Cerebellar Examination Flashcards by Amber Dabill

Describe ataxia

Neurological sign consisting of involuntary movements with an irregular oscillatory quality which interfere with the normal smooth trajectory of movement

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What are the two types of ataxia

Truncal (affecting the trunk)

Appendicular (affecting the limbs)

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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)

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Describe the cause of truncal ataxia

Is caused by damage to the cerebellar vermis and associated pathways (e.g. midline cerebellar lesions)

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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

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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

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What are you looking for in general inspection

Abdominal posture
Speech abnormalities
Scars
Gait

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What objects and equipment are important to look for in cerebellar examinations

Walking aids
Hearing aids
Prescriptions

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What does a broad gait suggest

Cerebellar atrophy

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What does abnormal gait suggest

Prescence if truncal ataxia

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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

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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

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In unilateral cerebellar disease which way will patient veer

Towards the side of the lesion

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What type of gait is typical of a cerebellar pathology

staggering, slow and unsteady gait

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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

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Define tandem gait

Walk to the end of the examination room and back with heels to their toes

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Why do you do tandem gait

Exacerbates underlying unsteadiness making it easier to identify more subtle gait

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What is tandem gait particularly sensitive to

Identifying dysfunction of the cerebellar vermis - e.g. alcohol-induced cerebellar degeneration

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Describe cerebellar degeneration

Involves the progressive loss of Purkinje cells in the cerebellum

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What are the cases of cerebellar degeneration

Chronic alcohol abuse

Nutritional deficiency (typically B12)

Paraneoplastic disorders

Neurological disease (MS, spinocerebellar ataxia)

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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