Where do I start? Keys to cost-effective neuro diagnosis

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: Neurology cases are a common presentation for veterinarians in general practice but can frequently seem overwhelming. In many patients it can be challenging to establish a neuroanatomical localisation making attempts to generate a list of focused differential diagnoses and determine a management plan feel like a lost cause. This lecture aims to provide a simple and logical approach to the neurological exam that works within general practice. Participants will learn the skills to determine if a neurological abnormality exists and develop the knowledge and confidence to interpret their findings in order to localise the lesion to a specific anatomic region of the nervous system. We also examine how the ‘Five-Finger Rule’ considers elements from the patient signalment, onset, progression, lateralisation and pain of the presenting condition to improve clinical reasoning in neurology cases to generate a list of prioritised differential diagnoses.

: In the past decade there has been an exponential increase in diagnostic tools in veterinary medicine fueled by an even faster developing toolkit in human medicine. The developments of diagnostics, especially in advanced imaging and genetics, have not only improved our clinical diagnostic abilities, but also enhanced our understanding of their pathophysiology and treatment. The rapid development of the new diagnostics paralleled with an increase in costs. The development of diagnostics for veterinary medicine, especially in the field of imaging, will be slowed by the increase in costs, if we are not careful. Taking this into account and the current financial climate, inappropriate use of diagnostics leads to unnecessary cost to the owner and frustrations (which might end up in complaints) and potentially morbidity to the patient. Many of the advanced techniques used in veterinary neurology are invasive, require an anaesthetised or sedated patient, therefore a logical clinical reasoning approach is essential to ensure the correct body part is looked at, the lesion is accurately and correctly identified and one is not hijacked by an incidental finding. Using the five-finger rule (Onset and course of the disease, symmetrical or asymmetrical, painful or non-painful, neuroin conjunction with the signalment will determine a handful of differentials which can then be verified by using your diagnostic toolkit. This lecture covers when, why and how you should use the various diagnostic tests which can be grouped into 1. Clinical pathology, 2. Assessment of structure using diagnostic imaging techniques and 3. Functional assessment (mainly electrodiagnostics).

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