Will My Regular Veterinarian Still Be Involved?
In many cases, your regular veterinarian will still supervise your pet's veterinary care, especially if your pet is coping with multiple disease states or conditions. In other cases, your referral doctor will take over the majority of your pet's medical care for the duration of its referred treatment. It depends on your pet's particular problem.
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Degenerative myelopathyA veterinarian who has been awarded this specialty status by the ACVIM will list the initials, 'DACVIM (Neurology),' after his or her veterinary degree. Or, the veterinarian may indicate that he or she is a 'Diplomate' of the ACVIM. The word 'Diplomate' typically means the specialist has achieved the following:
Obtained a traditional 8 year veterinary degree (four years of college plus four years of veterinary school).
Completed a one year internship and an additional two to three years of advanced training, including a residency at an approved program where the doctor will have trained with some of the best experts in the field and obtained hands on experience.
Following this training, the aspiring veterinary neurologist must pass a series of examinations covering all aspects of general internal medicine and neurology.
After completing and passing all of these rigorous requirements, the veterinarian is then recognized by his or her peers as a board certified specialist in veterinary neurology. Many veterinary neurologists are also trained in neurosurgery, while others limit their practice to the medical aspects of the discipline and work with a surgeon on the cases requiring surgery. When your pet needs the care of a veterinary neurologist, years of intensive training and additional education will be focused on helping him or her to recover from his or her problem or enjoy the highest quality of life possible.
• Epilepsy
• Congenital deafness
• Viral infection (canine distemper, feline infectious peritonitis, feline leukemia, rabies)
• Fungal infection (Cryptococcus, Coccidioides)
• Tick-borne infections (Rocky Mountain Spotted Fever, Ehrlichia)
• Granulomatous Meningioencephalitis (GME)
• Myasthenia gravis
• Hypoglycemia
• Hepatoencephalopathy (brain dysfunction due to liver disease)
• Hypothyrodism
• Toxicity due to pesticides, lead, ethylene glycol (antifreeze), certain antibiotics
• Nutritional disorders, such as thiamine or vitamin E deficiency
• Traumatic brain or spinal cord injury
• Degenerative myelopathy
• Cancer
• Behavior changes
• Altered consciousness (e.g., depression, disorientation, coma
• Seizures
• Complete or partial paralysis
• Neck or back pain
• Generalized weakness or weakness in one area of the body
• Incoordination or imbalance
• Gait or stance abnormalities (e.g., straddling or shuffling of rear limbs; crouched position)
• Loss of sensory function (sight or hearing)
• Confusion
• Head tilt
• Tremors
• Fecal or urinary incontinence
• Inappetence
In some cases, your veterinarian may be able to simply consult with the veterinary neurologist about your pet's care. In other cases, it is necessary to actually refer you to the specialist. Veterinary neurologists are trained in state of the art diagnostic techniques and will utilize advanced imaging such as CT or MRI scans to look at the structures of the nervous system. With electrodiagnostic tests, a neurologist can examine the function of the peripheral nervous system, particularly the nerves and muscles. Spinal fluid analysis can provide clues to such infectious diseases as encephalitis or meningitis. Veterinary neurologists also will be able to make appropriate recommendations for your pet's rehabilitation period, especially after such major procedures as back surgery. Lengthy recuperation times can be necessary, and your pet may be referred to rehabilitation facilities offering such services as water or physical therapy. Pain management will also be addressed.
Neurological examinations typically proceed from head to tail, with all areas of the body being given systematic attention in that order. In addition, your pet may be videotaped for future reference and to help train other veterinarians.
Mental status: The pet will be observed to determine whether it interacts normally with its owner, other people and animals, and the environment.
Gait and body posture: The veterinary neurologist will watch the animal walk around the room, in the hallway, or up and down stairs. Additionally, the neurologist will make observations regarding the animal's body posture.
Cranial nerve examination: The pet's senses of sight, smell, and hearing will be checked, as well as its ability to chew, swallow, and move its tongue, eye, and facial structures normally. Response to pain will also be checked.
Physical examination: The pet's body will be palpated for any signs of pain or muscle atrophy. The veterinary neurologist will also perform a number of tests with the pet's limbs to check reflexes and reactions, such as turning a pet's paw over to see if the pet will reposition it to the normal stance, and lifting a pet up off the ground and lowering it back down to see how it positions its legs upon contact with the ground.
Reflex testing: Just as in humans, a veterinary neurologist may check a pet's reflexes as part of the examination process.
• Seizure
• Complete loss of function of any or all limbs
• Recurrent or intractable pain, specifically of the back and neck
• Head trauma
• Spinal trauma
• Severe depression or inability of the patient to respond to its environment
Depending on the source, the incidence of epilepsy among the general pet population is estimated at between 0.5 and 2.3%. Epilepsy refers to chronic, recurrent seizures and can be inherited or acquired. Thus, epilepsy is a clinical condition, not a specific disease. Idiopathic epilepsy refers to recurrent seizures in which no identifiable cause is found to explain the seizures, such as metabolic disease, toxin exposure, encephalitis, or brain tumors. Seizure diagnosis involves ruling out common causes of seizures. Initially, your veterinary neurologist will likely order a series of blood tests to help rule out metabolic and toxic causes of seizures. Depending on the age of your pet, the course of the seizures, and the results of the neurological examination, the neurologist may recommend an MRI or CT scan of the brain and/or a spinal fluid tap to look for signs of encephalitis or brain cancer.
Idiopathic epilepsy is most common in purebred dogs, with an age of onset between one and five years of age (often before three years). Dogs and cats with idiopathic epilepsy are completely normal between seizures and have a normal neurological examination.
If your pet's first seizure occurs before 1 year of age or after 5 years of age, is not normal between seizures, or if there are any abnormalities on neurological examination, the veterinary neurologist may recommend advanced diagnostics, such as an MRI of the brain, to help determine the cause of the seizure.
Veterinary neurology is a challenging field in that some diseases are solely neurologic in origin while in other cases, the neurologic problem may be related to an underlying systemic disease. In the first case, the veterinary neurologist may be able to treat the neurologic problem directly. In the second case, resolution of the neurologic problem may hinge on the correct diagnosis and treatment of the underlying disease. For example, certain viral infections may result in neurologic signs.
