The feline neurological examination – in video

• Article and video by Louisa Saunders, BVSc, MRCVS; Leticia Escauriaza, DVM, MRCVS; George Nye, BVetMed, MVSc, DipECVN, MRCVS; Hélène Vandenberghe, DVM, DipECVN, MRCVS; and Nicolas Granger, DVM, PhD, DipECVN, FHEA, FRCVS. All are associated with Highcroft Veterinary Referrals in Bristol.

While the basis of the neurological examination in cats and dogs is similar, some differences exist in how to perform and interpret its findings.

Cats are not small dogs – and it is particularly true for the practitioner wishing to do a neurological examination. We therefore thought that a video presenting the neurological examination of the cat would form a useful tool for veterinary surgeons. This video presents our method, but others may have different techniques.

Please note, this video does not have any audio.

‘Hands-off’ examination

The neurological consultation starts by taking a history – a crucial aspect of the work-up of a neurological case. This is a good time for the “hands-off” examination – allowing assessment of behaviour within the consultation room, the cat’s mentation and how they respond to their environment.

Opening the travel carrier allows the cat to explore, jump or hide. We pay much attention to the posture (for example, crouched, plantigrade, presence of neck ventroflexion, a head tilt or head turn, tail position), gait (for example, circling, ataxia, paresis) and facial features (for example, nystagmus, anisocoria, strabismus, asymmetry of the face).

‘Hands-on’ examination

We aim to perform the “hands-on” examination starting with the least provoking tests. Some tests are considered to be unreliable in cats and could be dismissed in situations of poor patient compliance. It is good to separate clinical findings into those that are “certain” versus those that are “subjective or less compelling” to build a differential diagnosis.

Reliable postural reaction tests:

• Postural thrust.
• Wheelbarrow – a useful test for neuromuscular disorders such as myasthenia gravis, as it exacerbates skeletal muscle fatigue. However, this is not such a useful test in the ragdoll breed, which tends to go limp when held.
• Visual placing.
• Tactile placing .

Less reliable postural reaction tests:

• paw placement
• hopping
• paper slide

Reliable spinal reflexes:

• patellar reflex
• withdrawals
• perineal reflex

Less reliable spinal reflexes:

• Cutaneous trunci – 49% to 80% of neurologically normal cats will amount a bilateral response to haemostats, whereas only 29% respond to a pin prick.
• Muscle reflexes, such as biceps, triceps and gastrocnemius.
• Extensor carpi radialis and tibialis cranialis.

Less reliable cranial nerves:

• Olfaction: the olfactory nerve should be tested with appetising food (but not surgical spirit) to see if the cat follows the scent. It is a crude test that has some difficulty in interpretation when a lack of response occurs. Is it that they cannot smell (as a result of nasal disease), or are they uninterested, or is a neurological disease present? Has the owner noted a decreased appetite?
• Menace response: the menace response is learned from approximately 12 weeks of age. The response is more reliable when the examiner approaches from behind or from in front the animal’s head, inducing a blink in approximately 85% and 82% of cats respectively.

Presence of spinal pain is tested via neck and tail manipulation, and application of gentle pressure to dorsal and transverse processes of each vertebra. Many cats will respond to lumbar palpation or will just not tolerate spinal palpation. Therefore, the clinician must interpret carefully the result of spinal palpation and not give it too much weight in their clinical decision-making.

Deep pain assessment

The final part of the examination involves the assessment of deep pain. To test this, a noxious stimulus – such as applying artery forceps across digital bones (and tail base if no response is obtained) – is performed to look for a behavioural response, such as vocalising or turning to bite. Withdrawal of the limb should be seen first and is a spinal reflex, and therefore not an indicator of presence of sensation. The test is positive when the cat turns towards the clinician in response to the painful stimulation.

Before jumping to the artery forceps, we should first use our fingers to pinch the toes as this may be sufficient to induce a response and avoid unnecessary painful tests.

It should be remembered that if the animal has voluntary movement then it will have deep pain sensation, too.