CLINICAL TECHNIQUE

NEUROLOGICAL EXAMINATION AND DIAGNOSTIC

TESTING IN BIRDS AND REPTILES
Craig Hunt, BVetMed, CertSAM, DZooMed, MRCVS

Abstract
Neurological dysfunction is a frequently presenting sign in avian and reptile patients. Clinical neurological signs are rarely pathognomonic, often requiring the attending veterinary surgeon to perform more
involved diagnostic tests to achieve a diagnosis. Variations in patient anatomy, physiology and
demeanour present unique challenges to the veterinarian evaluating the bird or reptile that has
neurological disease signs. Despite these challenges, a well-structured physical and neurological
examination can often be accomplished with minimal equipment. A structured neurological examination
is essential to formulate an appropriate investigative plan and therapeutic regime for these difcult cases
and to provide the owner with an accurate prognosis. Copyright 2014 Elsevier Inc. All rights reserved.
Key words: avian; examination; neurological; reex; reptile

basic knowledge of the normal anatomy and physiology of the reptile and avian nervous
system is essential to enable the veterinary clinician to accurately diagnose neurological
disease in these animals.1-14 Variations in anatomy, physiology, temperament, and
tolerance to handling between the various avian and reptile species can make the
neurological examination and localisation of lesions challenging in these patients. Reptiles,
being ectothermic, have reexes that are inuenced by body temperature; therefore, reptiles should be
examined in an environment that is within their selected body temperature range.
Although there are few exceptions, the
neuroanatomy of reptiles and birds is similar to
mammals, and the neurological examination may
be approached in a similar manner to that
described for dogs and cats.15 Naturally some
modications may be required when performing a
neurological examination on a bird or reptile
patient owing to differences in anatomy and
temperament.
Neurological disease signs in birds and reptiles
are often nonspecic, consequently a disease
diagnosis using external clinical signs alone is
rarely achieved. Birds and reptiles mask illness, or
owners are unaware of subtle disease signs until
well advanced, resulting in many of these patients
being presented to the veterinary clinic in a critical
disease state. These critical presentations, with
often one or more life-threatening disease

problems, typically require extensive treatment

before a full neurological assessment.
Neurological disease in both birds and reptiles is
often secondary to inadequate husbandry (e.g.,
temperature) and nutrition (birds and reptiles) but
may be caused by toxins (e.g., heavy metals,
organophosphates, pyrethroids, drugs and plants),
infection (e.g. viral, parasitic, bacteria and fungus),
neoplasia, congenital abnormalities and
cardiovascular, hepatic and renal disorders.
Metabolic diseases (e.g., hypocalcaemia) and
musculoskeletal disorders (metabolic bone disease)
often present with similar clinical signs and may be
difcult to distinguish from primary neurological
disease without further investigation; hypothermia
may also mimic neurological disease in reptiles.
The evaluation of neurological disorders in
reptiles and birds follows a similar pattern to that

From the Chine House Veterinary Hospital, Leicestershire, England, UK.

Address correspondence to: Craig Hunt, BVetMed, CertSAM, DZooMed, MRCVS, Chine House Veterinary Hospital, Sileby Hall, Cossington
Road, Sileby, Loughborough, Leicestershire LE12 7RS, UK. E-mail: craighuntvet@googlemail.com.
2014 Elsevier Inc. All rights reserved.
1557-5063/14/2101-$30.00
http://dx.doi.org/10.1053/j.jepm.2014.12.005

3 4

Journal of Exotic Pet Medicine 24 (2015), pp 3451

TABLE 1. Equipment list

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)

Pen torch
Hypodermic needles
Mosquito forceps
Towel
Gloves
Perch
Digital thermometer
Mouth gags
Cotton-tipped applicators

