Neurology Terminology
Paresis: (Weakness)
Deficiency in the generation of the gait or in the ability to support weight while voluntary movements are still present.
Plegia: (Paralysis)
Severe paresis with complete absence of voluntary movement.
Ambulatory:
The patient has voluntary movement in all four limbs and can walk with minimal assistance.
Non-ambulatory:
The patient is unable to walk even with assistance.
Deep Pain Sensation:
The conscious perception of pain, pressure, or tension in the lower layers of the skin and deeper structures.
How to assess deep pain: Pinch the patient's hind toes one at a time and observe their reaction. A voluntary reaction (head turn, aggression, whimper, vocalization, etc.) should be noted. Withdrawal of the limb is an involuntary reflex and is not a sign of deep pain. Repeat this on the other hind foot and the tail. If there is no reaction then it is likely that your patient has a complete loss of deep pain. (It is useful to compare the reaction of the hind limbs to that of the front limbs if no reaction is seen as this helps to determine if the patient is stoic.)
Para:
Affecting the hind limbs only.
Tetra:
Affecting all four limbs.
Ataxia:
A condition relating to a group of neurologic diseases presenting with uncoordinated muscle movements, gait instability and/or head tilt.
Nociception:
The detection of painful stimuli and refers to the neural encoding of impending or actual damage to the tissue. This is not the same as "pain" which is a subjective experience of actual or impending harm.
Proprioception:
Also called kinesthesia, this neurological process relates to a patient's perception of their body position and movements. A proprioception deficit commonly describes a patient that lacks the ability to properly place their paw.
Myelopathy:
This is a general term that is used to describe any disease affecting the spinal cord. This should not be confused with Degenerative Myelopathy which is a progressive disease similar to some forms of ALS.
Cluster Seizures:
A condition in which a patient experiences 2 or more seizures within a 24 hour period and regains consciousness between the events.
Status Epilepticus:
A condition in which a patient experiences
- a seizure lasting for 5 minutes or longer, or
- 2 or more seizures in a short period of time without regaining consciousness between the events.
Idiopathic Epilepsy:
A seizure disorder that has no known cause. A diagnosis of idiopathic epilepsy can only be determined by ruling out structural abnormalities and inflammatory diseases that could cause seizures.
Vestibular Disease:
Any process that inhibits the patient's sense of balance or the ability to maintain the posture of the body in space. This could be caused by an issue inside of the brain (central vestibular disease) or outside of the brain (peripheral vestibular disease).
Meningoencephalitis of unknown origin (MUO):
An immune-mediated condition in which white blood cells attack the central nervous system resulting in inflammation of the brain and meninges.
Myasthenia Gravis (MG):
An auto immune disease occurring at the neuromuscular junction that results in generalized weakness in dogs and cats.
*This is a basic flow chart for understanding patient scheduling and prioritization. Obviously there will be exceptional cases that do not fit within these criteria. It is necessary for every case to be evaluated on an individual basis to determine the appropriate course of action.
Understanding Clinical Grading Scales
Clinical grading scales can be a useful tool to help determine and communicate a patient's condition as well as their prognosis for recovery. The scales listed below are used for evaluating effects on the spinal cord. The first two scales ("Scott & McKee" and "VCA") are utilized to evaluate a patient's condition in relation to inter vertebral disc disease. The other two scales ("MFS" and "TSCIGS") are designed to evaluate a patient's condition after an injury to the spinal cord.
You may stumble across a few other scales out in the world but you will notice that they are based on one or more of these scales and modified slightly to meet the specific needs of an individual organization.
However, you can probably guess that having multiple scales in the industry often leads to confusion and miscommunication regarding a patient's condition. We experience this often when a referring clinic may grade a patient on the most severe end of the scale but when they arrive the patient walks through the door on their own power. As a result the VSCAN does not utilize any of these scales when evaluating our patients. Our focus is to determine a patient's condition in strict relation to the definitions of the terminology. Is the patient's condition affecting just the front limbs or all four limbs? Is the patient ambulatory or truly non-ambulatory? Are there any movements in the patient's limbs, voluntary or involuntary? Do they have deep pain sensation and has it been evaluated in every toe of the affected limb? etc.
Only when we ask these questions can we determine a clear picture of a diagnostic plan, treatment options, and prognosis for recovery.
