Cerebellar examination Flashcards
What is the first part of any introduction to an examination?
Wash hands
Intro self
Pt details
Explain a cerebellar exam to a patient
I’ve been asked to examine your coordination today, it’s going to involve me watching you walking, moving your arms and legs and testing your eyes, would that be okay?
What else would you include in your intro?
Pain or discomfort?
When generally inspecting the what do you look for?
Observe for any mobility aids.
Truncal ataxia (sit upright with back off the chair) –
- Due to lesions of the vermis.
What should you ask about before assessing gait?
Vertigo symptoms
When inspecting gait what do you assess?
Stance
Stability
Tandem walking
What is a broad gait suggestive of?
Broad-based gait is suggestive of cerebellar disease.
What is a very sensitive test of cerebellar vermis and why?
Tandem walking
Exaggerates unsteadiness.
What test is involved in the arms part of the cerebellar exam?
Finger to nose test
Tone
Dysdiadochokinesia
What can past pointing suggest?
Cerebellar pathology.
When can an intention tremor be seen in a finger to nose test?
As the finger approaches the target
What side would tone be reduced?
Is it a strong or weak sign?
Same side as the lesion
Weak sign
How do you assess for dysdiadochokinesia?
What does inability suggest?
Demonstrate patting the palm of your hand with the back/palm of other hand as rapidly as possible + ask patient to copy.
Inability (very slow/irregular) may suggest cerebellar ataxia.
What test is involved in the head part of the cerebellar exam?
Nystagmus
Slurred speech
How do you assess for nystagmus?
Examine the eyes at rest.
Follow finger horizontally + vertically.
Look for pursuit where there’s alternating slow + fast movement of eyes.
How do you assess for slurred speech?
What does dysarthria + staccato speech suggest?
Ask the patient to say “British constitution” and “baby hippopotamus”.
Cerebellar dysfunction.
What test is involved in the legs part of the cerebellar exam?
Heel to shin
Knee jerk
What do you ask a patient to do for a heel to shin test?
What does incoordination / dysmetria suggest?
Put your heel on your knee, run it down your shin, lift it off + repeat again
Cerebellar pathology.
How to do test the knee jerk reflex?
How does this change in cerebellar disease?
Hold under the knee joint + strike tendon hammer at the patellar tendon.
Would be pendular meaning less brisk + slower in rise and fall making it appear to continue longer after hitting the tendon.
Upon completing the exam what do you do first?
Thank patient
Wash hands
To complete my exam…
I’d like to do an upper + lower limb neurological examination and a full cranial nerve examination
Summarise a normal cerebellar exam
Today I performed a cerebellar exam on ____ a ___ y/o __.
On general inspection ___ appeared comfy at rest
On examination Romberg’s test was -ve
There was no evidence of ataxic gait or truncal ataxia
Coordination was normal
There was no evidence of nystagmus, tremor or slurred speech
Tone was normal throughout and knee jerk was present
To conclude this was consistent with a normal cerebellar exam.
