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OSCE - examinations > Cerebellar examination > Flashcards

Cerebellar examination Flashcards

1
Q

What are parts of the cerebellar examination?

A
  1. General inspection
  2. Head
  3. Upper limbs
  4. Lower limbs
  5. Posture and gait
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2
Q

What are parts of the general inspection of the cerebellar examination?

A
  1. Abnormal posture: may indicate the presence of truncal ataxia.
  2. Speech abnormalities: slurred staccato speech is typical of cerebellar disease.
  3. Scars: may indicate previous neurosurgery (often difficult to see because of the patient’s hair).
  4. Gait: pay attention to the patient’s gait as they enter the room and take a seat, noting any abnormalities
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3
Q

What would you look for in the head during a cerebellar examination?

A
  1. Nystagmus - move finger quickly to elicit nystagmus

2. Speech: ask patient to read something out loud. Ask patient to say “baby hippopotamus”

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4
Q

What would you look for in the upper limbs during a cerebellar examination?

A
  1. Tone - as per normal
  2. Power - as per normal
  3. Co-ordination
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5
Q

How would you assess upper limb co-ordination?

A
  1. Rebound test: arms out, palms up & eyes closed. Push hand down and see how it bounces back
  2. Finger-nose test
  3. Hand slapping test (ask about dexterity first)
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6
Q

What does overshoot in the rebound test imply?

A

Dysmetria

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7
Q

What can you see in the finger-nose test?

A

Intention tremor, dysmetria

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8
Q

What can you see in the hand-slapping test?

A

Dysdiadochokinesia = the inability to perform rapid alternating muscle movements

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9
Q

What would you look for in the lower limbs during a cerebellar examination?

A
  1. Tone - as per normal
  2. Power - as per normal
  3. Co-ordination
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10
Q

How would you assess lower limb co-ordination?

A
  1. Foot tapping (ask patient to tap food as quickly as possible)
  2. Heel-shin test
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11
Q

What may the foot tapping test reveal?

A

Dysdiadochokinesia = the inability to perform rapid alternating muscle movements

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12
Q

What may the heel shin test test reveal?

A

Intention tremor, dysmetria

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13
Q

What would you look for in posture during a cerebellar examination?

A
  1. “How stable are you when sitting or standing up?
  2. Assess stability sitting (ask to cross arms in front and sit still)
  3. Assess stability standing (feet together, arms by side)
  4. Romberg’s test (sensory ataxia)
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14
Q

If patients cannot sit stabile, what does that imply?

A

Truncal ataxia

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15
Q

What would you look for in gait during a cerebellar examination?

A
  1. Ask patient to walk across room and back and look for features of cerebellar gait
  2. Ask to walk heel-toe (very difficult in cerebellar lesion)
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16
Q

What are clinical features of cerebellar degeneration?

A

Cerebellar degeneration involves the progressive loss of Purkinje cells in the cerebellum

Think DANISH

Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Speech (slurred, staccato)
Hypotonia
17
Q

What causes cerebellar degeneration?

A 
Chronic alcohol abuse
Nutritional deficiency (typically B12)
Tumours
MS
Stroke
Anti-epileptic medication 
Friedreich's ataxia
Arnold-Chiari (congenital)
18
Q

What is a typical cerebellar gait?

A

Wide-based gait
Unsteadiness with lateral veering
Irregular steps

19
Q

What is the Romberg’s test based on?

A

Romberg’s test is based on the premise that a patient requires at least two of the following three senses to maintain balance whilst standing:

  1. Proprioception: the awareness of one’s body position in space.
  2. Vestibular function: the ability to know one’s head position in space.
  3. Vision: the ability to see one’s position in space.
20
Q

What would you suggest after a cerebellar examination?

A

Complete a full neurological examination

MRI for visualising the posterior fossa

21
Q

What symptoms do central versus hemisphere lesions cause?

A

Central (vermis):

  1. Truncal ataxia sitting and standing
  2. Poor heel-toe walking
  3. Slurred staccato speech

Hemisphere:

  1. Ipsilateral limb ataxia
  2. Nystagmus
  3. Unsteady gait
22
Q

What symptoms would you see in the limbs of someone with cerebellar lesions?

A
  1. Dystmetria
  2. Past-pointing
  3. Intention tremor
  4. Dysdiadochokinesia
23
Q

What are the classic symptoms of Wernicke’s encephalopathy?

A
  1. Acute confusional state
  2. Ophthalmoplegia (Upwards gaze)
  3. Ataxia
24
Q

What is dysarthria?

A

Dysarthria occurs when the muscles you use for speech are weak or you have difficulty controlling them.

Dysarthria often causes slurred or slow speech that can be difficult to understand.

OSCE - examinations (13 decks)

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