Cerebellar Examination Flashcards
Describe ataxia
Neurological sign consisting of involuntary movements with an irregular oscillatory quality which interfere with the normal smooth trajectory of movement
What are the two types of ataxia
Truncal (affecting the trunk)
Appendicular (affecting the limbs)
Describe truncal ataxia
Affects proximal musculature that involved in gait stability
Is caused by damage to the cerebellar vermis and associated pathways (e.g. midline cerebellar lesions)
Describe the cause of truncal ataxia
Is caused by damage to the cerebellar vermis and associated pathways (e.g. midline cerebellar lesions)
Describe appendicular ataxia
Affect musculature of the arms and legs involved in the control of limb movement
Is caused by damage to the cerebellar hemisphere (e.g. lateral cerebellar lesions
What is the mnemonic on how to remember the steps of cerebellar examination
DANISH
Dyscliadochokinesia
Ataxia (gait and posture)
Nystagmus
Intention tremor
Slurred, staccato speech
Hypotonia/heel-shin test
What are you looking for in general inspection
Abdominal posture
Speech abnormalities
Scars
Gait
What objects and equipment are important to look for in cerebellar examinations
Walking aids
Hearing aids
Prescriptions
What does a broad gait suggest
Cerebellar atrophy
What does abnormal gait suggest
Prescence if truncal ataxia
What is a broad ataxia gait typically associated with
Midline cerebellar pathology
E.g. a lesion in multiple sclerosis of degeneration of the cerebellar vermis secondary to chronic alcohol excess
Name the causes of a broad based ataxic gait associated with midline cerebellar pathology
a lesion in multiple sclerosis of degeneration of the cerebellar vermis secondary to chronic alcohol excess
In unilateral cerebellar disease which way will patient veer
Towards the side of the lesion
What type of gait is typical of a cerebellar pathology
staggering, slow and unsteady gait
Describe what should be assessed in a patients gait
Ask patient to walk to the end of the examination room and turn and walk back
Stance
Stability
Turning
Define tandem gait
Walk to the end of the examination room and back with heels to their toes
Why do you do tandem gait
Exacerbates underlying unsteadiness making it easier to identify more subtle gait
What is tandem gait particularly sensitive to
Identifying dysfunction of the cerebellar vermis - e.g. alcohol-induced cerebellar degeneration
Describe cerebellar degeneration
Involves the progressive loss of Purkinje cells in the cerebellum
What are the cases of cerebellar degeneration
Chronic alcohol abuse
Nutritional deficiency (typically B12)
Paraneoplastic disorders
Neurological disease (MS, spinocerebellar ataxia)
What are the typical clinical features of cerebellar degeneration
Broad-based ataxic gait
Truncal ataxia
Dysmetria (incoordination)
Nystagmus (abnormal eye movements)
Define nystagmus
Abnormal eye movements
Define dysmetria
Incoordination
What are the causes of proprioceptive dysfunction
Joint hypermobility (Ehlers-Danlos syndrome)
B12 deficiency
Parkinson’s disease
Ageing (presbyopia)
What are the causes of vestibular dysfunction
Vestibular neuronitis
Menieres disease
In rombergs test what does swaying with correction suggest
Cerebellar disease due to truncal ataxia
What does a positive rombergs test suggest
Unsteadiness due to sensory ataxia
e.g. deficit of proprioceptive or vestibular function, rather than cerebellar function
How do you check speech
Ask British constitution
What speech problems can cerebellar lesions cause
Ataxia dysarthria
How can ataxic dysarthria present
Scanning speech (staccato speech)
Slurred speech
Describe scanning speech
Staccato speech
Words broken down into separate syllables - often separated by pauses and spoken with varying volume
Describe slurred speech
Patients often mistaken for being intoxicated as a result
Define nystagmus
Repetitive, involuntary oscillation of the eyes
What are the causes of nystagmus
Physiological (e.g. benign)
Associated with cerebellar pathology
Define nystagmus
Repetitive, involuntary oscillation of the eyes
Can be either physiological (benign) or associated with cerebellar pathology
Name 3 gaze disturbances that can be associated with cerebellar pathology
Dysmetric saccades
Impaired smooth pursuit
Describe dysmetric saccades
Hand approx. 30cm to side of your head
Ask to look at your nose and then the hand
Describe impaired smooth pursuit
Track finger - eyes should move slowly
What test is used to assess upper limb co-ordination
Finger-nose-test
Make sure hand is reached all the way out
With patients with cerebellar pathology what exabits may there be
Dysmetria
Intention tremor
Describe dysmetria
Refers to lack of coordination of movement
Describe intention tremor
Broad, coarse, low-frequency tremor that develops as a limb reaches the endpoint of a deliberate movement
What is the presence of dysmetria and intention tremor suggestive of
Ipsilateral cerebellar pathology
Define rebound phenomenon
Reflex that occurs when a patient attempts to move a limb against resistance that has been suddenly removed
How do you check rebound phenomenon
Hold hand out straight, close eyes
Put resistance against and then suddenly removed
Whats a normal reaction to rebound phenomenon
Move a short distance upwards
Describe the reason for an exaggerated rebound phenomenon
Suggestive spasticity e.g. stroke affecting the cerebrum
Describe the reason for a complete absence of rebound phenomenon
Caused by a failure of the antagonist muscles to contract - suggestive of cerebellar disease
Define dysdiaochokinesia
Describes the inability to perform rapid, alternating movements
Feature of ipsilateral cerebellar pathology
