (overreaching the intended object or goal) of the limbs is presente. - Dysmetria → change in amplitude: incorrect estimation of distance, opening the limbs exaggeratedly when turning ✓ hypometria (excessively short movements) ✓ hypermetria (excessively long movements) RCI I Nervous symptons 16  Semiotic approach to nervous symptons 1. Observation – Gait RCI I Nervous symptons 17  Semiotic approach to nervous symptons 1. Observation – Gait Involuntary movements: - Tremors: alternating contractions of antagonistic muscles (quick, small-amplitude oscillatory movements) at the station of intention→ more pronounced when starting a movement - Myoclonus: Sudden and gross contractions of a group of muscles - Cataplexy: Sudden and complete loss of muscle tone RCI I Nervous symptons 18  Semiotic approach to nervous symptons 1. Observation 2. Palpation 3. Postural reactions 4. Spinal reflexes 5. Cranial nerves 6. Sensation or Pain perception RCI I Nervous symptons 19  Semiotic approach to nervous symptons 2. Palpation Identify any regions of pain! Scars ▪ Skin Worn nails Surface temperature Masses ▪ Skeletal system Abnormal contour or motion Crepitation Size ▪ Muscular system Tone Strenght RCI I Nervous symptons 20  Semiotic approach to nervous symptons 1. Observation 2. Palpation 3. Postural reactions 4. Spinal reflexes 5. Cranial nerves 6. Sensation or Pain perception RCI I Nervous symptons 21  Semiotic approach to nervous symptons 3. Postural reaction ▪ Knukling Recognition of limb position without visual information. Support the patient under the chest or under the pelvis to prevent loss of balance when assessing thoracic and pelvic limbs, respectively. Flex the paw so the dorsum of the paw is on the floor. The patient should return the paw to a normal position. RCI I Nervous symptons 22  Semiotic approach to nervous symptons 3. Postural reaction ▪ Wheelbarrowing Lift the pelvic limbs from the ground and move the patient forward, just as you would push a wheelbarrow. Normal animals walk forward with coordinated movement. To make the test more challenging, visual compensation can be removed by gently extending the neck with the head elevated. RCI I Nervous symptons 23  Semiotic approach to nervous symptons In severely affected patients, hopping should either be done carefully or not at all, as these patients can fall, which may result in injury. 3. Postural reaction ▪ Hopping Place one hand under the abdomen to lift the pelvic limbs up from the ground, simultaneously, use your other hand to fold a thoracic limb gently back along the chest while pushing the patient toward the standing limb. Place one hand under the chest to lift the thoracic limbs off the ground, simultaneously, the other hand placed by the femur, lifts one pelvic limb off the ground and pushes the patient toward the standing limb. A normal response is that the patient will support their entire weight on the tested limb and hop as the patient is moved medially or laterally. RCI I Nervous symptons 24  Semiotic approach to nervous symptons 3. Postural reaction ▪ Extensor Postural Thrust Thrust is performed by supporting the animal under the thorax while lowering it to the floor. Normal response: extension of the pelvic limbs before reaching the ground. When the pelvic limbs touch the floor, they should move caudally in symmetric walking movements to achieve a position of support. RCI I Nervous symptons 25  Semiotic approach to nervous symptons 3. Postural reaction ▪ Placing Reaction Lift the animal off the ground and bring it closer to a surface (table). When the dorsal face of the digits touches the side of the table, the animal should place all of its limb on the table. RCI I Nervous symptons 26  Semiotic approach to nervous symptons 3. Postural reaction ▪ Hemi-walking Hemi-walking is performed by elevating the front and rear limbs of one side so that all of the animal’s weight is supported by the opposite limbs. Lateral walking movements are then evaluated. In severely affected patients, hopping should either be done carefully or not at all, as these patients can fall, which may result in