Cerebellar and Vestibular Disease

Question 0

Vestibulospinal tract

Answer 0

projection tract from vestibular nuclei
axons travel caudally in white matter of spinal cord
maintain posture
turn on extensors on same side
turn off flexors on same side
turn off extensors on opposite side

Question 1

Cerebellar Disease - clinical signs

Answer 1

1. symmetric cerebellar ataxia
2. dysmetria / hypermetria = overstepping
3. no paresis / paralysis - no loss of strength
4. head and neck intention tremors
5. trunkal ataxia
6. absent menace response

Question 2

Medial longitudinal fasciculus

Answer 2

projection tract from vestibular nuclei
travel rostrally to CNs III, IV, VI
responsible for normal vestibular nystagmus

Question 2

Vestibular Disease - clinical signs

Answer 2

1. head tilt to side w/ less vestibular tone
2. rolling, falling, tight circling to side w/ less vestibular tone
3. vestibular ataxia to side w/ less vestibular tone
4. ventrolateral strabismus - transient
5. abnormal nystagmus - spontaneous (vertical, horizontal, rotary) or positional

Question 3

Peripheral Vestibular Disease

lesion in inner ear or CN VIII

Answer 3

1. classic vestibular signs - head tilt, falling, rolling, circling, asymmetric ataxia, horizontal or rotary nystagmus, eye drop
   * *Fast phase of nystagmus AWAY from side of lesion
2. no loss of strength
3. postural responses are normal

Question 4

Bilateral peripheral vestibular disease indicators

Answer 4

doll eyes

appears balanced because everything is off balance

Question 4

Central Vestibular Disease

lesion in medulla

Answer 4

1. classic vestibular signs
2. spastic hemiparesis/paresis
3. proprioceptive ataxia
4. postural response deficits on same side as lesion
5. vertical nystagmus - Fast phase may be away from or toward side of lesion
6. nystagmus changes direction
7. changes in mentation
8. other CN LMNs affected - especially VII

Question 4

Paradoxical Vestibular Disease
~30% of central vestibular cases
lesion in floculonodular lobe or peduncle

Answer 4

1. same as Central Vestibular Disease except…
2. postural response deficits on opposite side from other signs on side with lesion
3. head tilt, rolling, fallin, circling on unaffected side
   - vestibular signs on side w/ less vestibular tone but its normal tone
   - lesion on side with more vestibular tone (loss of inhibition)

Question 5

Peripheral ataxia

Answer 5

know where feet are

Question 7

Central ataxia

Answer 7

don’t know where feet are

Question 9

General proprioceptive ataxia

Answer 9

don’t know where feet are

stumbly bumbly

Question 11

Cerebellar ataxia

Answer 11

know where feet are
symmetric on all 4 limbs
herky jerky

Question 12

Vestibular ataxia

Answer 12

maybe know where feet are
asymmetric
falling, leaning, tight circles