Time is critical for pets with injuries and diseases affecting their nervous systems but so is gathering accurate information about their condition. 

Completing a neurological triage assessment can collect vital information in a short amount of time, according to veterinary neurologist Susan Arnold, a member of the Neurology Service team at the University of Minnesota Veterinary Medical Center (VMC). 

There are several purposes of doing a neurological assessment, the first and foremost of which is to determine localization, or where in the nervous system a patient's issue lies if there is a neurological problem present. 

“A neuro exam is really good at telling us where a problem is—not so great at telling us what the problem is—but getting to where the problem is is the biggest hurdle in assessing a neurologically abnormal patient,” Arnold says. “Once you've done that, you can then refer to a variety of resources to determine what differential diagnoses make sense for your patient.”

Second, the assessment determines how severely affected a patient is, how quickly one needs to intervene, and what that intervention would look like. For example, a patient capable of moving across an exam room or moving their limbs would be considered less of an emergency than a patient who appears to be paralyzed. 

“There are times where animals are so severely affected neurologically that things become an emergency really quickly, or they're potentially beyond repair,” Arnold says. “Being able to determine what patients fall into that category is really important before referring a patient for continued care because it will dramatically change the conversation with the client.”

The final and very crucial part of the assessment is determining whether or not a patient needs to be tested for pain sensation. If a patient can move its limbs, it can feel them, and there is no need to check for pain sensation, Arnold says. But, if veterinary staff don’t observe any motor function, that means the animal is paralyzed. Paralysis in this sense means an inability to move but does not automatically mean the animal also cannot feel pain. 

“You have to check them for sensation, and this is where veterinarians make some really tragic mistakes,” Arnold says. “To put it simply: If it squeals, it feels.”

Testing for pain sensation often involves pinching or poking a toe or paw and may trigger a withdrawal reflex. This reflex tells clinicians examining an animal that the region of the nervous system involved in producing that reflex is unaffected.

However, it is not an indicator of pain. 

“People confuse a reflex for pain sensation,” Arnold says. “They are different things. A reflex is part of your neurolocalization. Pain sensation is part of your severity assessment.”

She urges clinicians to ignore what the limb is doing when testing pain sensation and observe an animal’s conscious response instead. 

“Are they trying to bite you? Are they trying to get away from you?” Arnold adds. “That shows that the signal is making its way to their brain past the injury, and that is not to be confused with whatever their limb is doing.”

In cases where a lack of pain sensation is not detected, the recommended treatment may be to let the animal recover on its own. Without proper medical intervention, this can lead to irreversible neurological damage, including permanent paralysis. An accurate neurological assessment is key to getting a primary veterinarian, client, and any potential specialists on the same page about the neurologic status of a patient.

“That way, we can ensure efficient continuity of care while guiding owner expectations fairly and confidently to provide the best possible care to the patient,” Arnold says. 

Veterinary clinics with patients in need of neuro care can contact the Neurology Service at the VMC. Arnold recommends calling ahead about emergencies and referrals so staff can give accurate prices and assist in explaining to the client what the process would look like when they are referred. 

“We're here to help, so use us as a resource,” Arnold says.