Cerebellar examination Flashcards
What are parts of the cerebellar examination?
- General inspection
- Head
- Upper limbs
- Lower limbs
- Posture and gait
What are parts of the general inspection of the cerebellar examination?
- Abnormal posture: may indicate the presence of truncal ataxia.
- Speech abnormalities: slurred staccato speech is typical of cerebellar disease.
- 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
What would you look for in the head during a cerebellar examination?
- Nystagmus - move finger quickly to elicit nystagmus
2. Speech: ask patient to read something out loud. Ask patient to say “baby hippopotamus”
What would you look for in the upper limbs during a cerebellar examination?
- Tone - as per normal
- Power - as per normal
- Co-ordination
How would you assess upper limb co-ordination?
- Rebound test: arms out, palms up & eyes closed. Push hand down and see how it bounces back
- Finger-nose test
- Hand slapping test (ask about dexterity first)
What does overshoot in the rebound test imply?
Dysmetria
What can you see in the finger-nose test?
Intention tremor, dysmetria
What can you see in the hand-slapping test?
Dysdiadochokinesia = the inability to perform rapid alternating muscle movements
What would you look for in the lower limbs during a cerebellar examination?
- Tone - as per normal
- Power - as per normal
- Co-ordination
How would you assess lower limb co-ordination?
- Foot tapping (ask patient to tap food as quickly as possible)
- Heel-shin test
What may the foot tapping test reveal?
Dysdiadochokinesia = the inability to perform rapid alternating muscle movements
What may the heel shin test test reveal?
Intention tremor, dysmetria
What would you look for in posture during a cerebellar examination?
- “How stable are you when sitting or standing up?
- Assess stability sitting (ask to cross arms in front and sit still)
- Assess stability standing (feet together, arms by side)
- Romberg’s test (sensory ataxia)
If patients cannot sit stabile, what does that imply?
Truncal ataxia
What would you look for in gait during a cerebellar examination?
- Ask patient to walk across room and back and look for features of cerebellar gait
- Ask to walk heel-toe (very difficult in cerebellar lesion)
What are clinical features of cerebellar degeneration?
Cerebellar degeneration involves the progressive loss of Purkinje cells in the cerebellum
Think DANISH
Dysdiadochokinesia Ataxia Nystagmus Intention tremor Speech (slurred, staccato) Hypotonia
What causes cerebellar degeneration?
Chronic alcohol abuse Nutritional deficiency (typically B12) Tumours MS Stroke Anti-epileptic medication Friedreich's ataxia Arnold-Chiari (congenital)
What is a typical cerebellar gait?
Wide-based gait
Unsteadiness with lateral veering
Irregular steps
What is the Romberg’s test based on?
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:
- 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.
What would you suggest after a cerebellar examination?
Complete a full neurological examination
MRI for visualising the posterior fossa
What symptoms do central versus hemisphere lesions cause?
Central (vermis):
- Truncal ataxia sitting and standing
- Poor heel-toe walking
- Slurred staccato speech
Hemisphere:
- Ipsilateral limb ataxia
- Nystagmus
- Unsteady gait
What symptoms would you see in the limbs of someone with cerebellar lesions?
- Dystmetria
- Past-pointing
- Intention tremor
- Dysdiadochokinesia
What are the classic symptoms of Wernicke’s encephalopathy?
- Acute confusional state
- Ophthalmoplegia (Upwards gaze)
- Ataxia
What is dysarthria?
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.
