Cerebellar Dysfunction Flashcards
What could be the cause if cerebellar dysfunction is acute/abrupt?
CVA or brain lesion
What could be the cause if cerebellar dysfunction has rapid progression (hours to days)?
- infarction
- immune-mediated disorders
What could be the cause if cerebellar dysfunction has slower progression (weeks to months)?
- paraneoplastic disorders
- encephalopathy
- vitamin deficiency states
- general medical conditions
What could be the cause if cerebellar dysfunction is chronic (months to years)?
- general ataxias
- toxins (alcohol)
Primary method of diagnosis of cerebellar issues
brain and brainstem MRI
What happens to the cerebrum and cerebellum with alcoholic ataxia?
starts to shrivel up
What is the most noticeable symptom of cerebellar dysfunction?
ataxia - poor muscle control that causes clumsy voluntary movements
S&S of alcoholic ataxia
- wide-footed, unsteady gait
- dysarthria
- clumsiness of their hands
- diplopia, saccades
- peripheral neuropathy
characteristics of Korsakoff’s psychosis
- severe impairments in immediate recall
- anterograde or retrograde amnesia
- disorientation
- emotional changes
- confabulation - honest lying
characteristics of Wernicke’s Encephalitis
- confusion
- ataxia
- ophthalmoplegia - weakness of optic muscles
- anisocoria - unequal pupil sizes
- nystagmust
What causes Wernicke-Korsakoff syndrome?
chronic alcohol use that leads to thiamine (vitamin B1) deficiency
What is chiari malformation?
congenital condition in which structural abnormalities lead to herniation of cerebellum through foramen magnum, compression involved structures
Type 1,2,3 of chiari malformation
Type 1 - symptoms appear in adolescence or adulthood
Type 2 - symptoms appear in childhood
Type 3 - symptoms appear in babies - rare but most severe
symptoms of chiari malformation
Can be asymptomatic
- neck pain
- occipital headache
- hearing or balance problems
- dizziness
- vomiting
- tinnitus
- incoordination
What is Friedreich’s ataxia? When do symptoms onset?
- degeneration of spinal and peripheral nerves, cerebellum
- symptom onset in childhood, latest mid-20s
S&S of cerebellar Friedreich’s ataxia
- imbalance
- incoordination
- dysarthria
- dysphagia
- weakness
S&S of non-cerebellar Friedreich’s ataxia
- scoliosis
- visual or hearing loss
- hypertrophic cardiomyopathy
- peripheral neuropathy
prognosis of Friedreich’s ataxia. What is the most common cause of death?
- mortality between 40s-60s
- most common cause of death is heart disease
- average time from someone going from walking to needing a wheelchair is ~ 10 years
treatment - symptom management and functional training
What is spinocerebellar ataxia? What type of symptoms will be seen?
- degenerative process involving the cerebellum and its efferent and afferent connections
- See UMN and LMN signs due to spinal cord and alpha motor neuron involvement
What is unique about spinocerebellar ataxia?
Significant degree of variations of presentation, prognosis, and progression because there are over 50 types
When does onset occur with spinocerebellar ataxia?
anywhere between childhood and adulthood
What will be seen with type 1 spinocerebellar ataxia?
most common
- optic atrophy
- ophthalmoplegia
- dementia/cog deficits
- amyotrophy - asymmetric lower limb motor neuropathy
- extrapyramidal signs
What are extrapyramidal signs?
basal ganglia impairments
- involuntary muscle contractions
- tremors
- stiff muscles
- bradykinesia
- involuntary movements
What will be seen with type 2 spinocerebellar ataxia?
dominated by visual loss
- retinal degeneration which may be associated with ophthalmoplegia and extrapyramidal signs
