WeaknessAtaxiaDull mentationBlindnessDisorientationSeizuresHead tilt A defined grading system provides a more objective means to determine the initial severity of intracranial disease and monitor for changes. Asymmetrical neurological deficits suggest a more focal disorder, such as mass, infarct or hemorrhage. Level of consciousness (LOC) is a medical term used to describe how awake, alert, and aware you are. 4 It is best to perform the initial neurological examination prior to administration of sedatives or analgesics when possible, unless seizures, delirium or pain warrants medication sooner. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), 15: Gastrointestinal system motility and integrity, Monitoring and Intervention for the Critically Ill Small Animal, Avoid nasal cannula if causes sneezing or agitation, Mechanical ventilation may be required to maintain normal PCO, Alterations in cerebral blood flow, cardiovascular effects, ROS, Correct fluid deficits, ventilation and other abnormalities, Alterations in cerebral blood flow, altered Na/K ATPase, increased intracellular calcium, ROS, Supplementation with solutions greater than 7.5% dextrose should not be administered in a peripheral catheter. Motor to extraocular muscles (retractor bulbi and lateral rectus) yellowbrick scholarship reviews. 3rd ed. 2001;15(6):5814. EOB Allround parcel scale with robust stainless steel weighing plate - also with XL platform and large weighing ranges. Normalize ionized calcium levels Veterinary Scale. J Vet Med. CNS signs In an awake patient, the quality of consciousness should also be considered. Bilateral unresponsive miosis and normal to reduced oculocephalic reflexes In conclusion, the MGCS is a useful index for . The four most critical presentations or changes in neurological signs in the ICU patient are listed at the top of the algorithm with guidelines for immediate patient stabilization. The history of head trauma and reduced mental status raise concern for increased intracranial pressure. Hansen BD. Psychiatry, Neurology. ADH - antidiuretic hormone, Vasopressin. VIAbducens 1. Facial asymmetry can be observed in patients with dysfunction of the facial nerve, often with unilateral drooping of the lip and ear. veterinary mentation scale. In this way, the neurologic examination should be considered a patient assessment tool, as demonstrated in the following examples. You can also check out our Balances collection for precision weighing equipment. The nervous system includes the brain, which is structurally divided into the forebrain, cerebellum, and brainstem; the spinal cord; and peripheral nerves (FIGURE 1). Fluid boluses are re-dosed if enough improvement is not seen. Neck or back pain is noted and affected animals are handled little until analgesics are given and vertebral fracture or dislocation is ruled out. Secondary injury occurs minutes to days later and results from intracranial and extracranial factors secondary to the primary insult. Here's a list of abbreviations your veterinarian uses, from A to Z. Abc Or Abx - antibiotic (s) Abd - abdomen. 6 Motor to larynx and pharynxSensory supply to pharynxSensory and taste to caudal 1/3 of tongueParasympathetic supply to parotid and zygomatic salivary gland Mechanical ventilation may be required to maintain normal PCO2 Discontinue diazepamDiscontinue if possible Plasma is not recommended unless clinical risk of bleeding is high or there is active hemorrhage Normalize3.55mEq/L Table 12.1 Systemic disorders that influence CNS function. Difficult to assess Seven dogs died within 48 hours of the head trauma. The prognostic value of the Modified Glasgow Coma Scale in head trauma in dogs. Seizures, coma, paraplegia, quadriplegia, and generalized tremors are four of the most devastating neurological problems that necessitate early recognition and immediate therapeutic intervention for ICU patients (Figure 12.1). Hyperventilation can occur with severe midbrain disease, but must be differentiated from hyperventilation associated with acidosis or pain. 9. Olfaction Figure 6. Level of consciousness ( LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment. Ataxia with widebased stanceCircling, head tiltResting nystagmusPositional ventrolateral strabismusVestibuloocular reflex slowly move the nose to one side, the eyes should move in the opposite direction to stabilize the visual field forward (physiological nystagmus) High cervical lesions can result in respiratory paresis or paralysis due to loss of intercostal and diaphragm motor function from compression, edema or hemorrhage and immediate ventilatory assistance may be required. ). Peripheral neuropathyMyxedema comaHypertensive signsThyroid stormAgitationSeizuresThyrotoxic periodic paralysis A score of 8 at admission is associated with a 50% probability of survival [4]. Coma and stupor are serious medical conditions that should be addressed immediately by a veterinarian. Respiratory rate and effort, cardiac output, blood pressure, endocrine regulation, and basal organ functions depend upon the integrity of the brain and spinal cord. Synthesis of the neurologic examination information allows for focused localization of neuroanatomic deficits and identification of more specific diagnostic differentials to investigate. Measures should be taken to reduce the risk of increasing intracranial pressure, such as positioning the patient with the head elevated, avoiding jugular compression, and alleviating pain and/or anxiety to keep the patient calm.6 Careful monitoring of the patients heart rate, blood pressure, and respiratory pattern can identify hypertension and bradycardia, components of the Cushing reflex. Gender, weight, and presence of skull fractures did not predict survival. SodiumDecreasedIncreased Toxins associated with seizures Figure 1. united airlines verifly; micro labels lgbt list; how to summon amalgalich; martha kalifatidis before surgery A person with an altered level of consciousness may have decreased cognitive function or be difficult to arouse. Pain on manipulation of the neck or back can provide an initial localization of a spinal cord lesion. A score of 18 is normal; as the score decreases from this, the severity of neurological injury increases [3]. activities around mental health on a national scale, and it is therefore ideally placed to both host such an event, and continue to drive the . Stupor, coma, dilated (CN III) or midrange fixed pupils; ventrolateral strabismus (CN III); absent pupil light response (CN III); pupil rotation (CN IV) // If there's another sharing window open, close it. Careful examination for evidence of trauma, systemic disease, pain, bleeding or bruising should be performed to detect systemic problems that can impact the nervous system. }); Use a hemostat for pinching. Generalized weaknessParalysisVentral flexion of neck in cats if ( 'undefined' !== typeof windowOpen ) { Other techniques that may be performed along with or in lieu of proprioceptive placing include hopping, hemi-walking, wheelbarrowing, extensor postural thrust, and visual or tactile placing (BOX 3). Table 12.2 Potential CNS sideeffects of drugs frequently used in the ICU. Basic physical parameters to monitor begin with temperature, pulse, and respiration, which reflect central nervous system (CNS) energy demands, CNS perfusion capabilities, and brain control of ventilation. Stupor Introduction Veterinary Scale, 440LB Heavy Duty Digital Livestock Platform Scale with Power Adapter for Vet Animal Pet Cat Dog Cattle . Changes in levels of consciousness include stupor (laterally recumbent responsive only to noxious stimuli) or coma (unconscious, unresponsive to any stimuli) (Table 12.5). The choice of tests and the sequence in which they are performed will vary depending on patient status. Tremors ACTH - adrenocorticotropic hormone. TremorsFacial scratchingStiff gaitSeizuresLethargyWeaknessAtaxiaTwitchingSeizures window.WPCOM_sharing_counts = {"https:\/\/veteriankey.com\/12-neurological-status\/":148628}; . // If there's another sharing window open, close it. A change in mentation or level of consciousness with normal cranial nerve functions suggests cerebral and diencephalic disease. Lead _stq.push([ 'view', {v:'ext',j:'1:6.2.3',blog:'125230388',post:'148628',tz:'0',srv:'veteriankey.com'} ]); Discontinue, reduce dose, naloxone, change drugDiscontinue, reduce dose, flumazenilDiscontinue, reduce dose The MS2210R is a heavy-duty veterinary scale with medical-grade loadcells for excellent accuracy, available in 150kg or 300kg models. Hemiwalking: Lift the limbs on the same side from the ground and push the patient toward the other side, which forces the animal to hop with the limbs on the ground. It is important to note that a patients level and quality of consciousness can wax and wane; therefore, keeping a frequent record of mental status can be of benefit. 