Veterinary Neurological Examination Form
Pet's Name
First Name
Last Name
Pet Species
Pet Breed
Pet Age (years)
Pet Weight (kg)
Reason for Examination / Presenting Symptoms
Level of Consciousness
*
Normal / Alert
Dull
Stuporous
Comatose
Behavioral Assessment
*
Normal / appropriate response to new environment
Inappropriate responses
Posture
*
Normal
Right Head Tilt
Left Head Turn
Left Head Tilt
Right Head Turn
Wide-Based Stance
Nerve root Signature
Kyphosis / Scoliosis
Ventroflexed neck
Palmigrade / Plantigrade
Schiff-Sherrington
Decerebellate
Decerebrate
Gait
*
Normal
Ataxic
Hypermetria
Hypometria
Ambulatory Paraparesis
Ambulatory Tetraparesis
Non-Ambulatory Paraparesis
Non-Ambulatory Tetraparesis
Paraplegic
Hemiparesis
Hemiplegic
Describe If Inappropriate
Cranial Nerve Assessment - 0=absent; 1= reduced; 2= normal
Left
Right
Menace Response (II, Cerebrum, VII)
Dazzle (II, Thalamus, VII)
Pupillary Light Reflex (II, III)
Palpebral Reflex (V, VII)
Corneal Reflex (V, VI)
Physiological Nystagmus (III, IV, VI, VIII)
Nasal Stimulation (V, Forebrain)
Gag Reflex (IX, X)
Tongue Size and Movement (XII)
Jaw Tone (V)
Masticatory Muscle Mass (V)
Other Observations
Postural Reactions - 0=absent; 1=decreased; 2=normal
Left Thoracic
Right Thoracic
Left Pelvic
Right Pelvic
Proprioceptive Positioning
Hopping
Wheelbarrow / Extensor Postural Thrust
Visual Placing
Tactile Placing
Spinal Reflexes - 0=absent; 1=decreased; 2=normal;3=increased
Left
Right
Extensor Carpi Radialis
Thoracic Withdrawal
Patellar
Cranial Tibial
Gastrocnemius
Pelvic Withdrawal
Cutaneous Trunci
Perineal
Pain Assessment - 0=absent;1=reduced; 2=normal; 3=increased
Left Thoracic
Right Thoracic
Left Pelvic
Right Pelvic
Tail Head / Perineal
Nociception
Suspected Lesion Localization
*
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