Cerebellar Dysfunction Flashcards
what are the functions of the cerebellum?
called the “little brain
4 main functions
1. maintenance of balance and posture
2. coordination of voluntary movements ➔ fine movements
3. motor learning ➔ riding a bike or learning a sport
4. cognitive function ➔ language
what general physical manifestations may occur with cerebellar dysfunction?
balance problems and gait disorders + difficulties in coordination
what does DANISH stand for for cerebellar dysfunction?
D - dysdiadochokinesia
A - ataxia
N - nystagmus
I - Intention tremor
S - scanning speech
H - hypotonia
what does dysdiadochokinesia stand for? what p/e can you do to test for it?
inability to perform rapid alternating movements
upper: finger tapping (thumb + pointer finger) or pronation/supination
lower: toe tapping
what does ataxia stand for? what p/e can you do?
loss of muscle control in arms and legs
gait - tandem walking, broad-based, Romberg’s stance
what does Romberg’s stance tell you?
if positive ➔ imbalanced with eyes closed and feet together = cerebellar problem
swaying or falling
what does nystagmus stand for? what test can you do to test?
repetitive uncontrolled eye movements
H-test
- horizontal is less concerning; vertical is concerning
what does intention tremor mean? how to test?
tremor that appears with goal-directed movement at the end of the movement
finger-to-nose test ➔ overshooting or undershooting of the pt’s index finger d/t improper movement coordination
heel-to-shin test
what does scanning speech look like?
pauses after each word, as if they are searching for words
also known as dysarthria: scanning or slurred speech
what does hypotonia look like? what test to examine?
decrease tone ➔ decrease resistance to passive muscular extension
normal p/e assessing for tone ➔ passive ROM
what other symptoms could a pt experience with cerebellar dysfunction beyond DANISH?
- dysmetria: irregular placement during voluntary movement of limb or eye ➔ finger to nose/heel to chin test
- postural instability
- pendular patellar reflex
- rebound phenomenon: over-correction after limb displacement
- hypermetric saccades ➔ cannot track objects with smooth eye movements
- pronator drift
common causes for cerebellar dysfunction
- head trauma
- toxins and drugs ➔ ALCOHOL
- vitamin deficiency ➔ B, E, THIAMINE (relate to alcohol)!!
- infectious ➔ HIV, neurosyphilis, brain abscess, HIV
- hereditary: ataxia telangiectasia etc.
- autoimmune: MS or GBS
- Vascular: stroke
- space-occupying lesions: tumours, neurofibromatosis
- paraneoplastic syndromes
- neurodegenerative diseases – parkinson disease or Huntington disease
- metabolic conditions: thyroid, Hashimoto, Wilson, Celiac
- Psychiatric: schizophrenia
what is Wenicke-Korsakoff Syndrome?
its a group of alcohol induced amnestic disorders d/t thiamine deficiency (poor nutrition or malabsorption)
def Wenicke’s encephalopathy + s/s
acute and reversible
triad of oculomotor dysfunction (nystagmus; CN VI palsy), gait ataxia, and confusion
def Korsakoff’s syndrome + s/s
chronic and only ~20% reversible
s/s: anterograde amnesia (no ST memories), and confabulation ➔ persists beyond usual duration of intoxication and withdrawal
how do you tx wernicke’s encephalopathy?
THIAMINE ➔ can also give to any pt in alcohol withdrawal (for preventative or acute management)
folic acid supplementation
how do you tx Korsakoff’s syndrome?
thiamine! folic acid supplementation
how can we provide support for alcohol cerebellar degeneration?
harm reduction approach: social support, EtOH cessation, local community health centre resources
nutrition: thiamine and folic acids
PT, OT, assistive devices, fall prevention, gait training
Cx from alcohol use
- cirrhosis
- Wernicke Korsakoff syndrome
- HTN
- Gout
- alcoholic ketoacidosis
- fetal alcohol syndrome
- holiday heart - alcohol-induced myopathy
- pancreatitis
- hepatic encephalopathy - astreixis
- gastritis and malabsorption
- neuropathy