2 The neurologic examination, joined with patient history and . Moderate (w ~ 8%) Moderate loss of skin turgor, dry mucous membranes, weak rapid pulses, enophthalmos. Common causes of alterations in mentation and consciousness include brain trauma, neoplasia, and inflammation as well as systemic metabolic or inflammatory disease, intoxication or prescribed medications (see Table 12.2). Veterinary nurses who understand neurologic concerns can improve patient outcomes with appropriate care, observation, and interventions.1. determine lesion severity _stq = window._stq || []; Only gold members can continue reading. Biceps reflex: While pulling the limb slightly caudally, place a finger over the tendon and tap the finger with the pleximeter. The CB compact scale boasts best-in-class performance and value. touching the lip and Withdrawal reflex (thoracic limb): Watch for flexion of all joints; the reduced reflex often is best seen in the shoulder joint. Ad Lib - as desired. A patient with abnormal mentation may be described by a progression of adjectives that range from least to most affected: depressed, obtunded, stuporous, and comatose. $159.89 . Abnormal jaw tone, loss of muscle mass palpated in the muscles of mastication, or loss of facial sensation can occur in disease affecting the trigeminal nerve. 0.1g to 1g. Dementia in pets is diagnosed by excluding other diseases that could affect mentation and cognitive abilities. Irregular and apneustic breathing is often associated with caudal pontine or medulla oblongata lesions due to loss of the vagal nerve and pneumotaxic center function. Hopping (pelvic limb): One hand under the chest lifts the thoracic limbs off the ground; the other hand, placed by the femur, lifts one pelvic limb off the ground and pushes the patient toward the standing limb. The techniques for these tests are as follows: Abnormalities noted in these reflexes indicate a neurologic problem with the associated nerves and/or spinal cord segments. The neurologic examination consists of evaluation of the following: 1) the head, 2) the gait, 3) the neck and thoracic limbs, and 4) the trunk, pelvic limbs, anus, and tail. The veterinary nurse can diagnose the problem, b. Brain edema and swelling within an intact cranium can progress to lifethreatening brain herniation with coma and respiratory paralysis. 2 Questions and answers online may differ from those below. Any temperature < 99 An abnormality indicates a lesion anywhere along the ascending or descending pathways in the peripheral or central nervous systems. The pupillary light reflex evaluates the function of which nerves? $435: Add To Cart: Add To Quote. Motor to extraocular muscles (lateral, medial, ventral rectus)Motor to levator palpebrae superiorisParasympathetic control to pupil It is important to note that intact reflex pathways in the limb do not correlate to intact perception of pain sensation. Conscious proprioception testing. J Vet Med. Decreased consciousness or stupor is diminished awareness or alertness. Free registration is required. Enrofloxacin IVLidocaineDobutamineIohexol contrast In order of increasing severity, these categories are normal, obtunded, stuporous, and comatose. Table 12.3 Localization of neurological lesions in the brain by clinical signs. Table 12.4 Modified Glasgow Coma Scale. AAHC. Inputs are received and responded to by the cerebral cortex. Manage Your Day-to-Day Schedule With Ease. WordPress theme by UFO themes Seizures, coma, paraplegia, quadriplegia, and generalized tremors are four of the most devastating neurological problems that necessitate early recognition and immediate therapeutic intervention for ICU patients (Figure 12.1). IIOptic CheyneStokes respirations are cycles where respiration becomes increasingly deeper then increasingly shallower with possible apneic periods. Am J Vet Res 1993; 54:976-983. Functional anatomy of the central and peripheral nervous system. VTrigeminal is it illegal to eat hamburgers on sunday in minnesota. Wheelbarrow: Lift the pelvic limbs from the ground and move the patient forward, just as you would push a wheelbarrow. The neurologic examination systematically evaluates all parts of the nervous system through a series of simple tests and observation of the results. A score of 18 is normal; as the score