Cerebellar examination

Question 1

What is the first part of any introduction to an examination?

Answer 1

Wash hands
Intro self
Pt details

Question 2

Explain a cerebellar exam to a patient

Answer 2

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?

Question 3

What else would you include in your intro?

Answer 3

Pain or discomfort?

Question 4

When generally inspecting the what do you look for?

Answer 4

Observe for any mobility aids.
Truncal ataxia (sit upright with back off the chair) –
- Due to lesions of the vermis.

Question 5

What should you ask about before assessing gait?

Answer 5

Vertigo symptoms

Question 6

When inspecting gait what do you assess?

Answer 6

Stance

Stability

Tandem walking

Question 7

What is a broad gait suggestive of?

Answer 7

Broad-based gait is suggestive of cerebellar disease.

Question 8

What is a very sensitive test of cerebellar vermis and why?

Answer 8

Tandem walking

Exaggerates unsteadiness.

Question 9

What test is involved in the arms part of the cerebellar exam?

Answer 9

Finger to nose test
Tone
Dysdiadochokinesia

Question 10

What can past pointing suggest?

Answer 10

Cerebellar pathology.

Question 11

When can an intention tremor be seen in a finger to nose test?

Answer 11

As the finger approaches the target

Question 12

What side would tone be reduced?

Is it a strong or weak sign?

Answer 12

Same side as the lesion

Weak sign

Question 13

How do you assess for dysdiadochokinesia?

What does inability suggest?

Answer 13

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.

Question 14

What test is involved in the head part of the cerebellar exam?

Answer 14

Nystagmus

Slurred speech

Question 15

How do you assess for nystagmus?

Answer 15

Examine the eyes at rest.
Follow finger horizontally + vertically.
Look for pursuit where there’s alternating slow + fast movement of eyes.

Question 16

How do you assess for slurred speech?

What does dysarthria + staccato speech suggest?

Answer 16

Ask the patient to say “British constitution” and “baby hippopotamus”.

Cerebellar dysfunction.

Question 17

What test is involved in the legs part of the cerebellar exam?

Answer 17

Heel to shin

Knee jerk

Question 18

What do you ask a patient to do for a heel to shin test?

What does incoordination / dysmetria suggest?

Answer 18

Put your heel on your knee, run it down your shin, lift it off + repeat again

Cerebellar pathology.

Question 19

How to do test the knee jerk reflex?

How does this change in cerebellar disease?

Answer 19

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.

Question 20

Upon completing the exam what do you do first?

Answer 20

Thank patient
Wash hands

Question 21

To complete my exam…

Answer 21

I’d like to do an upper + lower limb neurological examination and a full cranial nerve examination

Question 22

Summarise a normal cerebellar exam

Answer 22

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.