Episode 17 – Why See a Veterinary Neurologist Dr. Ryan Gallagher

If you’ve ever wondered what exactly a veterinary neurologist does or why your primary care vet might refer you to one, this episode is for you. Partner Neurologist, Dr. Ryan Gallagher helps demystify what happens when our pets experience neurological issues and explains why seeing a veterinary neurologist is so important.

In this episode, he goes over everything from what makes a neurological exam different from your pet’s regular checkup, to the advanced imaging that helps diagnose conditions affecting the brain and spine. We’ll explore practical questions, too, like whether there’s value in seeing a specialist even if advanced diagnostics aren’t in the budget, what your pet experiences during an MRI or CT scan, and when each type of imaging is needed. Plus, Dr. Gallagher will share his vision for the impact he wants to make on the veterinary profession.

Whether you’re trying to understand a recent referral or simply curious about this specialized field of veterinary medicine, you’re in the right place.

What You’ll Learn?

What is the role of a veterinary neurologist?
What the difference is between a neuro exam and the regular physical exam pets receive at their primary vet?  
If people can’t afford advanced diagnostics, is there still value in having the examination and consult?  
What the difference is between an MRI and a CT scan.
Will some patients need to have both an MRI and CT scan?
What can clients expect when their pet needs an MRI or CT scan?
Are there risks in having either one?

[Music]

Narrator:

Host: Welcome back to Did You Know?, a podcast by Partner Veterinary. In this series, we dive into everything veterinary medicine—and everything Partner. In each episode, we tackle some of the most common questions we hear, from HR to emergencies and everything in between. If it happens at Partner, we talk about it.

So: your cat is stumbling, or your dog won’t stop tilting their head. Maybe your pet suddenly can’t use their back legs. Something’s off. This is when your primary care veterinarian might suggest seeing a veterinary neurologist.

In this episode, Dr. Ryan Gallagher, veterinary neurologist at our Frederick location, pulls back the curtain on one of veterinary medicine’s most specialized fields. He’ll break down what a neurological exam actually looks like, when an MRI or CT scan is the right call, and why a referral to a specialist might be the most important step in your pet’s care. Whether you just got that referral or you’re simply curious, this one’s for you.

Dr. Ryan Gallagher:

So, my name is Ryan Gallagher. I’m a neurologist here at Partner Veterinary Emergency & Specialty. As far as how I got into veterinary medicine—I didn’t really have that childhood dream of being a veterinarian. Through high school and into undergrad, I gravitated towards the sciences. I knew I liked the life sciences, as I think many of us do.

I actually started by volunteering at a veterinary hospital when I was in my undergraduate years, and I loved the experience. Both the medicine and the connections with people really drew me in. I kind of worked my way up from volunteer to veterinary technician, eventually veterinary student, young veterinarian, intern, and finally specialist. It was during my vet school years that I really gravitated toward neurology. So, it’s been a pretty long road—about 30 years in the industry at various levels, and I’ve been a practicing neurologist here in Maryland for the past 14 years. Time flies.

Jen Mellace:

What brought you to Partner, Dr. Gallagher?

Dr. Gallagher:

Honestly, meeting everyone here. The team at Partner—from top to bottom—has tons of experience in the industry. Our management team has worked in client services, on the technical side, and in practice management. They really understand what support looks like because they’ve done the job before and have been in the team’s shoes.

Jen Mellace:

Can you explain what the role of a veterinary neurologist is?

Dr. Gallagher:

Absolutely. It can get confusing with all the different specialties. Neurologists are veterinarians who have completed additional training to gain expertise in diagnosing and treating conditions that affect the nervous system—so, the brain, spinal cord, peripheral nervous system, and neuromuscular junction. In the clinic, that means consulting on cases suspected of having neurological issues, localizing exactly where in the nervous system the problem is, diagnosing, figuring out treatment options, and implementing that treatment plan.

Jen Mellace:

What’s the difference between a neuro exam and a regular physical exam that pets receive at their primary care vet?

