6. Cerebellar syndrome Flashcards
What is cerebellar syndrome?
Inv. cerebellum, leading to incoordination; walking, limb move., speech (mus.), eyes (mus.)
PARTS:
- Archicerebellum (vestibulocerebellum): Maintain equilibrium and coordinate eye, head, and neck move.; interconnected w/vestibular nuclei
- Midline vermis (paleocerebellum): Coordinate trunk and leg move. (stance & gait)
- Lateral hemispheres (neocerebellum): Control quick and finely coordinated limb move. (predominately arms)
Signs and symptoms
No weakness, no signs of UMN or LMN Decomposition of move. Dysarthria, scanning speech Dysdiadochokinesia, and -metria Hypotonia Nystagmus Tremor
Pathophysiology
Information from motor plan
Position sense to cerebellum
Feedback from cerebellum
Etiology
Congenital malformations
- Sporadic; part of complex malformation syndromes (eg, Dandy-Walker malformation)
Hereditary ataxias
- Autosomal recessive: e.g. Friedreich ataxia, ataxia w/isolated vit. E def.
- Autosomal dominant: e.g. Spinocerebellar ataxias
Acquired conditions
- Nonhereditary neurodegenerative disorders: e.g. multiple system atrophy
- Systemic disorders: e.g. alcoholism, celiac disease, heatstroke, hypothyroidism, vit. E def.
- MS, cerebellar strokes
- Toxin exposure: e.g. CO, heavy metals, lithium, phenytoin, anticonvulsants
- Idiopathic
Children
- Primary brain tumors: e.g. medulloblastoma, cystic astrocytoma
- Viral infections
Diagnosis
Clinical evaluation, history, CT/MRI, sometimes genetic testing
Treatment
Treat the cause if possible, usually only supportive
- E.g. hypothyroidism, celiac disease and toxin exposure can be treated
- Surgery for structural lesions
Midline cerebellar syndromes
Imbalance, and unable to stand in Romberg w/eyes open or closed and well perform tandem gait
Hemispheric cerebellar syndromes
Incoordination of the limbs; decomposition of move., dysmetria, and rebound.
- Finger-to-nose and heel-to-knee tests are classic tests
