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