decreases from this, the severity of neurological injury increases [3]. Monitor often to titrate needs, Depressed muscle excitability causing severe weakness or paralysis. Lack of air movement between the toes due to the patients inability to walk can lead to interdigital dermatitis that can be addressed with cleaning and drying the toes periodically. An attempt should be made to explain all neurological deficits by a single lesion. Disease affecting this area of the spinal cord can also affect urinary and fecal continence. Figure 15. Ipsilateral hemiparesis; spinal reflexes normal or exaggerated in all four limbs Vestibular mechanical tissue damage, contusion, infarction). Dewey CW, da Costa RC, Thomas WB. American Animal Hospital Association. The UPDRS scale consists of the following six segments: 1) Mentation, Behavior, and Mood, 2) ADL, 3) Motor sections, 4) Complications of Therapy (in the past week) 5) Modified . High cervical lesions can result in respiratory paresis or paralysis due to loss of intercostal and diaphragm motor function from compression, edema or hemorrhage and immediate ventilatory assistance may be required. Tests are valid for 3 years from the date of approval. Evaluation of muscle mass and tone provides additional information, as low muscle tone or atrophy also reflects nerve or segmental spinal cord dysfunction. sugar leaves turning purple; michael phelps cousins; beautiful smile in portuguese; michelle ritter eric schmidt; goodwill employee handbook illinois; houses for rent in pa no credit check; boston marathon 2023 qualifying window; rick stein's mediterranean escapes recipes; Holton L, Reid J, Scott EM, et al. 1. Brittany earned her associate of science degree in veterinary technology from Purdue University in 2010. royal asia vegetable spring rolls microwave instructions; An association also exists with:Peripheral vestibular signsFacial nerve paralysisLaryngeal paralysisMegaesophagusTreatment of thyroid storm will necessitate rapid reduction in hormone production and release as well as cardiovascular support Postural reaction tests are challenging to perform well and require good technique and a cooperative patient. Edema of the nervous tissue occurs due to the release of inflammatory mediators, reactive oxygen species, and enzyme systems, each leading to cell death. In today's VETgirl online veterinary continuing education blog, Dr. Garret Pachtinger, DACVECC reviews the underlying pathophysiology of head trauma (e.g., brain/spinal injury), neurologic evaluation, and Modified Glascow Coma scoring.Make sure to check back next week to read Part 2 for more information on treatment and management of head trauma in your feline and canine patients! localize the lesion(s) Clinical signs Evaluation of joint range of motion or pain can identify concurrent orthopedic concerns that may affect ability to flex the joints. 1 In patients presenting with neurologic signs, systematic examination of the nervous system can identify an area of concern, a process called neuroanatomic localization. Euhydrated (normal) Mild (w ~ 5%) Minimal loss of skin turgor, semidry mucous membranes, normal eye. IOlfactory jQuery('a.ufo-code-toggle').click(function() { OxygenPaO280mmHgPaO260mmHg=severe hypoxemia Free Quote: 0333 344 7476 Select Page. The meaning of MENTATION is mental activity. NormalizeDogs: 1.92.5mg/dL totalor 0.40.6mmol/LCats: 1.82.9mg/dL totalor 0.40.7mmol/L Performing a spinal reflex examination assesses the integrity of the nerves involved in the reflex as well as the associated spinal cord segments. Horners syndrome Avoid nasal cannula if causes sneezing or agitation Within each category a score of 16 is assigned. Figure 12.1 Prioritization and approach to severe neurological signs in the ICU patient. In the pelvic limb, this evaluates the L4 through S3 segments as well as the sciatic nerve. Normal heart rate for dogs. How did the clinical signs occur (acute versus insidious onset)? determine if there are neurological deficits present Read. Authors Channel Summit. Careful examination for evidence of trauma, systemic disease, pain, bleeding or bruising should be performed to detect systemic problems that can impact the nervous system. Menace responseVisual tracking of cotton ball/object 660Lbs. Discontinue, reverse drug if possibleWait for effects of drug to wear off Severe cerebral or diencephalic (cranial