Dr. Gallagher:

General physical exams are designed to encompass everything—not just the nervous system, but also cardiovascular, respiratory, gastrointestinal, and more. It’s essentially casting a wide net to figure out what’s going on. Sometimes, as part of the general physical, we’ll spot signs that suggest a neurological issue, and that’s when a neurological exam is needed. The neuro exam is a much more in-depth look at specific functions. We screen not just general mentation but also reflexes, cranial nerves, coordination, pain, and more. It’s really an expansion of the general physical exam, giving us much more information about what’s going on with the nervous system.

Jen Mellace:

What kind of information do you get from the actual neuro exam?

Dr. Gallagher:

The goal of the neurological exam is to help us localize exactly where within the nervous system the problem is. We use nerve pathways and reflex arcs as a sort of map. A thorough evaluation allows me to identify the issue with a fair degree of accuracy. Of course, there are always patients that don’t read the textbooks and can be challenging! For example, sometimes I’ll have patients come in with blindness or visual deficits, bumping into walls with no response to visual input. Is it an eye issue—like with the retina or lens? Is it the nerve carrying impulses from the retina to the brain? Or is it the brain itself, which processes vision?

As part of the evaluation, we’ll test visual input—like a menace response, or shining a bright light into the eye to see if the pupil constricts. If a patient isn’t visual or menacing, but the pupil constricts to light, that tells me the retina and optic nerve are working, and the midbrain reflex is intact. So, the source of the visual deficit must be in the visual cortex—the higher brain that processes vision. In cases like that, we know we need an MRI, not a referral to an ophthalmologist. That’s how helpful localization can be.

Jen Mellace:

Are there certain neurological problems you see more often in pets today?

Dr. Gallagher:

Absolutely. The distribution is interesting. The vast majority of my patients are dogs—kitties are pretty resistant to a lot of the neurological diseases we see. We definitely see cats, but they’re probably only about 10–15% of my caseload. Internal medicine sees more cats because they tend to get other organ dysfunctions rather than neurological issues. My caseload tends to be either seizure disorders—which are common neurological issues for a variety of reasons, from idiopathic or genetic epilepsy to inflammatory brain diseases and tumors—or mobility issues due to spinal disease. Intervertebral disc disease is very common: disc degeneration and herniation, either bulging or rupture, causing spinal compression, pain, lameness, or weakness.

Many patients have already had some management for suspected disc disease—medications and rest—but if we’re not getting where we need to be, that’s when the specialist steps in. We might need to consider more aggressive intervention, or maybe our suspicion is wrong and we need to look deeper.

Jen Mellace:

Do some neurological problems seem to be breed-specific in dogs?

Dr. Gallagher:

Yes, there are breed predispositions for many conditions, and disc disease is a great example. It’s common in all dogs, but especially in smaller breeds with longer backs and shorter legs—what we call chondrodystrophic breeds. These breeds are particularly prone, even at a young age, to developing disc changes. So, when we’re talking about our suspicions, age and breed definitely factor into our differential list.

For example, if a certain breed and age presents with back pain, we’re more suspicious of disc herniation. If a dog presents with seizures and is of a breed and age where we frequently see epilepsy, that will affect how aggressive we are with diagnostics. If there’s a family history, I’m more comfortable managing them as an epileptic without advanced diagnostics; if not, I get more concerned about underlying pathology and would recommend diagnostics more strongly.

Jen Mellace:

If people can’t afford advanced diagnostics, is there still value in getting a neuro exam and consult?

Dr. Gallagher:

Absolutely. While most general practitioners are highly trained in screening for and treating certain neurological conditions, there are cases where consulting with a specialist is very helpful—even if you’re not planning on advanced diagnostics. For example, difficult-to-manage epileptics: if you’ve tried options one, two, and three, and aren’t getting the control you want, a referral to an expert can help fine-tune the medical management or consider other treatment options.

