March 2025
By Missy Carpentier, DVM, DACVIM (Neurology) with Minnesota Veterinary Neurology, Columbus, MN

In this VETgirl online veterinary continuing education blog, Dr. Missy Carpentier, DACVIM (Neurology) details the main goal of the neurologic examination is to identify if the patient is truly neurologic, and if so, further identify the specific area of the nervous system that is affected, known as neurolocalization. Neurolocalizing your patient is the only way that you can make an appropriate list of differentials and come up with the best recommendations for your patient.

Neurolocalization in Dogs and Cat

I am not going to go through the step-by-step neurologic examination – you can open any textbook and find this information – but I am going to review the main points of the neurologic examination and discuss how you use this information to neurolocalize your patient.

Is Your Patient Neurologic?

The first goal of the neurologic examination is to identify if your patient’s signs are neurologic in origin – this can sometimes be the hardest part! Below are the bullet points for a good neurologic examination. To me, the most important part of the neurologic examination is the hands-off evaluation. Don’t worry if you don’t know what muscle belly you are supposed to be hitting and what the reflex is called – you can neurolocalize most patients based on their signalment, history, and gait evaluation. This doesn’t mean that you shouldn’t be performing a hands-on neurologic examination to the best of your abilities but think of the hands-on part of the exam as further solidifying what part of the nervous system is affected.

Hands-Off Neurologic Assessment

SIGNALMENT: Many neurologic disorders have an age and breed predilection that is helpful when forming your list of differentials.

HISTORY/PRESENTING COMPLAINT: The first question that I have my technicians ask when they go into the room is what brought the owners in to be evaluated. We encourage the owners to give as much descriptive information as they can about their concerns. If they start to use medical terminology and they are not in the medical field, we will ask them to clarify what they mean (i.e., if they come in saying their dog had a tonic clonic seizure with loss of consciousness and autonomic dysfunction, ask for an actual description to be sure they didn’t just pull this information from Google and that truly is what occurred). Allowing the owners to describe abnormal events in detail also allows us to pick up additional information about the event or clinical signs that the owner may not know are important to the history. You should be able to gather the following information from the owners:

As my technicians are going through the above history with me, I am observing the patient. How is their mentation and attitude? Do they have a low head carriage, do they look painful, are they kyphotic, is there pronounced muscle atrophy, do they have a head tilt or turn? This not only provides me with more information, but it also allows me to modify my evaluation if needed. If I have a patient with a low head carriage and is clearly exhibiting signs of cervical hyperesthesia, there is no need to assess the dog for neck pain – we don’t need to make them hurt any more than they already do. And on this subject, you should NEVER do range-of-motion of a dog’s cervical spine. Lateral palpation is all you need if you are assessing for neck pain. You never know when an atlantoaxial luxation is lurking, and you don’t want to find out during your neurologic examination.

Gait Evaluations

The more cases you see the more you will be able to identify “classic” gaits. Below are descriptions of some of the classic gaits. Remember, a normal gait doesn’t rule out neurologic disease. Also, these gaits are in the context that these patients are ambulatory, but a lot of these dogs will present non-ambulatory. If the patient is non-ambulatory, you should still be performing a gait evaluation and classifying the motor function of the patients (i.e., paretic or plegic).

Forebrain: Pacing, wide circles with lateralization if there is a focal forebrain lesion (always circling in one direction TOWARDS the side of the lesion), head pressing, proprioceptive ataxia or proprioceptive deficits that are CONTRALATERAL to the side of the lesion.

Cerebellar: Hypermetria, wide based stance, fine oscillating head tremors, truncal sway, menace deficit with normal vision.

Vestibular: Head tilt, rolling or falling to one side, nystagmus, strabismus, if central vestibular other cranial nerve deficits or proprioceptive +/- proprioceptive ataxia and paresis (+ if central).

Bilateral peripheral vestibular: Wide based head excursions with a low body carriage (decreased extensor tone).

C1-C5 myelopathy: Tetraparesis and proprioceptive ataxia with a FLOATING thoracic limb gait and a spastic pelvic limb gait.

C6-T2 myelopathy: A two-engine gait, which is characterized by a tetraparesis with a SHORT, CHOPPY thoracic limb gait and a spastic pelvic limb gait. Proprioceptive ataxia also present.

T3-L3 myelopathy: Paraparesis and proprioceptive ataxia with a spastic pelvic limb gait.