used for other species and begins by obtaining a

thorough history and performing a detailed
external physical examination. Further assessment
of the patient will often include one or all of the
following diagnostic modalities: haematology and
serum biochemistry, radiography, ultrasonagraphy
and endoscopy. Additional diagnostic tests such as
heavy metal analysis, serology/PCR for infectious
diseases and cerebral spinal uid analysis may be
required in select bird or reptile neurological cases.
Increasingly, computed tomography and magnetic
resonance imaging are becoming more accessible
and may give detailed images of the central
nervous system, though the small size of many
patients can be a limiting factor in the use of these
advanced imaging modalities. Electromyography
and nerve conduction studies may be useful in
selected cases, but these tests are rarely available in
the typical veterinary hospital.
HISTORY
All but the most compromised of avian and reptile
patients will have normal behaviour under mild to
moderate conditions of stress (e.g., veterinary
visit). Observation of patients from afar in a
quietened room, preferably after a period of
acclimatisation, allows the patient to relax and
display abnormal clinical signs, if present, or
behaviour, which may otherwise go unnoticed.
Whilst the patient is acclimatising, a thorough
history may be obtained from the owner, giving
the clinician time to evaluate the animal from a
distance. This hands-off evaluation will allow the
veterinarian to ascertain the patients ability to
cope with restraint and physical examination and/
or whether steps should be taken to medically
stabilise the patient before handling.
Important aspects of the history pertaining to the
neurological patient include nutritional offering
(including any supplements), what it is eating
from, and what is being fed; the patients ability to
recognise and obtain food in an appropriate
manner for that particular species; access to toxins;
Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

recent administration of medication; provision of

appropriate ultraviolet light (many reptiles and
some birds); and access to suitable thermal
gradients (reptiles).
CLINICAL EXAMINATION
Much of the neurological examination may be
incorporated into a well-structured physical
examination. Following the physical examination,
the clinicians goal is to localise the disease process
to one or more areas of the nervous system. As
stated previously, the natural behaviour of many
avian and reptile patients routinely complicates the
veterinarians ability to accomplish the task of
localising the lesion associated with the
neurological disease process.
The aim of the neurological examination is to
localise any lesion to the brain or 1 of 4 major
spinal cord divisions. The spinal cord divisions
described in birds and reptiles are the cervical,
brachial, thoracic and lumbosacral plexus; snakes
and presumably limbless lizards have reduced or
absent brachial and sacral plexuses.
Accurate localisation of pathology allows the
clinician to determine which diagnostic test will
conrm a disease diagnosis. Once a denitive
disease diagnosis has been made, the veterinarian
can form a prognosis and institute a treatment plan
thus avoiding the unnecessary use of sometimes
expensive and invasive tests.
HOW TO PERFORM A NEUROLOGICAL
EXAMINATION
Equipment required to perform a proper
neurological examination on reptile and avian
patients is provided in Table 1. Cranial nerve
function tests for birds and reptiles and signs of
neurological dysfunction are in Tables 2 and 3,
respectively.
Step-by-step guide for birds:
(1) Observe the patient from a distance
assess posture and symmetry of the head, facial
features and body, demeanour, level of alertness
and responsiveness to surroundings (Fig. 1).
(2) Make a loud noise such as clapping of
hands or dropping keys onto oor whilst the bird
is otherwise occupied to assess hearing.
(3) Approach patient calmly and evaluate
response to determine visual acuity and alertness.
Note: birds with unilateral blindness often turn
the blind side away from the examiner, therefore
the blind eye is not easily observed.
3 5

TABLE 2. Avian cranial nerves and their function and clinical tests to determine normal function and clinical
signs of dysfunction
Nerve
I Olfactory

Sensoryolfaction

II Optic

Sensoryvision

III Oculomotor

Motorextrinsic ocular
muscles and upper
eyelid muscle
Parasympathetic
intrinsic ocular muscle

IV Trochlear
V Trigeminal:
Ophthalmic branch

Maxillary branch
Mandibular branch
VI Abducens

VII Facial

VIII Vestibulocochlear

IXa Glossopharyngeal

Xa Vagus

3 6

Function

Motorextrinsic ocular
muscle
Sensory (upper lid,
forehead skin, nasal
cavity and upper beak)
Sensory (both lids, hard
palate, nasal cavity
and lateral upper
beak)
Motor (orbicularis, lower
lid and chewing)
Sensory (lower beak skin
commissures)
Motorextrinsic ocular
muscles and nictitans
Motorfacial expression
Sensorytaste
Parasympatheticmost
glands of the head
Sensoryhearing
Sensorybalance and
coordination
Sensorytaste and
sensation in the
tongue and trachea
Motorpharynx, larynx,
crop and syrinx
Sensorylarynx, pharynx
and viscera
Motorlarynx, pharynx,
oesophagus and crop