injury. RCI I Nervous symptons 27  Semiotic approach to nervous symptons RCI I Nervous symptons 28  Semiotic approach to nervous symptons 1. Observation 2. Palpation 3. Postural reactions 4. Spinal reflexes 5. Cranial nerves 6. Sensation or Pain perception RCI I Nervous symptons 29  Semiotic approach to nervous symptons 1. Observation Reflex evaluation: ▪ Absent (0) 2. Palpation ▪ Reduced (1+) ▪ Normal (2+) 3. Postural reactions ▪ Increased (3+) ▪ Clonic (4+) 4. Spinal reflexes 5. Cranial nerves 6. Sensation or Pain perception RCI I Nervous symptons 30  Semiotic approach to nervous symptons 4. Spinal reflexes ▪ Patellar reflex Slightly flex the stifle and tap the patellar tendon with the pleximeter. A normal response is forward movement of the tibia and extension of the stifle. Patellar reflex evaluates L4 to L6 spinal nerves and the femoral nerve. RCI I Nervous symptons 31  Semiotic approach to nervous symptons 4. Spinal reflexes ▪ Gastrocnemius reflex Flex and abduct the hock by holding the limb over the metatarsus; keep the hock flexed, which keeps the tendon tense. Gastrocnemius reflex evaluates (L6) L7 to S1 spinal nerves and, peripherally, the tibial branch of sciatic nerve. RCI I Nervous symptons 32  Semiotic approach to nervous symptons 4. Spinal reflexes ▪ Cranial tibial reflex The uppermost leg is supported by placing a hand under the hock with the stifle and hock slightly flexed. When the insertion of the cranial tibial muscle is struck briskly with a reflex hammer, the response is slight flexion of the hock. Cranial tibial reflex evaluates L6-L7 (S1) spinal nerves and the peroneal branch of the sciatic nerve. RCI I Nervous symptons 33  Semiotic approach to nervous symptons 4. Spinal reflexes ▪ Triceps reflex Flex and abduct the elbow by holding the limb over the radius/ulna. Tap the triceps tendon with the hammer. Triceps reflex evaluates C7 to T2 spinal nerves and, peripherally, the radial nerve. The triceps reflex is difficult to elicit in normal animals; thus, absent or depressed reflexes may not indicate an abnormality. An exaggerated reflex, if elicited, indicates a lesion cranial to C7 (UMN). RCI I Nervous symptons 34  Semiotic approach to nervous symptons 4. Spinal reflexes ▪ Biceps reflex While pulling the limb slightly caudally, place a finger over the tendon and tap the finger with the pleximeter. Biceps reflex evaluates C6 to C8 spinal nerves and, peripherally, the musculocutaneous nerve. The reflex is difficult to attain in normal animals. Absent or decreased reflexes suggest a lesion involving spinal cord segments C6-T2 (LMN). An exaggerated reflex indicates a lesion cranial to spinal cord segment C6 (UMN). RCI I Nervous symptons 35  Semiotic approach to nervous symptons 4. Spinal reflexes ▪ Withdrawal reflex (thoracic limb) The thoracic withdrawal reflex engages all nerves in the thoracic (C6–T2) intumescence. This reflex is induced by touching or pinching the skin of the finger. A stronger stimulus may be required in a tense patient with increased muscle tone. Exaggerated reflexes, when associated with other signs of UMN dysfunction, indicate a lesion cranial to spinal cord segment C6 (UMN). RCI I Nervous symptons 36  Semiotic approach to nervous symptons 4. Spinal reflexes ▪ Withdrawal reflex (pelvic limb) The pelvic withdrawal reflex engages all nerves in the lumbar intumescence, mainly L6-S1. This reflex is induced by touching or pinching the skin of the toe web. A stronger stimulus may be required in a tense patient with increased muscle tone. An exaggerated withdrawal reflex indicates a lesion cranial to spinal cord segment L6 (UMN). RCI I Nervous symptons 37  Semiotic approach to nervous symptons 4. Spinal reflexes ▪ Cutaneous trunci reflex Cutaneous trunci reflex is elicited by pin-prick stimulus to the skin over the back, beginning at the lumbosacral region and continuing cranially. Normal response is twitching of the cutaneous trunci muscle on both sides of the dorsal midline, at the point of stimulation and cranially. Absence of a response occurs one or two segments caudal to the spinal cord lesion. This reflex must