貓與兔子神經學檢查可信度之調查與貓神經病灶定位準確性之評估

Abstract

在小動物臨床神經學領域中，神經學檢查可協助獸醫師區別神經症狀與其他系統症狀，及進行神經學病灶定位。然而，各物種神經學檢查之可信度和預測病灶位置之準確度並未被完整建立。根據作者臨床經驗，貓和兔子為較難以保定、操作的物種，且神經學檢查結果時常變異度大且不一定可靠。在貓，根據神經學檢查獲得之病灶定位，有時也不一定與進階檢查中的實際病灶位置吻合。 此研究目的為評估正常貓及兔子神經學檢查的可行性和可信度，並統計患有神經疾病的貓，藉由神經學檢查獲得之病灶定位是否與磁振造影中之病灶位置相同。 本研究共收集 55 隻貓及 34 隻兔子，結果顯示，兩種物種皆有數種神經學測驗的可信度偏低。比較同一測試中不同操作方法的可信度，也發現某些特定方式可獲得較佳的結果。另評估 73 隻患有神經疾病的貓，神經學病灶定位預測磁振造影影像上病灶位置的準確度，則發現整體準確度僅呈中間偏低。個別病灶定位中，以週邊神經和前腦定位的準確度最高，而神經學檢查顯示有多發病灶的病例與影像學檢查結果則無一吻合。 根據研究結果，當進行貓或兔子的神經學檢查時，建議選擇可信度較高的測驗，針對個別測驗，也應選擇可信度較高的方法進行檢查，可提高神經學檢查結果的準確度。此外，應注意神經學病灶定位和進階檢查診斷之病灶位置不一定吻合，當考慮影像檢查範圍時，由神經學檢查推斷出的病灶定位之臨近區域，也應列入影像檢查的範圍中。

The neurological examination is crucial for clinicians to identify neurological problems, and obtain anatomical diagnosis. However, the reliability and accuracy of the neurological examination has not been fully established in many species. Cats and rabbits are especially difficult to handle, and results obtained from the neurological examination in these two species are often uncertain and inconsistent between examiners. Based on clinical experience, the author also notices that the agreement between neuro-localization based on examination and lesion location obtained from further diagnostic modalities is sometimes not ideal in feline patients. The purpose of the present study was to evaluate the feasibility and reliability in normal cats and rabbits, aiming to provide a revised neurological examination that produces more accurate results. In addition, the agreement between neuro-localization obtained from neurological examination and lesion location identified on MR images in feline patients were evaluated. Fifty-five cats and thirty-four rabbits were included in the first and second part of study. In both species, several tests were identified as poor either in feasibility or reliability. Specific methods producing higher reliability in certain tests were identified. The agreement between neuro-localization obtained from neurological examination and lesion location identified on magnetic resonance images was assessed in 73 cats with neurological diseases. The overall agreement was relatively low, especially in cases with a multifocal neuro-localization. Regarding individual neuro-localizations, agreement was high in the peripheral nervous system and forebrain. Based on the results, clinicians should bear in mind that the neurological examination may be misleading, and there may be a certain degree of mismatch between neuro-localization and lesion location. Identifying and performing reliable tests with suitable methods may increase the accuracy of the neurological examination in obtaining correct anatomic diagnosis.