Clinical Test

Sign of Dysfunction

Response to odour such

as alcohol; patient
should avoid noxious
odour
Menace reex

No response; beware that

aversion is not always
owing to odour but to
physical irritation
Absent blink and/or
aversive movements of
head and body in
response to a threat.
Inability to avoid objects
placed in path
Ventrolateral deviation

Eyeball position and

movement
Menace reex

Drooped upper eyelid

Pupillary light reex

Eyeball position and
movement

Dilated pupil
Dorsolateral deviation

Response to touch,
palpebral reex

Lack of sensation

Unable to blink

Menace reex

Unable to close jaw

Eyeball position and

movement

Medial deviation
Nictitans immobility
Facial asymmetry
Poor taste
Decreased secretions

Response to sound
Oculocephalic reex
Righting reex
Gag reex

No response to sound,
head tilt, nystagmus,
abnormal posture and
poor righting reex
No gag reex

Dysphagia and voice loss

Gag reex

No gag reex

Oculocardiac/vago-vagal
reexapply pressure
to both eyes for several
minutes and check for
decreased heart rate

Inability to swallow,
regurgitation, voice
change, increased
heart rate and no crop
motility

Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

TABLE 2. Continued
Nerve

XIa Accessory
XIIa Hypoglossal

Function
Parasympatheticglands,
heart and viscera
Motorsupercial neck
muscles
Motortongue, trachea
and syrinx

Clinical Test

Sign of Dysfunction
Inability to open and
close the glottis
Poor neck movement

Tongue grab

Tongue deviation

Modied with permission from Clippinger TL, Bennett RA, Platt SR. The avian neurological examination and ancillary
neurodiagnostic techniques. J Av Med Surg 1996;10(4):221-47.
a
Anastamoses present involving cranial nerves IX-XII.

(4) If tame, encourage the bird to step up onto

and off a perch or hand (glove for raptors)
noting coordination and strength of legs and grip
(Fig. 2).
(5) Perform menace reex by obscuring the
vision in one eye with one hand whilst making a
threatening gesture close to the opposite eye with
the other hand, taking care not to cause any air
movement that may be detected by the bird
(Fig. 3).
(6) Drop and/or throw a ball of cotton wool
in the patients normal eld of vision and assess
response. Assessment of the response to being
shown a favourite food item may also be
performed and is especially useful in raptors and
corvids.
(7) Assess the pupillary light reex (PLR) by
shining a bright light into each eye and assess
pupil response (Fig. 4). Note: there is no
consensual response in birds.
(8) Whilst on hand/glove, rotate the hand in
all directions to assess balance and strength of
grip (Fig. 5).
(9) Lower the hand quickly to stimulate a fall;
the normal bird should extend wings ap to
maintain balance. Observe for symmetry and
speed with which the wings are returned to a
normal resting position.
(10) Palpate legs for symmetry, muscle mass
and tone.
(11) Pinch the toes of each foot in turn and
asses the withdrawal response and determine
whether there is any conscious perception of
pain (Fig. 6); caution must be observed by the
examiner. Raptors may strike out with their
feet, and parrots may attempt to bite.
(12) At this point, some patients may be
restrained in a towel to allow access to the
head whilst limiting wing and leg movement,
which allows more control over the patient
(Fig. 7).
Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

(13) Assess the palpebral reex by lightly

touching the medial canthus with a nger or
cotton-tipped applicator (Fig. 8).
(14) Pinch the skin over the face and cere to
assess facial sensation using nger or mosquito
forceps (Fig. 9).
(15) Open the beak to assess jaw tone and oral
secretions, and observe the glottis and tongue for
symmetry and normal movement (Fig. 10).
(16) In nonpsittacine birds, place the
index nger of the hand restraining the head in
the commissure of the beak to maintain the
beak in an open position whilst manipulating
the tongue and glottis with a cotton-tip
applicator or a nger on the free hand to
assess the gag reex and tongue-grab reex
(Fig. 11). In psittacine birds, the oral cavity is
best opened and examined with the aid of a
suitable speculum to avoid injury to the
examiner.
(17) Assess the oculocephalic reex by moving
the head from side to side whilst maintaining the
head in a horizontal plane. In healthy birds,
nystagmus should be observed with the fast
phase in the direction of the head movement.
(18) Palpate the neck for muscle mass and tone
and palpate the crop.
(19) Extend each wing individually and pinch
the wing tip to evaluate a withdrawal response
and pain perception, then release the wing
observing how quickly the bird retracts the wing
into the normal resting position (Fig. 12).
(20) Assess the muscle tone of the vent and
then pinch or prick the vent with a needlein
the normal bird, the vent sphincter should
constrict (Fig. 13).
(21) Whilst restraining the bird from above
around the shoulders with the wings held
against the body but with the legs unrestricted,
bring the feet towards the examining table or a
perch to evaluate the placing reex (Fig. 14);
3 7