be interpreted with some caution. RCI I Nervous symptons 38  Semiotic approach to nervous symptons 4. Spinal reflexes ▪ Perineal reflex Evaluates S1 to S3 spinal nerves and, peripherally, the pudendal nerve. Absence or depression of the reflex (failure of the anus to contract) indicates a sacral spinal cord or pudendal nerve lesion (LMN). An exaggerated response indicates a lesion above the S1 spinal cord segment. RCI I Nervous symptons 39  Semiotic approach to nervous symptons RCI I Nervous symptons 40  Semiotic approach to nervous symptons 1. Observation 2. Palpation 3. Postural reactions 4. Spinal reflexes 5. Cranial nerves 6. Sensation or Pain perception RCI I Nervous symptons 41  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Olfactory (I) Mediates the sense of smell. Rarely has a primary neurologic problem. Examined by observing response to pleasurable odors (food) or noxious odors that are nonirritating (e.g. cotton soaked in alcohol) → cause an aversion or licking reaction. RCI I Nervous symptons 42  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Optic (II) Carries visual signals from retina to occipital lobe of brain. Examined by: ▪ Following of moving objects (cotton balls test) ▪ Movements in unfamiliar surroundings, avoidance of obstacles ▪ Menace response (II for visual cue and VII for blink response) ▪ Pupillary light response (II for visual cue and III for pupil constriction) - check ipsilateral and contralateral constriction RCI I Nervous symptons 43  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Oculomotor (III) Provides motor to most of the extraocular muscles (dorsal, ventral and medial rectus) and for pupil constriction Examined by: ▪ Observing for physiologic nystagmus when turning head (also involves IV, VI and VIII) ▪ Rotation of the head →Lesion: lateral strabismus ▪ Pupillary light response (II for visual cue and III for pupil constriction) - check ipsilateral and contralateral constriction RCI I Nervous symptons 44  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Trochlear (IV) Provides motor function to the dorsal oblique extraocular muscle and rolls globe medially. Rotation of the head → lesion: Dorso-medial strabismus. RCI I Nervous symptons 45  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Trigeminal (V) Provides motor to muscles of mastication (masseter, temporal) and sensory to eyelids, cornea, tongue, nasal mucosa and mouth. Examine by: ▪ Palpate masseter and temporal muscles for symmetry, atrophy, pain ▪ Check jaw tone ▪ Touch medial septum of nose and look for retraction ▪ Touching the globe and observing for retraction (also tests VI for motor) ▪ Palpebral response blink reflex when touching medial canthus (also tests VII for motor) ▪ Pinching the lip and observing for snarl response (also tests VII for motor) RCI I Nervous symptons 46  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Abducens (VI) Provides motor function to the lateral rectus extraocular muscle and retractor bulbi. Examined by: ▪ Touching the globe and observing for retraction (also tests V for sensory) ▪ Rotation of the head →Lesion: medial strabismus ▪ Observing for physiologic nystagmus when turning head (also involves III, IV and VIII) RCI I Nervous symptons 47  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Facial (VII) Provides motor to muscles of facial expression (eyelids, ears, lips) and sensory to medial pinna. Also taste to rostral tongue and parasympathetic innervation to lacrimal glands and some salivary glands. Examined by: ▪ Menace response (II for visual cue and VII for blink response) ▪ Palpebral response blink reflex when touching medial canthus (Also tests V for sensory) ▪ Observe for facial paralysis, deviation of nose to one side, or droopy lips. ▪ Ear flick in response to stimulation of medial pinna RCI I Nervous symptons 48  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Vestibulocochlear (VIII) Sensory input for hearing and head position. Examined by: ▪ Hearing assessment: deaf animals may startle easily ▪ Observe for head tilt, look for abnormal and physiologic nystagmus RCI I