Cerebellar Disease

Question 1

Causes of Cerebellar Disease - DANISH PASTRIES

Answer 1

Dysdiadokinesis
Ataxia
Nystagmus
Intention Tremor
Slurred speech/Stacatto
Hypotonia

Posterior fossa tumour
Alcohol
Sclerosis (MS)
Trauma
Rare
Inherited (eg Friedrich's Ataxia)
Epilepsy meds (Carbamazepine, Phenytoin toxicity)
Stroke

Question 2

Cerebellar Lesion - DANISH

Answer 2

Dysdiadokinesis
Ataxia
Nystagmus
Intention tremor 
Slurred Speech/ Staccato
Hypotonia/Heel Shin Test

Question 3

Cerebellar Stroke vs Vestibular Neuritis

Answer 3

May present in similar way!

Cerebellar Stroke:

• vertical nystagmus
• patient cannot stand without support, even with eyes open

Acute Vestibular Neuritis:
- Patient usually able to stand without support

Question 4

Arnold Chiari Malformation

Answer 4

Arnold-Chiari malformation describes the downward displacement, or herniation, of the cerebellar tonsils through the foramen magnum. Malformations may be congenital or acquired through trauma.

Features
non-communicating hydrocephalus may develop as a result of obstruction of cerebrospinal fluid (CSF) outflow
headache
syringomyelia

Question 5

Arnold Chiari Malformation - Example Question

Answer 5

A 34-year-old woman is referred to the neurology clinic for a 6 month history of progressively worsening headaches. The headaches tend to be occipital in nature and are worsened by coughing.

Neurological examination is unremarkable.

Her MRI is shown below:

SEE PASSMED IMAGE

What finding is shown on the MRI?

	Brainstem cavernous angioma
	Pituitary adenoma
	> Arnold-Chiari malformation
	Arachnoid cyst
	Spina bifida

The MRI shows herniation of the cerebellar tonsils through the foramen magnum consistent with a Chiari type I malformation.

Question 6

Upbeat vs Downbeat Nystagmus

Answer 6

UPBEAT NYSTAGMUS = Cerebellar vermis lesions (Cerebellar or brainstem lesions)

DOWNBEAT NYSTAGMUS = Foramen magnum lesions ie Arnold Chiari Malformation