TABLE 3. Reptile cranial nerves and their function and clinical tests to determine normal function and clinical
signs of dysfunction
Nerve

Function

Clinical Test

Sign of Dysfunction

I Olfactory (including the

vomeronasal nerve
branch)

Sensoryolfaction

Patient should avoid

noxious odour such as
alcohol or show
ability to nd food
when eyes are covered

No response; beware that

aversion is not always due
to odour but to physical
irritation

II Optic

Sensoryvision

Menace reex

Absent blink (in species with

eyelids) and/or aversive
movements of head and
body in response to a
threat. Inability to avoid
objects placed in path

III Oculomotor

Motorpulls eye in or
x gaze;
Parasympathetic
controls iris and
ciliary body

Eyeball position

Abnormal eyeball position,

movement and pupil
Shape/size; dilated pupil

Menace reex

Pupillary light reex

IV Trochlear

V Trigeminal
Ophthalmic branch
and maxillary branch

Mandibular branch

Motordraws gaze
anteriorly and
dorsally

Eyeball position

Abnormal eyeball position

and movement

Sensoryfrom skin
around eye and
mouth. Sensory pits
of pit vipers and
boids.
Motorjaw adductor
muscles, muscles of
skin around teethbearing bones in
snakes and
intermandibularis (in
oor of mouth)

Assess sensation around

face, lower lid and
nasal area

Lack of sensation

Assess normal jaw

closure and buccal
pumping.

Unable to close jaw

Absent buccal pumping

VI Abducens

Motordraws gaze
posteriorly

Eyeball position

Abnormal eyeball position

and movement

VII Facial

Sensoryfrom skin and

muscle around the
ear, upper jaw and
pharynx.
Motorsupercial neck
muscles and
mandibular depressor

Assess sensation

Unable to move eyelids (in

species with eyelids).

Palpebral reex

Unable to open mouth

voluntarily

Voluntary opening of
mouth
VIII Auditory/Acoustic

Sensoryhearing

Response to sound

Sensorybalance and
coordination

Oculocephalic reex

No response to sound, head

tilt, nystagmus, abnormal
posture and poor righting
reex

Righting reex

3 8

Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

TABLE 3. Continued
Nerve
IX Glossopharyngeal

Function
Sensorytaste and
sensation in the
pharynx
Motorcontrols tongue
muscles

Clinical Test

Sign of Dysfunction

Gag reex

No gag reex

Examine tongue for

active protrusion and
retraction and observe
ability to swallow

Absent or abnormal tongue

movements

Dysphagia
X Vagus

Sensory and motor to the

glottis, heart and
viscera

XI Spinal accessory

Motortrapezius and
sternomastoid
muscles

XII Hypoglossal

Motorhyoid muscles
and tongue

Gag reex

No gag reex

Oculocardiac/vago-vagal
reexapply pressure
to both eyes for
several minutes and
check for decreased
heart rate

Inability to swallow,
regurgitation and ileus
Inability to open and close
the glottis

Assess muscle tone in

dorsal neck and
shoulders (difcult to
assess in snakes and
chelonia)
Tongue grab

Poor muscle tone in neck and

shoulders.
Poor neck movement

Tongue deviation

Adapted with permission from Wyneken J. Reptilian neurology: anatomy and function. Vet Clin North Am Exot Anim
Pract 2007;10:837-853.

