Cerebellar exam

Question 1

How would you explain to the patient about the cerebellar exam?

Answer 1

Hello, my name is ….. I am one of PA students at UCLan.
Can I take your full name and DOB?
Today I have been asked to perform a cerebellar exam, this will involve me testing your coordination by watching you walking and moving your arms and legs as well as testing your eyes, would that be okay?
Before I begin, are you in any pain or discomfort?

Question 2

What things do you look out for when doing a general inspection?

Answer 2

• Tremor
• Nystagmus
• Speech abnormality
• Truncal ataxia

Question 3

When the patient is sat down, what tests do you perform?

Answer 3

1) Speech for dysarthia
- British constitution
- Baby hippopotamus
2) Eye movement
- H test
3) Pronator drift
- Cock your wrists in front of you, close your eyes
4) Rebound phenomena
- Close eyes, I’m going to push your arms down, just
try to keep your arms up.
5) Upper limb tone, reflexes and coordination

6) Lower limb tone, reflexes and coordination

Question 4

When the patient is standing, what tests do you perform?

Answer 4

1) Gait
2) Heel-to-toe (tandem gait)
3) Romberg’s test

Question 5

If nystagmus is present, what will you check further?

Answer 5

• Direction of nystagmus

- Direction of gaze

Question 6

What does the direction of nystagmus tell you about a lesion?

Answer 6

Fast phase toward side of cerebellar lesion

Question 7

How does a positive gait ataxia indication location of a lesion?

Answer 7

They may fall to the side of the lesion

Question 8

What further investigation would you suggest at the end of the exam?

Answer 8

• Full neurological assessment (UL/LL/cranial)
• Labyrinthine assessment
• NEWS chart
• CT/MRI scan
• Referral to appropriate unit