Jen Mellace:

How is the neurological exam performed? What can somebody expect when they come in with their pet?

Dr. Gallagher:

Generally, the neurological exam starts with observation—looking at posture, gait, compulsive behaviors, and whether the pet appears to be visual. Then we move to more hands-on evaluation, testing proprioception (the limb’s positional awareness), coordination, reflexes, cranial nerve function, vision, and sensory responses. We finish by screening for pain, palpating to localize discomfort if present.

Jen Mellace:

How long does this exam take, or does it just depend on the pet?

Dr. Gallagher:

It can vary based on the pet’s cooperation—cats, for example, will only give you what they want to give you that day! But generally, a detailed neurological exam can be completed in 10 to 15 minutes.

Jen Mellace:

If further diagnostics are needed, what are they? I know at Partner we have MRI and CT—can you talk about those and what’s the difference?

Dr. Gallagher:

The diagnostic plan depends on where we think the problem is and what structures might be involved. While MRI and CT are often the endpoint, we usually start with simpler things like bloodwork or X-rays. Bloodwork helps us rule out systemic causes of seizures, like liver or kidney dysfunction. X-rays can help with back pain cases, looking for fractures or bone tumors.

Often, bloodwork and X-rays won’t give us the definitive answer, and that’s when we move to advanced imaging. Both CT and MRI are three-dimensional imaging techniques. The difference is in what tissues they’re best at seeing: CT is based on X-ray technology and is great for bone detail, so we use it for complex bone structures like the skull or certain spinal fractures. MRI, on the other hand, gives beautiful soft tissue detail, making it the go-to for brain or spinal cord pathology. For the conditions I see, MRI is probably the modality we reach for 90% of the time.

Sometimes we do additional tests, like sampling spinal fluid—a spinal tap—if we’re concerned about inflammatory diseases. MRI can show us inflammation, but not always the cause, so sometimes a spinal tap is needed.

Jen Mellace:

What is fluoroscopy? Is that something you use?

Dr. Gallagher:

Fluoroscopy is used less often for my patients but is great for some other conditions. It’s an X-ray study, but unlike regular X-ray or CT, it gives a live-action picture. It’s useful for interventional radiology procedures, like mapping blood flow or placing stents to hold blood vessels or airways open. It has limited soft tissue detail, so for brain and spinal cord cases, I don’t use it often, but it does have a role in select cases.

Jen Mellace:

Will some patients need both an MRI and a CT scan?

Dr. Gallagher:

That’s possible. Usually, MRI is our workhorse because of the soft tissue detail, but CT can be useful for head trauma, skull fractures, or complex bone injuries. Sometimes, for tumors or cancers, we’ll use MRI for the diagnosis, but CT’s spatial resolution is better for planning radiation therapy—we want to precisely target the tumor and avoid collateral damage. So, in some cases, we’ll do both, but it’s the minority.

Jen Mellace:

What can pet parents expect when it’s time for their pet to have an MRI or CT scan?

Dr. Gallagher:

Both CT and MRI are non-invasive procedures. We’re not doing anything surgically. The machines are the same as in human medicine, but the big thing is that the patient must be completely motionless. That’s hard for people—and even harder for pets! So, both require sedation, and MRI usually requires general anesthesia. We want people to know their pet will need to go under anesthesia, but it’s a light plane—just enough to keep them still, as if they were having a dental cleaning.

General anesthesia is always a risk, but for otherwise healthy patients, it’s usually very low risk. The main times we might reconsider are with significant heart or lung disease. But in most cases, pets take a brief nap, wake up, and we have the images we need. Some additional tests, like a spinal tap, can be done while they’re under, and that’s a quick procedure.

Dr. Gallagher:

Jen Mellace:

Narrator:

“Thank you for listening to ‘Did You Know?’ Is there something about Partner that you want to know? Email us at [email protected]. Who knows? We might turn your question into an entire episode! And you can now find us wherever you listen to all of your other favorite podcasts. Subscribe now!”