Cerebellar Dysfunction Flashcards
Clinical signs that should be noted during general inspection in cerebellar examination?
Abnormal posture: may indicate the presence of truncal ataxia.
Speech abnormalities: slurred staccato speech is typical of cerebellar disease. Ask to say phrases like “baby hippopotamus” and “British constitution”
Scars: may indicate previous neurosurgery (often difficult to see because of the patient’s hair).
Gait: pay attention to the patient’s gait as they enter the room and take a seat, noting any abnormalities (e.g. broad-based gait in cerebellar pathology).
What is ataxia?
Ataxia is a neurological sign consisting of involuntary movements with an irregular oscillatory quality which interfere with the normal smooth trajectory of movement. Ataxia can be truncal (affecting the trunk) or appendicular (affecting the limbs)
What is assessing tandem gait?
Ask the patient to walk to the end of the examination room and back with their heels to their toes.
What is Romberg’s test?
Used to assess for loss of proprioceptive or vestibular function (known as sensory ataxia).
The test does not assess cerebellar function and instead is used to quickly screen for evidence of sensory ataxia (i.e. non-cerebellar causes of balance issues).
Romberg’s test is based on the premise that a patient requires 2 out of what 3 senses to remain standing?
Proprioception: the awareness of one’s body position in space.
Vestibular function: the ability to know one’s head position in space.
Vision: the ability to see one’s position in space.
Process of Romberg’s test?
- Position yourself within arms reach of the patient to allow you to intervene should they begin to fall.
- Ask the patient to put their feet together and keep their arms by their sides (be aware that patients with truncal ataxia may struggle to do this, however, this type of unsteadiness is not the same as a positive Romberg’s sign).
- Ask the patient to close their eyes.
What is a positive Romberg’s test?
Falling without correction is abnormal and referred to as a positive Romberg’s sign.
This indicates unsteadiness is due to sensory ataxia (i.e. a deficit of proprioceptive or vestibular function, rather than cerebellar function).
Upper limb assessments in cerebellar test?
Finger to nose test (ask patient to place finger from their nose to your finger-try to do as fast as possible)
Rebound phenomenon (ask patient to place arms stretched out in front of them and push down against resistance before letting go)
Tone (assess tone in muscle groups of shoulder, elbow and wrist . With this ask the patient to completely relax arm and allow you full control)
Dysdiadochokinesia (inability to perform rapid, alternating movements, which is a feature of ipsilateral cerebellar pathology).
Lower limb assessments in cerebellar test?
Tone (similar to upper limbs)
Reflexes - Explain to the patient that you are now going to assess their reflexes by tapping gently on their leg with a tendon hammer (it is useful to show the patient the tendon hammer at this stage).
For each of the reflexes, the patient’s lower limb needs to be completely relaxed. Make sure to hold the tendon hammer handle at its end to allow gravity to aid a good swing. Reflexes typically less brisk on rise and fall.
Heel shin test
What is heel shin test in cerebellar examination?
Used to assess lower limb co-ordination. Patient is asked when lying down to bring heel of right foot up to opposite knee and slide down leg. This is repeated for each leg.
Overall components of cerebellar examination?
D - dydiadochokinesia
A - ataxia (sensory) which assessed using Romberg’s
N - nystagmus assessed getting patient to follow finger in “H” shape to look for abnormal eye movement
I- intention tremor can be assessed using nose to finger test
S-slurred speech (assessed getting patient to say words i.e. British constitution or baby hippopotamus)
H - hypotonia (assess tone in upper and lower limbs by relaxing limbs and moving to see if there is reduced tone)
PENdular reflexes (use tendon hammer to assess for reflexes L3/L4 in knee)
Main reflexes of the body?
S1/S2 - ankle
L3/L4 - knee
C5/C6 - bicep
C7 - triceps