brainstem) lesions can result in CheyneStokes respirations. The prognostic value of the modified Glasgow Coma Scale in head trauma in dogs, J Vet Intern Med 15:581, 2001. Metabolic and homeostatic changes such as hypotension, hypoxia, hypoglycemia or fever contribute to secondary damage (Table 12.1). Stay current with the latest techniques and information sign up below to start your FREE Todays Veterinary Nurse subscription today. Others like the 1-5 scale, which has fewer categories. ROS, reactive oxygen species generation. Brainstem eflexes The neurologic examination, joined with patient history and physical examination, is an important diagnostic and monitoring tool in veterinary medicine that enables the healthcare team to identify potential issues with the brainstem, cerebellum, spine, and more. Patellar reflex evaluates L4 to L6 spinal nerves and the femoral nerve (Figure 10). Carbon dioxideHypocarbiaPCO2<35mmHgHypercarbiaPCO2>45mmHg and limb movement and limb pain sensation. Treat primary disease to correctMake sure to take into account the K amount given to avoid overdosing Ships from and sold by A and A Scales LLC. Have the signs progressed and how have they done so? fj45 for sale alberta; nilgai hunting yturria ranch; veterinary mentation scale; sales hunter interview questions. Several techniques can be used to assess proprioception in a veterinary patient. Treatment goal Disease affecting this area of the spinal cord can also affect urinary and fecal continence. Bilateral vestibular signsMydriasisVentral flexion of neck in catsLethargySeizures Evaluation of muscle mass and tone provides additional information, as low muscle tone or atrophy also reflects nerve or segmental spinal cord dysfunction. Objective. For veterinary nurses, using the neurologic examination as an assessment tool provides objective information about a patients status. IIIOculomotor 3.8 out of 5 stars 90 ratings | 8 answered questions . Neck or back pain is noted and affected animals are handled little until analgesics are given and vertebral fracture or dislocation is ruled out. var themeMyLogin = {"action":"","errors":[]}; In the thoracic limb, this evaluates the C6 through T2 spinal cord segments as well as the brachial plexus (axillary, median, musculocutaneous, radial, and ulnar nerves). 3 An apneustic breathing pattern is characterized by deep gasping inspirations held for 3090 seconds then expelled. A guide for localization of intracranial lesions by neurological and clinical signs is provided in Table 12.3. The veterinary nurse plays a role by understanding the tests and communicating the findings to other team members to ensure continuity of care and improve patient outcomes. Evaluation of the patients mental state can be of critical concern and should be considered first. The mentation can be classified as conscious with normal, hysterical, inappropriate, or obtunded behavior. 2 Nystagmus, or involuntary jerking eye movements with a fast-to-slow rhythm, occurs in disease involving the vestibular system. In this technique, the patients weight is semisupported and the paw is turned over, so the dorsal surface is touching the ground (FIGURE4). Abnormalities noted in these reflexes indicate a neurologic problem with the associated nerves and/or spinal cord segments. A change in mentation or level of consciousness with normal cranial nerve functions suggests cerebral and diencephalic disease. IVTrochlear Each of the three categories of the examination (i.e., level of consciousness, motor activity, brain stem reflexes) is . veterinary mentation scale. This evaluation requires some knowledge of the patients normal behavior. The nervous system includes the brain, which is structurally divided into the forebrain, cerebellum, and brainstem; the spinal cord; and peripheral nerves (. In the central nervous system, the pathway of the pupillary light reflex is shown. In any patient with a suspected neurologic condition, a complete neurologic examination should follow the physical examination. Score Depressed muscle excitability causing severe weakness or paralysis Myelencephalon(cranial medulla) Table 12.5 Levels of consciousness in the cat and dog. PotassiumDecreased XIAccessory It allows for more comprehensive and dynamic nursing care plans, c. It determines the prognosis for the patient, d. It should not be used by veterinary nurses because it is outside of