Cerebellar examination signs

Question 1

What does DANISH stand for? (A helpful way of remembering the important points to cover in a cerebellar examination)

Answer 1

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

Question 2

What clinical signs are you looking for in a general inspection?

Answer 2

• abnormal posture: ?truncal ataxia
• speech abnormalities
• scars (may indicate previous neurosurgery)
• gait (e.g. broad-based gait)

Question 3

What objects or equipment are you looking for?

Answer 3

• walking aids
• hearing aids
• prescriptions

Question 4

What is ataxia?

Answer 4

A group of conditions which affect balance, coordination and speech.
(+ more about different types of ataxia)

Question 5

What are you looking for when assessing the patients gait?

Answer 5

• stance (broad-based ataxic gait is typically associated with midline cerebellar pathology - e.g. a lesion in multiple sclerosis or degeneration of the cerebellar vermis secondary to chronic alcohol excess)
• stability (in unilateral cerebellar disease, patients will veer towards the side of the lesion)
• turning

Question 6

What does heel-to-toe walking exacerbate?

Answer 6

Underlying unsteadiness making it easier to identify more subtle ataxia

Question 7

What is tandem (heel-to-toe) gait particularly sensitive at identifying?

Answer 7

Dysfunction of the cerebellar vermis (e.g. alcohol-induced cerebellar degeneration)