Nervous symptons 49  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Glossopharyngeal (IX) Provides motor and sensory innervation to pharynx. Examined by: ▪ Eliciting a gag reflex and observing for dysphagia RCI I Nervous symptons 50  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Vagus (X) Innervates the larynx, esophagus and pharynx. Also provides parasympathetic innervation to the heart and viscera. Examined by: ▪ Elicit a gag reflex ▪ Elicit deglutition reflex ▪ Observe for laryngeal paralysis RCI I Nervous symptons 51  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Accessory (XI) Innervates cranial cervical muscles. Examined by: Palpation of the neck, evaluate the muscles (atrophy or hypotonia) RCI I Nervous symptons 52  Semiotic approach to nervous symptons 5. Cranial nerves ▪ Hypoglossal (XII) Provides motor to the tongue. Examined by: ▪ Observing tongue movement and symmetry or for problems drinking and prehending food. RCI I Nervous symptons 53  Semiotic approach to nervous symptons 5. Cranial nerves B – Lateral strabismus (lesion of cranial nerve III – oculomotor) C – Medial strabismus (lesion of cranial nerve VI – abducens) D - Dorsomedial strabismus (lesion of cranial nerve IV – trochlear) RCI I Nervous symptons 54  Semiotic approach to nervous symptons RCI I Nervous symptons 55  Semiotic approach to nervous symptons 1. Observation 2. Palpation 3. Postural reactions 4. Spinal reflexes 5. Cranial nerves 6. Sensation or Pain perception RCI I Nervous symptons 56  Semiotic approach to nervous symptons 6. Sensation or pain perception Evaluate superficial pain perception by pinching the toe web; evaluate deep pain perception by pinching the periosteum of the toe. Use a hemostat for pinching. A conscious response from the animal indicates pain (ie, vocalizing, trying to bite, turning the head, whining, dilating pupils, increased respiratory rate). Lack of deep pain perception carries a guarded to poor prognosis. Note that a withdrawal reflex can be elicited in animals with loss of pain perception; this reflex should not be mistaken for voluntary motor function or pain perception. RCI I Nervous symptons 57  Semiotic approach to nervous symptons 1. Observation 2. Palpation Is it neurologic? Where is the lesion? 3. Postural reactions 4. Spinal reflexes 5. Cranial nerves 6. Sensation or Pain perception RCI I Nervous symptons 58  Semiotic approach to nervous symptons Extracranial lesions Intracranial lesions C1 – C5 Brainstem C6 – T2 Diencephalon T3 – L3 Vestibular System L4 – S3 Cerebellum Cerebral Hemispheres RCI I Nervous symptons 59  Semiotic approach to nervous symptons Extracranial lesions Clinical features UMN - LMN UMN LMN Motor function Paresis-paralysis Paresis-paralysis Muscle function Spastic (increased) Flaccid (decreased) Spinal reflexes Normal to increased Decreased to absent Muscle atrophy Slow (difuse) Fast (neurogenic) RCI I Nervous symptons 60  Semiotic approach to nervous symptons Extracranial lesions Spinal lesions Thoracic limbs Pelvic limbs C1 – C5 UMN UMN C6 – T2 LMN UMN T3 – L3 Normal UMN L4 – S3 Normal LMN RCI I Nervous symptons 61  Semiotic approach to nervous symptons Extracranial lesions Intracranial lesions C1 – C5 Brainstem C6 – T2 Diencephalon T3 – L3 Vestibular System L4 – S3 Cerebellum Cerebral Hemispheres RCI I Nervous symptons 62  Semiotic approach to nervous symptons Feline cerebellar hypoplasia RCI I Nervous symptons 63  Semiotic approach to nervous symptons Diagnostic Tests in Neurology ✓ Cerebrospinal fluid (CSF) collection and examination ✓ Radiography ✓ Cerebral angiography ✓ Computerized Axial Tomography ✓ Magnetic resonance ✓ Scintigraphy ✓ Electromyography and Electroneurography RCI I Nervous symptons 64  Semiotic approach to nervous symptons Cerebrospinal fluid (CSF) is a biologic fluid, formed mainly in the ventricular choroid plexus, distributed within the Cerebrospinal fluid (CSF) collection and examination ventricular system, basal cisterns, and subarachnoid space. Useful when suspected of: meningitis, meningoencephalitis, seizures of unknown origin, suspected tumors, suspected infectious