the scope of practice. As the patient recovers and pelvic limb withdrawal reflexes return, the care plan should be updated to reflect the decreasing risk of decubital ulcers, urinary incontinence, and skin damage. Biceps reflex evaluates C6 to C8 spinal nerves and, peripherally, the musculocutaneous nerve (, Triceps reflex evaluates C7 to T1 spinal nerves and, peripherally, the radial nerve (, Patellar reflex evaluates L4 to L6 spinal nerves and the femoral nerve (, Gastrocnemius reflex evalutes L7 to S1 spinal nerves and, peripherally, the tibial branch of sciatic nerve (, The withdrawal reflex engages all nerves in the thoracic (C6T2) and lumbar (L4S3) intumescences, respectively (, Neck flexion is usually not performed postoperatively or if an atlantoaxial subluxation (instability between C1 and C2) or fracture is suspected (, Once the neurologic examination has been completed, a neuroanatomic diagnosis can be made. Comparison of a visual analog scale and a numerical rating scale for assessment of lameness, using sheep as the model. windowOpen.close(); 89. If that is impossible then a multifocal neurological disorder is most likely present. CN, cranial nerve. Each cranial nerve has specific functions, and most can be evaluated through the following standard tests: ). WeaknessSeizuresStuporComaWeaknessStuporComaNeuropathy Dull mentationSeizuresDull mentationSeizures This is best described with quantifying terminology indicating the number of limbs affected. We offer up to $10,000 in financing to veterinarians. VETERINARY PLATFORM SCALE. Performing a spinal reflex examination assesses the integrity of the nerves involved in the reflex as well as the associated spinal cord segments.2. 440Lbs. ). Any sedative drugEpidural/local block Exhibits a response typical of the normal temperament of the patient 500g to 3000g. }); Assessment of pain in dogs: veterinary clinical studies. Tremorgenic mycotoxins See Cranial Nerve Assessment for a description of cranial nerve assessment tests, available at todaysveterinarypractice.com (Resources). $159.89 $ 159. > 10%) Considerable loss of skin turgor, severe enophthalmos, tachycardia, extremely dry mucous . ). Information from the brain travels through the spinal cord to the rest of the body. windowOpen = window.open( jQuery( this ).attr( 'href' ), 'wpcomfacebook', 'menubar=1,resizable=1,width=600,height=400' ); The integumentary system is an organ system that forms the protective covering of an animal and comprises the skin (including glands and their products), haircoat or feathers, scales, nails, hooves and horns. Normalize2.55.5mg/dLSupplementation with KH2PO4. Normal reflexes all four limbs unless opisthotonus or decerebellate rigidity (conscious animal) As mentioned, the spinal cord is considered in 4sections. The majority of seizures in dogs are generalized with loss of consciousness and tonic clonic movements. Avoid aggravating pain in limb joints by palpating the patient in lateral recumbency. Brain edema and swelling within an intact cranium can progress to lifethreatening brain herniation with coma and respiratory paralysis. 1. Primary injury occurs immediately and directly from the initial effects of the insult (e.g. Monitor coagulation factor parameters and platelet numbers Some patients with stuporous or comatose level of consciousness may also exhibit decerebrate rigidity characterized by opisthotonos and extension of all limbs. Confirm the existence of a neurologic condition. Patients with severe hypertension should have a stepwise decrease in pressure while hospitalized to avoid signs of hypotension Complete paralysis is the result of total loss of voluntary motor function in the affected limbs. Correct fluid deficits, ventilation and other abnormalitiesAdminister sodium bicarbonate only if refractory metabolic acidemia Figure 10. Then test a 3-step command, such as "Take this piece of paper in your right hand. Deficit results in medial strabismus I've heard that one of the most useful parts of my book, Dictionary of Veterinary Terms: Vet-Speak Deciphered for the Non-Veterinarian, is the "commonly used acronyms" appendix. Hypoxia and hypoglycemia are the two most devastating systemic abnormalities. Decreased acetylcholine release and neuromuscular blockade, Correct any potassium or calcium abnormalities as well as magnesium, Signs usually secondary to calcium sequestration leading