raptors may be hooded to increase test

sensitivity.
(22) With the bird still restrained as
described before and with one leg held up
against the body wall, perform the hopping
test on the standing leg by manoeuvring the
patients body to change the centre of gravity
laterally, medially, forward and backward
while measuring the compensatory movements
of the leg (Fig. 15).
(23) With the bird standing but with the body
being supported, knuckle the toes of one foot
over and evaluate how long it takes for the bird
to return the foot to a normal position (Fig. 16);
alternatively, place a card under the foot and
slide it laterally and evaluate the speed with
which the bird returns the foot to a normal
position.
(24) Finally, pinch the skin or gently pull at the
feathers along either side of the dorsal midline
working methodically cranial to caudal or vice
Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

versa to assess cutaneous pain sensation. Note:

birds lack a panniculus reex.
Step-by-step guide for reptiles:
(1) Observe the patient from a distance
assess posture and symmetry of head, facial
features and body, demeanour, level of alertness
and responsiveness to surroundings. In snakes
and monitor lizards, note the presence or absence
of tongue icking (Fig. 17).
(2) Make loud noise such as clapping of hands
or dropping keys onto the oor whilst the patient
is otherwise occupied to assess hearing. Note:
many normal reptiles may not demonstrate a
visible response.
(3) Approach patient calmly and observe
response to assess vision and alertness. Note:
many reptiles, especially lizards with unilateral
blindness, often turn the blind side away from
the examiner.
3 9

FIGURE 1. Before hands-on physical examination, the patient should be examined from a distance. (A) Mute swan
(Cygnus olor) demonstrating neck weakness. (B) Harris hawk (Parabuteo unicinctus) presented with seizures because of
hypoglycaemia. (C) A juvenile emu with hindlimb paresis resulting from zinc toxicity after ingesting several zinc
screws and nails. (D) An aged Toulouse goose (Anser anser domesticus) with multiorgan failure demonstrating
torticollis. (E) Wild European kestrel (Falco tinnunculus) found unable to y presented with knuckling of the right foot
and absent withdrawal reex; note also the soiling of the tail feathers resulting from an inability to perch and preen
appropriately. (F and G) An aged blue-and-gold macaw (Ara ararauna) with pulmonary carcinoma demonstrating
Horner syndrome in the right eye (ptosis of the upper eyelid and miotic pupil); compare with the left eye of the
same bird.

4 0

Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

FIGURE 4. Pupillary light reex being assessed on a

domestic chicken; this test is best performed early in the
examination to minimise conscious reaction of the pupil,
which often occurs during excitement or stress in birds.

FIGURE 2. Hybrid falcon (Falco cherrug  Falco rusticolus)

stepping up onto a T perch from the gloved hand.

(4) If tame, encourage the patient to climb up

onto a perch/branch (chameleons/snakes) or
hand (smaller lizards) noting coordination,
muscle tone and strength of grip (Fig. 18).
(5) Perform menace reex by obscuring the
vision in one eye with one hand
whilst making a threatening gesture close to

FIGURE 3. Menace reex being performed on a domestic

chicken; note the head reaction.

Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

FIGURE 5. Hybrid falcon (Falco cherrug  Falco rusticolus) perched on the gloved hand; the hand is rotated into
different positions to alter the birds centre of gravity,
forcing the bird to make compensatory movements to
retain balance.

4 1

FIGURE 8. Palpebral reex being elicited in a domestic

chicken by gently touching the medial canthus with a
cotton-tipped applicator.

FIGURE 6. The withdrawal reex performed on a

hybrid falcon (Falco cherrug  Falco rusticolus)
noting withdrawal response and any conscious
perception.

FIGURE 7. African grey parrot (Psittacus erithacus) being

wrapped in a towel to allow control over the head; this
procedure is not always necessary depending on the
patients demeanour.

4 2

the opposite eye with the other hand taking

care not to cause any air movement that may
be detected by the reptile (Fig. 19)
(6) Drop and/or throw a ball of cotton wool
in the patients normal eld of vision and

FIGURE 9. Facial sensation being assessed in a domestic

chicken by gently pinching the comb, wattles, cere and facial
skin using ngers or forceps.

Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

(10) Extend each limb individually and pinch

the toes to measure the withdrawal response
and pain perception (Fig. 23); then release the
limb whilst in extension observing how
quickly the limb is retracted into the normal
resting position (caution must be observed by
the examiner as some species may attempt to
bite or tail whip).
(11) Depending on the demeanour of the
patient and to gain more control over the patient,
either restrain in-hand or wrap the patient in a
towel to allow access to the head whilst limiting
leg and tail movement. Depending on the size
and species, snakes may be allowed to coil
around the examiners arm whilst being held
behind the head with the examiners hand or the
body is supported by one or more assistants
whilst the examiner holds the head.
(12) Assess the palpebral reex by lightly touching
the medial canthus with a nger or cotton-tipped

FIGURE 10. Jaw tone being assesses in a domestic

chicken by gently opening the beak; the oral cavity
and glottis are assessed for symmetry and presence of
any lesions.

assess response. Judging an animals response

to being offered a favourite food item (e.g.,
live insects) may be especially useful in
insectivores (e.g., chameleons) (Fig. 20). Note:
it may be difcult to completely differentiate
an olfactory response from a visual one in
some species.
(7) Assess the PLR by shining a bright light
into each eye and assess pupil response (Fig. 21).
Note: the consensual response may be difcult to
appreciate in reptiles.
(8) Whilst on hand/perch, rotate hand in all
directions to assess balance and grip. Snakes
should be allowed to move from hand to hand
and determine strength of coiled grip and
strength in extension as the snake traverses the
gap (Fig. 22).
(9) Palpate body and limbs (where present)
for symmetry, muscle mass and tone.
Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

FIGURE 11. In nonpsittacine birds, the index nger of

the hand restraining the head is placed in the commissure of the beak to maintain the beak in an open
position whilst manipulating the tongue and glottis
with a cotton-tip applicator or a nger on the free hand
to assess the gag reex and tongue-grab reex. In
psittacine birds, the oral cavity is best opened and
examined with the aid of a suitable speculum to avoid
injury to the examiner.

4 3

FIGURE 12. Wing of a domestic chicken being extended and then released to assess proprioception; the test is
repeated, and the wing tip is pinched to evaluate the withdrawal reex making note of any conscious perception
of pain.

FIGURE 13. Cloacal muscle tone and pinch reex being

measured in a domestic chicken.

4 4

FIGURE 14. Placing reex in a domestic chicken (raptors may

be hooded to increase test sensitivity).

Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

FIGURE 16. Proprioception being assessed in a domestic chicken by knuckling the toes of one foot over and
assessing speed and coordination with which the foot is
returned to normal standing position.

FIGURE 15. The hopping test is being performed on a

domestic chicken.

applicator (Fig. 24). Note: it is not possible to assess

the palpebral reex in species without eyelids such
as snakes and many gecko species.
(13)Pinch the skin over the face and head to
assess facial sensation using nger or mosquito
forceps or by pricking with a needle.
(14) Open the oral cavity to assess jaw tone
and observe the glottis opening and tongue for
symmetry and normal movement and assess oral
secretions (Fig. 25).
(15) For
smaller
terrestrial
tortoises,
place the index nger in the commissure of the
beak to maintain the mouth
open and manipulate the tongue and glottis
with a cotton-tipped
applicator to assess the gag reex and tonguegrab reex (Fig. 26). A speculum may be
required for larger species and/or those with
sharp teeth and/or a powerful bite.
(16) Assess the oculocephalic reex by moving
the head from side to side whilst maintaining the
Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

head in a horizontal plane. In healthy reptiles,

nystagmus should be observed with the fast
phase in the direction of the head movement.
(17) Palpate along the neck and spine for
muscle mass and tone.
(18) Assess the muscle tone of the vent and then
pinch or prick the vent with a needle (Fig. 27); in
the normal reptile, the vent sphincter should
constrict and the tail will often move to the side.
(19) Roll the patient on both its left and right
sides to assess the righting reex (Fig. 28).
(20) If the patient is a species with limbs,
restraint should be achieved without restricting
limb movement; bring each foot in turn towards
the examination table or a perch (chameleons) to
assess the placing reex (Fig. 29).
(21) With the patient in a normal standing
posture, hold the limbs on one side against the
body wall and push the patient in a lateral
direction (away from the side with the limbs
restrained), repeat for the other side and evaluate
the compensatory movements of the limbs
(Fig. 30).
(22) Restrain the patient with only one foot
standing on the examination table, and perform
the hopping test on the standing leg by
manoeuvring the patients body to change the
centre of gravity laterally, medially, forward, and
backward to calculate the compensatory
movements of the limb (Fig. 31).
(23) With the patient standing but with the body
supported, knuckle the toes of one foot over and
evaluate how long it takes for the patient to return
the foot to a normal position (Fig. 32);
alternatively place a card under the foot and slide
4 5

