Cerebellar Disease Flashcards
What does the cerebellum do
It is responsible for the coordination of skilled voluntary movement, gait and posture
What are some causes of cerebellar disease
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
What is the imaging modality of choice in cerebellar disease
MRI - CT scans are not good at looking at the posterior cranial fossa
What other examinations would you ask to do to a patient with cerebellar disease
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
Why is testing the corneal reflex useful in a patient with cerebellar disease
Loss of this reflex is the earliest sign of a cerebellopontine angle tumour
Due to the proximity of the cerebellopontine angle to cranial nerves
Why would you examine for optic neuritis in cerebellar disease
Cerebellar problems may be cause by MS. MS also causes optic neuritis which leads to optic atrophy
What are the signs of cerebellar disease
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
Are signs ipsilateral or contralateral to the lesion in cerebellar syndrome?
Ipsilateral
When is dysmetria seen?
At the extreme of arm length.
What is dysmetria?
The incorrect velocity and amplitude of a planned movement
What is another example of dysmetria?
The rebound phenomenon
How is tone affected in cerebellar syndrome?
May be slightly hypotonic
In what direction is the fast phase of the nystagmus in cerebellar syndrome?
Towards lesion side
Is Romberg’s test positive in cerebellar disease?
No- differentiates a cerebellar broad based gait from a sensory broad based gait.
How is the speech in cerebellar syndrome described?
Scanning, slurred with an explosive character.
What are the common causes of cerebellar syndrome?
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)
What drugs cause a cerebellar syndrome?
Phenytoin
Lithium
Carbamazepine
Chemotherapeutic agents
How could you differentiate a lesion of the vermis and a lesion of the cerebellar hemispheres?
Vermis- trunk and axial muscles affected
Hemispheres- ipsilateral limb ataxia
What malignancies are associated with paraneoplastic cerebellar degeneration?
Cancers of the ovary, lung, breast, uterus and Hodgkin’s lymphoma.
Neuro sx may precede tumour diagnosis
Can detect antibodies in serum.
What features would got against a diagnosis of paraneoplastic cerebellar degeneration?
Unilateral cerebellar dysfunction
Paraneoplastic = bilateral rapid onset.
What is lateral medullary syndrome?
Occlusion of vertebral artery or posterior inferior cerebral artery (PICA)
What are the symptoms of lateral medullary syndrome?
DANVAH: Dysphagia Ataxia Nystagmus Vertigo Anaesthesia: dissociated pain loss Horner's syndrome Body anaesthesia to pain
Variable presentation
Are the signs in lateral medullar syndrome ipsilateral or contralateral?
Ipsilateral apart from body anaesthesia to pain (spinothalamic tracts- contralateral)
NB also CNV pain and temperature sensation lost
What may be found on examination of a patient with a cerebellopontine angle lesion?
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
What CNs are most often affected by a cerebellopontine angle lesion?
V, VII and VIII
What are the causes of a cerebellopontine angle lesion?
Acoustic neuroma
Meningioma
Cholesteatoma
Basilar artery aneurysm
What are the common causes of a cerebellopontine angle lesion?
Acoustic neuromas
Meningiomas 2nd
What is an acoustic neuroma?
Benign, slow-growing tumour of superior vestibular nerve.
Surgically excise to remove
What condition is acoustic neuroma associated with?
Neurofibromatosis II
How would an cerebellopontine angle lesion present?
Unilateral sensorineural hearing loss
Tinnitus, vertigo
Headache (raised ICP)
Signs CPA lesion
What is Von-Hippel-Lindau syndrome?
Condition characterised by: Renal cysts, Bilateral renal cell carcinoma, Phaeochromocytomas, Islet cell tumours Haemangioblastomas- often in cerebellum --> cerebellar signs
