Cerebellar Disorders (3)

Question 1

What are the causes?

Answer 1

• Posterior Circulation Stroke
• MS
• SOL
• Multiple system atrophy
• Toxins and Drugs – Phenytoin, Alcohol, Lithium, Carbamazepine
‣ Phenytoin is used for seizure prevention, but may need to be changed due to the risk of cerebellar toxicity
• Metabolic – Thyroid, B12 deficiency, Wilson’s disease
• Inherited - Friedreich ataxia

Question 2

What are its signs?

What does Romberg’s test?
→ How does this clinically differ from cerebellar ataxia?

How does its presentation differ with the location of the cerebellar lesion?

Answer 2

➊ DANISH:
* DDK and Dysmetria (past-pointing)
* Ataxia (Limb/Truncal – Broad-based, unsteady gait)
‣ Romberg’s +ve indicates sensory ataxia, therefore a sign of Dorsal column disease – Cerebellar disease is Romberg’s +ve
* Nystagmus
* Intention tremor
* Speech (Dysarthria) – Slurred/Staccato
* Hypotonia and reduced power

➋ It tests for ataxia, and a +ve sign is indicative of sensory or cerebellar ataxia
→ In cerebellar ataxia, the pts are unstable in both stages of having their eyes open and closed. When their eyes are closed, they tend to tilt toward the diseased side of the cerebellum.

➌ * Lesions to the cerebellar vermis typically causes truncal ataxia and gait instability, with few cerebellar signs in the limbs
* Lesions to the cerebellar hemisphere will cause signs in the ipsilateral limb