FIGURE 17. Before hands-on physical examination, the reptile patient should be examined from a distance. (A)
Dwarf reticulated python (Python reticulatus) with uraemic encephalopathy presented with seizures and incoordination. (B) Bosc monitor (Varanus exanthematicus) with severe nutritional secondary hyperparathyroidism (NSHP)
presenting with muscle fasciculation; note the abnormal posture, maloccluded jaw and deformity of the spine. (C)
Leopard gecko (Eublepharis macularius) presented with dysecdysis; this patient was suffering from NSHP. (D) Female
bearded dragon (Pogona vitticeps) demonstrating a head tilt and circling to the left. (E and F) Veiled chameleon
(Chamaeleo calyptratus) with a sunken left eye. (G) Corn snake (Pantherophis guttatus) with strabismus during recovery
from general anaesthesia.

4 6

Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

FIGURE 18. Panther chameleon (Furcifer pardalis) being encouraged to reach out and walk from one hand to
another.

FIGURE 19. Menace reex being performed on a Russian tortoise (Agrionemys horseeldii).

FIGURE 20. A food item (arrow) being offered to a panther FIGURE 21. Pupillary light reex testing in a Russian
tortoise.
chameleon in an attempt to assess vision.

Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

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FIGURE 22. (A) Tail grip being assessed in a panther chameleon; (B) strength of coiled grip and demeanour being
examined in a king snake (Lampropeltis getula); note also the tongue icking, which suggests a degree of alertness.

it laterally and evaluate the speed with which the

patient returns the foot to a normal position.
(24) Finally, pinch the skin along either side of
the dorsal midline working methodically cranial
to caudal or vice versa to assess cutaneous pain
sensation. Note: reptiles lack a panniculus reex.

FIGURE 23. The withdrawal reex performed on a

panther chameleon noting withdrawal response and
any conscious perception.

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USEFUL TIPS
Some reptile species have the potential to cause
signicant injury to the examiner, especially during
examination of the head (e.g., monitors, iguanas,
large boids and venomous species) whereas some
species (e.g., iguanas) may attempt to whip the

FIGURE 24. The palpebral reex being assessed in a Russian

tortoise.

Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

FIGURE 28. Righting reex being assessed in red iguana

(Iguana iguana); this patient failed to return to a normal
standing position.

FIGURE 25. Determination of a Russian tortoises jaw tone can

be achieved by gently opening the mouth; the oral cavity and
glottis opening are assessed for symmetry and the presence of
any lesions.

FIGURE 29. Placing reex being assessed in a Russian

tortoise.
FIGURE 26. Gag reex and tongue-grab reex being assessed in
a Russian tortoise using the index nger as a speculum.

FIGURE 27. (A) Cloacal tone and pinch reex being assessed in a Russian tortoise. (B) Prolapsed hemipenes in a king snake with
neoplasia of the spine.

Hunt/Journal of Exotic Pet Medicine 24 (2015), pp 3451

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FIGURE 32. Proprioception being evaluated in a bearded

dragon by knuckling the toes of one foot over and assessing
speed and coordination with which the foot is returned to a
FIGURE 30. Hemistanding being assessed in a Russian tortoise.
normal standing position.

examiner with their tail. Raptors may strike with

their talons, and psittacines and some raptors
(especially vultures and eagles) can deliver a
substantial bite. Ratites can deliver a powerful kick,
which can cause serious injury.
The ciliary muscle is under voluntary control in
birds and reptiles giving these species the ability to
override the PLR particularly when the animal is
stressed. The PLR is best performed early in the
examination, preferably with the patient

unrestrained, to minimise stress effect on the test

results.
SUMMARY
Birds and reptiles present unique challenges to the
veterinarian attempting to investigate and diagnose
neurological conditions in these species.
Performing an adequate neurologic examination
on avian and reptile patients is perceived by many
veterinarians as a formidable challenge owing to
the wide variations in anatomy, physiology and
demeanour; however, success can be achieved by
adapting recognised examination techniques used
for dogs and cats.
REFERENCES

FIGURE 31. Hopping test being performed on a Russian

tortoise.

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