  • Some of these cases may present with a Shiff-Sherrington posture. If they present with a Shiff-Sherrington posture, then they are either going to be non-ambulatory paraparetic or paraplegic. They will have increased extensor tone of the thoracic limbs, but they have normal movement and proprioception of the thoracic limbs when you support them in a normal standing position. It is important to know that this can occur, because these patients can be confused with cervical myelopathies.

L4-S3 myelopathy: Paraparesis and proprioceptive ataxia with a floppy pelvic limb gait.

Lower motor neuron: Walking on eggshells, short-strided gait, holding the limbs directly beneath the body (think of a circus dog standing on a ball).

Hands-On Neurologic Assessment

Based on the information you have gathered above, you likely have a good idea of where you would neurolocalize your patient. The hands-on evaluation helps you to confirm your suspicion/solidifies you are down the right track.

Cranial Nerve Evaluation

First up is the cranial nerve evaluation. Below is a chart that goes through the cranial nerve reflexes, responses, and other evaluations of the head, as well as the cranial nerves that are involved in these tests.

Hands-on Evaluation of the Limbs

I normally start with the pelvic limbs and move to the thoracic limbs – do what works best for you. I like to start in the back because I start with evaluating for good femoral pulses, especially if they are presenting for intermittent pelvic limb weakness.

When evaluating the limbs you are trying to decide if you have an upper motor neuron or a lower motor neuron limb. To figure this out, you are focusing on evaluation of conscious proprioception/CP’s and the NEURO RAT.

Remember, you have already assessed evidence of paresis or plegia during the gait evaluation, so you already have that information. Below is a chart of what you should be minimally assessing with the limbs.

Once you evaluate the above for each limb, you then can identify each limb as either:

Based on all of the above information that you have gathered, you can then neurolocalize your patient more confidently to one of the following areas.

Still not convinced of your neurolocalization? Good news, there are a few more steps you can take to continue to narrow it down!

Tail tone and movement: Can be abnormal (decreased) with L4-S3 lesions.

Anal tone: Can be abnormal with L4-S3 lesions.

Cutaneous trunci reflex: This reflex is normally present between T2 through L4/5 and can be most helpful with C6-T2 and T3-L3 myelopathies. It can be lost just caudal to a lesion anywhere along the T2 through L4/5 path. Start testing caudally and work your way forward, once you get the reflex there is no reason to continue evaluating it cranially.

Spinal hyperesthesia: Save this for last and only assess if it isn’t obvious where the patient is painful. There are many patients that come in and you can clearly see where they hurt, in those cases spinal palpation is not performed. If I am not certain, then I will evaluate for spinal hyperesthesia with gentle spinal palpation. Again, never perform range of motion of the cervical spine.

Pain sensation: This is also a component of the neurologic examination that should be saved for last and only should be performed in plegic animals. I cannot stress this enough – you should only be assessing for pain sensation in a limb if the animal is plegic. If the animal is ambulatory, don’t do it. If the animal is non-ambulatory paraparetic (i.e., you can see good movement of the pelvic limbs but the patient isn’t strong enough to ambulate alone), don’t do it. There is no reason to evaluate a patient for pain sensation in a limb if there is movement of the limb. If they can move the limb, they can feel it. The one exception to this rule is the patient that is chewing their foot off due to a sensory neuropathy – but this is rare.

When you are assessing pain sensation you need to be sure that the patient consciously acknowledges that you are pinching their toes. A conscious response means either the patient vocalizes, turns their head or tries to bite you. A withdrawal of the limb is just a reflex and does not indicate pain sensation. Most paraplegic, deep pain negative dogs that come in will have intact withdrawal reflexes, so don’t let it fool you. There must be a conscious acknowledgement, not just pulling back of the limb.

If after all your hard work, you still can’t fit your patient into one of the nice neurolocalization regions in the chart above, don’t worry! It is likely, because your patient is multifocal and therefore, they shouldn’t fit nicely into one of the boxes above. A multifocal neurolocalization is a neurolocalization region!

End Result

Now, your patient is successfully neurolocalized and you can open any neurology textbook to start making your list of differentials to make your best recommendations for diagnostics and treatment options.

Please note the opinions and views of this author are not directly or indirectly endorsed by VETgirl.

  1. Marie-Pier Cormier says:

    As a RVT, I do the initial evaluation and I will definitely remember the Neuro RAT. It will be incorporated in my triage routine now!

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