Cerebellar Disease

Question 1

What does the cerebellum do

Answer 1

It is responsible for the coordination of skilled voluntary movement, gait and posture

Question 2

What are some causes of cerebellar disease

Answer 2

DISBIT

Demyelination - MS
Inherited - Friedrich’s ataxia, spinocerebellar ataxias
Space-occupying lesions in posterior fossa - cerebellopontine angle tumour, medulloblastoma
Brainstem vascular disease - vertebrobasilar stroke
Infection - HIV, abscesses
Toxicity - alcohol, anti-convulsants

Question 3

What is the imaging modality of choice in cerebellar disease

Answer 3

MRI - CT scans are not good at looking at the posterior cranial fossa

Question 4

What other examinations would you ask to do to a patient with cerebellar disease

Answer 4

COP

Corneal reflex - loss of this reflex in cerebellopontine angle tumours
Optic atrophy - occurs in MS
Pes cavus - Freidrich’s ataxia and Charcot-Marie Tooth

Question 5

Why is testing the corneal reflex useful in a patient with cerebellar disease

Answer 5

Loss of this reflex is the earliest sign of a cerebellopontine angle tumour

Due to the proximity of the cerebellopontine angle to cranial nerves

Question 6

Why would you examine for optic neuritis in cerebellar disease

Answer 6

Cerebellar problems may be cause by MS. MS also causes optic neuritis which leads to optic atrophy

Question 7

What are the signs of cerebellar disease

Answer 7

DANISH T

Dysdiadochokinesis
Ataxia - broad based gait falling to side of lesion
Nystagmus - fast beat towards side of lesion
Intention tremor
Staccato speech - cerebellar dysarthria
Hypotonia
Titubation - rhythmic nodding of head

Question 8

Are signs ipsilateral or contralateral to the lesion in cerebellar syndrome?

Answer 8

Ipsilateral

Question 9

When is dysmetria seen?

Answer 9

At the extreme of arm length.

Question 10

What is dysmetria?

Answer 10

The incorrect velocity and amplitude of a planned movement

Question 11

What is another example of dysmetria?

Answer 11

The rebound phenomenon

Question 12

How is tone affected in cerebellar syndrome?

Answer 12

May be slightly hypotonic

Question 13

In what direction is the fast phase of the nystagmus in cerebellar syndrome?

Answer 13

Towards lesion side

Question 14

Is Romberg’s test positive in cerebellar disease?

Answer 14

No- differentiates a cerebellar broad based gait from a sensory broad based gait.

Question 15

How is the speech in cerebellar syndrome described?

Answer 15

Scanning, slurred with an explosive character.

Question 16

What are the common causes of cerebellar syndrome?

Answer 16

PASTRIES:
Paraneoplastic cerebellar syndrome
Alcoholic cerebellar degeneration
Sclerosis (MS)
Tumour (posterior fossa SOL)
Rare (Freidrich's ataxia and ataxia telangiectasia)
Iatrogenic (Phenytoin toxicity)
Endocrine (hypothyroidism)
Stroke (brainstem vascular event)

Question 17

What drugs cause a cerebellar syndrome?

Answer 17

Phenytoin
Lithium
Carbamazepine
Chemotherapeutic agents

Question 18

How could you differentiate a lesion of the vermis and a lesion of the cerebellar hemispheres?

Answer 18

Vermis- trunk and axial muscles affected

Hemispheres- ipsilateral limb ataxia

Question 19

What malignancies are associated with paraneoplastic cerebellar degeneration?

Answer 19

Cancers of the ovary, lung, breast, uterus and Hodgkin’s lymphoma.

Neuro sx may precede tumour diagnosis

Can detect antibodies in serum.

Question 20

What features would got against a diagnosis of paraneoplastic cerebellar degeneration?

Answer 20

Unilateral cerebellar dysfunction

Paraneoplastic = bilateral rapid onset.

Question 21

What is lateral medullary syndrome?

Answer 21

Occlusion of vertebral artery or posterior inferior cerebral artery (PICA)

Question 22

What are the symptoms of lateral medullary syndrome?

Answer 22

DANVAH:
Dysphagia
Ataxia
Nystagmus
Vertigo
Anaesthesia: dissociated pain loss
Horner's syndrome
Body anaesthesia to pain 

Variable presentation

Question 23

Are the signs in lateral medullar syndrome ipsilateral or contralateral?

Answer 23

Ipsilateral apart from body anaesthesia to pain (spinothalamic tracts- contralateral)

NB also CNV pain and temperature sensation lost

Question 24

What may be found on examination of a patient with a cerebellopontine angle lesion?

Answer 24

VI nerve palsy (in some)
LMN facial weakness- VII nerve palsy
Loss of corneal reflex, CNV sensory loss and muscle wasting
Sensorineural hearing loss
If large- may involve bulbar nerves (tongue and uvula deviation to affected side)

Ipsilateral cerebellar signs

Question 25

What CNs are most often affected by a cerebellopontine angle lesion?

Answer 25

V, VII and VIII

Question 26

What are the causes of a cerebellopontine angle lesion?

Answer 26

Acoustic neuroma
Meningioma
Cholesteatoma
Basilar artery aneurysm

Question 27

What are the common causes of a cerebellopontine angle lesion?

Answer 27

Acoustic neuromas

Meningiomas 2nd

Question 28

What is an acoustic neuroma?

Answer 28

Benign, slow-growing tumour of superior vestibular nerve.

Surgically excise to remove

Question 29

What condition is acoustic neuroma associated with?

Answer 29

Neurofibromatosis II

Question 30

How would an cerebellopontine angle lesion present?

Answer 30

Unilateral sensorineural hearing loss
Tinnitus, vertigo
Headache (raised ICP)
Signs CPA lesion

Question 31

What is Von-Hippel-Lindau syndrome?

Answer 31

Condition characterised by: 
Renal cysts, 
Bilateral renal cell carcinoma, 
Phaeochromocytomas, 
Islet cell tumours 
Haemangioblastomas- often in cerebellum --> cerebellar signs