to hypocalcemia, Patients with severe hypertension should have a stepwise decrease in pressure while hospitalized to avoid signs of hypotension, Deficiency in carbohydrate metabolism leading to energy depletion and neuronal necrosis, Seen with diets mainly of raw fish or diets heated to excessive temperatures, Not completely understood possibly depletion in energy metabolism and altered cerebral blood flow, Decreased metabolic demand and altered blood flow, Warming should be performed slowly with careful attention to blood pressure, Hemorrhage directly into or around nervous tissue leading to dysfunction and potential increased intracranial pressure, Monitor coagulation factor parameters and platelet numbers, Plasma is not recommended unless clinical risk of bleeding is high or there is active hemorrhage, Decreased cell membrane threshold potential, Always measure ionized levels as other factors can affect total calcium levels, Do not change serum sodium level faster than 0.5mEq/L/h unless the disease is acute to avoid worsened neurological insult, Discontinue or change route of administration, Discontinue, reduce dose, naloxone, change drug, Seizures, behavior change, dementia, delirium, depression, stupor or coma with normal or miotic pupils; head pressing; pacing; circling; loss of smell (CN I); blind with dilated pupils (CN II) or normal pupils; CheyneStokes breathing pattern, Acute lesions may have transient contralateral hemiparesis or quadriparesis; spinal reflexes normal or exaggerated, Stupor, coma, dilated (CN III) or midrange fixed pupils; ventrolateral strabismus (CN III); absent pupil light response (CN III); pupil rotation (CN IV), Quardriparesis with bilateral lesion; decerebrate rigidity with severe lesion; spinal reflexes normal or exaggerated in all four limbs, Depression, stupor, coma; miotic pupils with normal mentation; atrophy of temporal and masseter muscles or decreased facial sensation or hyperesthesia of face (CN V), Ipsilateral hemiparesis; spinal reflexes normal or exaggerated in all four limbs, Depressed or normal mentation; stupor or coma; medial strabismus (CN VI); reduced blink, lip and ear reflex (CN VII); nystagmus and disequilibrium (CN VIII), Depressed or normal mentation; stupor or coma; hyperventilation; apneustic breathing; heart rate and blood pressure alterations; dysphagia (CN IX or X); megaesophagus (CN X); laryngeal paresis (CN X); tongue atrophy or paralysis (CN XII), Intention tremors and ataxia of the head; head tilt away from lesion; nystagmus; loss of menace response; ipsilateral or bilateral dysmetria; normal limb strength, Normal reflexes all four limbs unless opisthotonus or decerebellate rigidity (conscious animal), Hemiparesis, tetraparesis, or decerebrate activity, Recumbent, intermittent extensor rigidity, Recumbent, constant extensor rigidity with opisthotonus, Recumbent, hypotonia of muscles, depressed or absent spinal reflexes, Normal pupillary reflexes and oculocephalic reflexes, Slow pupillary reflexes and normal to reduced oculocephalic reflexes, Bilateral unresponsive miosis and normal to reduced oculocephalic reflexes, Pinpoint pupils with reduced to absent oculocephalic reflexes, Unilateral, unresponsive mydriasis and reduced to absent oculocephalic reflexes, Bilateral, unresponsive mydriasis and reduced to absent oculocephalic reflexes, Occasional periods of alertness and responsive to environment, Depression or delirium, responsive, but response may be inappropriate, Semicomatose, responsive to visual stimuli, Semicomatose, responsive to auditory stimuli, Semicomatose, responsive only to repeated noxious stimuli, Comatose, unresponsive to repeated noxious stimuli, Exhibits a response typical of the normal temperament of the patient, Response is not typical of the normal temperament of the patient or is different from what is a normal expected response, Irrational or uncontrollable emotional response, Decreased conscious response to external nonnoxious stimuli subjectively is graded as mild, moderate or severe, Conscious response only with the application of a noxious stimulus, Lack of any conscious response to any external stimuli limited to a brief period of time (seconds or minutes), Prolonged lack of any conscious response to any external stimuli spinal and cranial nerve reflexes may or may not be present depending on the location of the lesion, Not usually tested.