Your dog suddenly won’t stop tilting his head. Your cat is stumbling across the kitchen floor. Maybe your pet’s back legs have stopped working altogether. Something is clearly wrong, but what? And more importantly, who is the right person to help?
For many pet owners, the answer leads them to a veterinary neurologist for the very first time. Dr. Ryan Gallagher, neurologist at Partner Veterinary’s Frederick location, helps demystify the specialty, walk through what a neurological exam actually involves, and explain when advanced imaging like an MRI becomes the right call.
What is a Veterinary Neurologist?
Veterinary neurologists are veterinarians who have completed additional, advanced training specifically focused on conditions affecting the nervous system. That means the brain, the spinal cord, the peripheral nervous system, and the neuromuscular junction. Essentially, it’s how all of those structures connect and communicate.
“The role in the clinic is consulting with patients who are suspected of having neurological issues,” Dr. Gallagher explains, “localizing exactly where in the nervous system the problem is, diagnosing it, and figuring out not just what’s going on but what our treatment options are.”
The Neuro Exam: More Than a Regular Check-Up
Most pet owners are familiar with the standard physical exam that a primary care veterinarian performs at every annual visit. That exam casts a wide net, checking cardiovascular health, the respiratory system, the gastrointestinal tract, and more. An exam by a neurologist for dogs and cats is different.
“It’s an expansion of the general physical exam,” says Dr. Gallagher. “It’s a more in-depth dive into testing specific functions, like reflexes, cranial nerves, coordination, and pain screening.”
The goal is localization, or pinpointing exactly where within the nervous system a problem originates. A textbook example is a pet presenting with blindness. The cause could lie anywhere from the eye itself, to the optic nerve, to the visual cortex deep in the brain. By running targeted tests, such as checking whether pupils constrict in response to bright light, Dr. Gallagher can often determine the source with a high degree of confidence before any imaging is ordered.
“If I shine a bright light in and we’re seeing pupillary constriction,” he explains, “that tells me the retina is working, the optic nerve is working, and the midbrain reflex pathway is working. So the visual deficit has to be at the level of the visual cortex, and that tells me we need an MRI, not an ophthalmologist.”
The exam itself typically takes about 10 to 15 minutes, though Dr. Gallagher jokes that cats have a way of complicating that timeline. “We always have to take what they’re willing to give us that day.”
The Most Common Neurological Conditions in Pets
Dogs make up the vast majority of Dr. Gallagher’s caseload. Cats, he notes, tend toward other organ dysfunctions and account for only about 10-15 percent of his patients.
Among canines, two categories dominate:
- Seizure Disorders: Ranging from idiopathic (heritable genetic) epilepsy to seizures caused by inflammatory brain disease, tumors, or systemic illness such as liver or kidney dysfunction.
- Mobility and spinal problems: Most commonly intervertebral disc disease (IVDD), where disc degeneration leads to degeneration leads to herniation, compression of the spinal cord, pain, lameness, or weakness.
Breed and age both play a meaningful role in how Dr. Gallagher builds his list of suspicions. Chondrodystrophic breeds (those with long backs and short legs, like Dachshunds, French Bulldogs, and Corgis) are particularly prone to disc disease, sometimes even at a young age. For seizure patients of a breed and age commonly associated with heritable epilepsy, and with a family history to match, Dr. Gallagher may be comfortable managing the condition based on the clinical presentation without immediately pursuing advanced diagnostics. In patients without those risk factors, he becomes considerably more vigilant.
“Common things occur commonly,” he says, “but my patients very rarely read the textbooks.”
MRI vs. CT: Understanding the Difference
When basic blood work and X-rays don’t provide a clear answer, advanced imaging becomes the next step. Here’s how Dr. Gallagher distinguishes between them:
| CT Scan | MRI |
| Based on X-ray technology | Based on magnetic resonance technology |
| Excellent for evaluating bones and dense structures | Exceptional soft tissue detail |
| Ideal for skull fractures, complex spinal fractures, and head trauma | The go-to for brain and spinal cord pathology |
| Superior spatial resolution for precise targeting (e.g., radiation therapy planning) | Used for roughly 90% of Dr. Gallagher’s cases |
| Shorter scan time; lighter sedation | Longer scan time; requires general anesthesia |
| Limited soft tissue detail | Less precise spatial resolution than CT |
Both tests require the patient to be completely motionless during image acquisition, which is straightforward for humans, but impossible to ask of an animal. This means sedation for CT or full general anesthesia for MRI is always required. “It’s on the level of going in for a dental cleaning,” says Dr. Gallagher. “It’s a light plane of anesthesia, and for otherwise healthy patients, the risk is quite low.”
In some cases, particularly when tumors are involved, both modalities may be used together: MRI to identify the soft-tissue pathology, then CT to map its precise boundaries for radiation planning.
Occasionally, imaging is supplemented by a spinal tap, particularly when inflammatory disease of the brain or spinal cord is suspected and imaging alone doesn’t explain why the inflammation is present.
What to Expect on the Day of Imaging
Pet owners often want to know: what does the day actually look like? Dr. Gallagher’s advice is to plan for a half day, not an all-day ordeal. But, don’t plan to wait in the lobby. “I don’t recommend owners wait because that’s just stressful,” he says. “Go do your thing. I’ll call you as soon as we have images and a better timeline for when they’ll be awake and ready to go home.”
As for results, Dr. Gallagher will typically share his initial impressions at the end of the imaging session. All images are also reviewed by a veterinary radiologist, with the specialist’s written report usually returning within a day. From there, follow-up conversation covers the diagnosis and treatment options, which can range from medical management to surgery, depending on what’s found.
Is a Visit Worth It Even Without Advance Diagnostics?
Cost is a real concern for many families. Dr. Gallagher recognizes this but makes the case that consultations from veterinary neurology specialists can offer value even when advanced diagnostics aren’t on the table.
“For difficult-to-manage epileptics where options one, two, and three haven’t worked, referral to an expert can be very helpful for fine-tuning medical management and potentially exploring other treatment options,” he says.
For pet owners who carry pet insurance, the news is generally encouraging because advanced diagnostics, when there’s a clear clinical indication, are typically covered. The degree of coverage varies by plan, so checking with your individual provider is always worth doing.
When to Seek a Referral
Signs that often prompt a referral to a veterinary neurologist include sudden or progressive weakness, difficulty walking or using limbs, head tilt or circling behavior, vision loss, unexplained back or neck pain, and new-onset or poorly controlled seizures.
Dr. Gallagher’s rule of thumb is simple—if your primary care veterinarian’s initial management isn’t getting your pet to where they need to be, that’s the moment to call veterinary neurology specialists. It doesn’t necessarily mean something serious is wrong, but it does mean it’s worth getting a more targeted look.
If you’re looking to learn even more from Dr. Gallagher, listen to Episode 17 of our podcast—Why See a Veterinary Neurologist with Dr. Ryan Gallagher.
Partner’s Richmond location: 804.206.9122 | Partner’s Frederick location: 301.200.8185
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