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Phase 2B > Cerebellar Examination > Flashcards

Cerebellar Examination Flashcards

1
Q

Describe ataxia

A

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

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2
Q

What are the two types of ataxia

A

Truncal (affecting the trunk)

Appendicular (affecting the limbs)

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3
Q

Describe truncal ataxia

A

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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4
Q

Describe the cause of truncal ataxia

A

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

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5
Q

Describe appendicular ataxia

A

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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6
Q

What is the mnemonic on how to remember the steps of cerebellar examination

A

DANISH

Dyscliadochokinesia
Ataxia (gait and posture)
Nystagmus
Intention tremor
Slurred, staccato speech
Hypotonia/heel-shin test

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7
Q

What are you looking for in general inspection

A

Abdominal posture
Speech abnormalities
Scars
Gait

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8
Q

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

A

Walking aids
Hearing aids
Prescriptions

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9
Q

What does a broad gait suggest

A

Cerebellar atrophy

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10
Q

What does abnormal gait suggest

A

Prescence if truncal ataxia

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11
Q

What is a broad ataxia gait typically associated with

A

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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12
Q

Name the causes of a broad based ataxic gait associated with midline cerebellar pathology

A

a lesion in multiple sclerosis of degeneration of the cerebellar vermis secondary to chronic alcohol excess

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13
Q

In unilateral cerebellar disease which way will patient veer

A

Towards the side of the lesion

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14
Q

What type of gait is typical of a cerebellar pathology

A

staggering, slow and unsteady gait

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15
Q

Describe what should be assessed in a patients gait

A

Ask patient to walk to the end of the examination room and turn and walk back

Stance
Stability
Turning

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16
Q

Define tandem gait

A

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

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17
Q

Why do you do tandem gait

A

Exacerbates underlying unsteadiness making it easier to identify more subtle gait

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18
Q

What is tandem gait particularly sensitive to

A

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

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19
Q

Describe cerebellar degeneration

A

Involves the progressive loss of Purkinje cells in the cerebellum

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20
Q

What are the cases of cerebellar degeneration

A

Chronic alcohol abuse

Nutritional deficiency (typically B12)

Paraneoplastic disorders

Neurological disease (MS, spinocerebellar ataxia)

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21
Q

What are the typical clinical features of cerebellar degeneration

A

Broad-based ataxic gait
Truncal ataxia
Dysmetria (incoordination)
Nystagmus (abnormal eye movements)

22
Q

Define nystagmus

A

Abnormal eye movements

23
Q

Define dysmetria

A

Incoordination

24
Q

What are the causes of proprioceptive dysfunction

A

Joint hypermobility (Ehlers-Danlos syndrome)

B12 deficiency

Parkinson’s disease

Ageing (presbyopia)

25
Q

What are the causes of vestibular dysfunction

A

Vestibular neuronitis
Menieres disease

26
Q

In rombergs test what does swaying with correction suggest

A

Cerebellar disease due to truncal ataxia

27
Q

What does a positive rombergs test suggest

A

Unsteadiness due to sensory ataxia

e.g. deficit of proprioceptive or vestibular function, rather than cerebellar function

28
Q

How do you check speech

A

Ask British constitution

29
Q

What speech problems can cerebellar lesions cause

A

Ataxia dysarthria

30
Q

How can ataxic dysarthria present

A

Scanning speech (staccato speech)

Slurred speech

31
Q

Describe scanning speech

A

Staccato speech

Words broken down into separate syllables - often separated by pauses and spoken with varying volume

32
Q

Describe slurred speech

A

Patients often mistaken for being intoxicated as a result

33
Q

Define nystagmus

A

Repetitive, involuntary oscillation of the eyes

34
Q

What are the causes of nystagmus

A

Physiological (e.g. benign)

Associated with cerebellar pathology

35
Q

Define nystagmus

A

Repetitive, involuntary oscillation of the eyes

Can be either physiological (benign) or associated with cerebellar pathology

36
Q

Name 3 gaze disturbances that can be associated with cerebellar pathology

A

Dysmetric saccades
Impaired smooth pursuit

37
Q

Describe dysmetric saccades

A

Hand approx. 30cm to side of your head

Ask to look at your nose and then the hand

38
Q

Describe impaired smooth pursuit

A

Track finger - eyes should move slowly

39
Q

What test is used to assess upper limb co-ordination

A

Finger-nose-test

Make sure hand is reached all the way out

40
Q

With patients with cerebellar pathology what exabits may there be

A

Dysmetria

Intention tremor

41
Q

Describe dysmetria

A

Refers to lack of coordination of movement

42
Q

Describe intention tremor

A

Broad, coarse, low-frequency tremor that develops as a limb reaches the endpoint of a deliberate movement

43
Q

What is the presence of dysmetria and intention tremor suggestive of

A

Ipsilateral cerebellar pathology

44
Q

Define rebound phenomenon

A

Reflex that occurs when a patient attempts to move a limb against resistance that has been suddenly removed

45
Q

How do you check rebound phenomenon

A

Hold hand out straight, close eyes

Put resistance against and then suddenly removed

46
Q

Whats a normal reaction to rebound phenomenon

A

Move a short distance upwards

47
Q

Describe the reason for an exaggerated rebound phenomenon

A

Suggestive spasticity e.g. stroke affecting the cerebrum

48
Q

Describe the reason for a complete absence of rebound phenomenon

A

Caused by a failure of the antagonist muscles to contract - suggestive of cerebellar disease

49
Q

Define dysdiaochokinesia

A

Describes the inability to perform rapid, alternating movements

Feature of ipsilateral cerebellar pathology

50
Q
A

Phase 2B (15 decks)

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