diseases,… RCI I Nervous symptons 65  Semiotic approach to nervous symptons EQUINE NEUROLOGIC EXAM Dynamic Examination Static Examination - Similar to Small Animals 1. Walk 1. Observation – Behaviour and mentation ▪ Straight line ▪ Zig-zag 2. Cranial nerves ▪ Head elevation ▪ Back 3. Posture of head, neck, trunk, tail, and limbs while ▪ Use diferente surfaces for visual input into gait standing ▪ Circles ▪ Up and down a curb, Hill 4. Palpation to assess body mass, detect ▪ Tail pull/ body push if safe to test for strength, muscle/bone asymmetry, tone, pain, and alterations reaction and limb placement in local temperature (check flexion/extension of joints) 2. Lameness examination if safe and indicated since concurrent muskuloskeletal and orthopedic diseases are 3. Spinal reflexes (++ cutaneous trunci reflex, common perineal reflex) RCI I Nervous symptons 66  Semiotic approach to nervous symptons EQUINE NEUROLOGIC EXAM RCI I Nervous symptons 67  Semiotic approach to sense organs IntegratedClinicalReasoningI Inês Dias F. Cabral, DVM [email protected] 2024/2025 M a s t e r ’s D e g r e e i n Ve t e r i n a r y M e d i c i n e - 3 t h y e a r RCI I Sense Organs 68  Introduction 1. Vision (sight) 2. Audition (hearing) 3. Olfaction (smell) 4. Gustation (taste) The olfactory system plays an essential role in the overall flavor perception. 5. Tactile (touch) Neurologic exam RCI I Sense Organs 69  Semiotic approach to sense organs Does the problem 1. Vision (sight) start in the eye? Ocular changes/ blindness: Eye-related (cataracts, glaucoma, progressive retinal atrophy, uveitis,…) Neurologic (central or optic nerve) Systemic (Diabetes mellitus) Toxic (…) RCI I Sense Organs 70  Semiotic approach to sense organs Minimum database: Complete blood count Biochemistry Electolytes 1. Vision (sight) Neurologic Exam Distant Examination Physical Complementary Anamnesis Examination tests (“look”) Citology Culture/ Antibiogram Reason for consultation? Ocular Orbit palpation Tonometry How it appear? dimensions/ Nictitant membrane Flurescein test Time since first complaint? asymmetries observation Schirmmer tear test Is it getting worse? Behaviour Ocular discharge Slit lamp Reflexes-reactions: Gonioscopy Neuro-ophthalmology Direct and indirect ophthalmoscopy Ocular ecography (…) RCI I Sense Organs 71  Semiotic approach to sense organs 1. Vision (sight) RCI I Sense Organs 72  Semiotic approach to sense organs Does the problem 2. Audition (hearing) start in the ear? Audition changes/ deafness: Ear-related (otitis, tumors) Congenital (Dalmatians, white blue-eyed cats,…) Ototoxicity drugs Neurologic Traumatic (…) RCI I Sense Organs 73  Semiotic approach to sense organs Minimum database: Complete blood count Biochemistry Electolytes 2. Audition (hearing) Neurologic Exam Distant Examination Physical Complementary Anamnesis Examination tests (“look”) Reason for consultation? Head posture Ear palpation Citology How it appear? Behaviour Signs of pain Culture/ Antibiogram Time since first complaint? Reaction to Ear discharge Otoscopic examination Is it getting worse? external noises Facial nerve (VII) and Radiography Vestibulocochlear nerve CT/ MRI (VIII) – neurologic exam (…) RCI I Sense Organs 74  Semiotic approach to sense organs Does the problem 3. Olfaction (smell) start in the nose? Olfactory disfunction: nose-related (chronic rhinitis, foreign bodies, nasal polips or tumours) Infections (e.g. feline herpesvirus and calicivirus) Neurologic (Olfactory nerve damage, brain tumor) Toxic inhalants (…) RCI I Sense Organs 75  Semiotic approach to sense organs Minimum database: Complete blood count Biochemistry Electolytes 3. Olfaction (smell) Neurologic Exam Distant Examination Physical Complementary Anamnesis Examination tests (“look”) Reason for consultation? Head posture Nose and face Citology How it appear? Behaviour palpation Culture/ Antibiogram Time since first complaint? Reaction to smells Signs of pain Rhinoscopy Is it getting worse? Nose discharge CT/ MRI Olfactory nerve (I) – (…) neurologic exam RCI I Sense Organs 76  Bibliography RCI I Nervous symptons/ Sense Organs 77