Cerebellar Function Flashcards
General Inspection
Bruising, scars
Symmetry, wasting, fasciculations - LMN lesion
Head
Nystagmus
Speech: read something aloud (staccato?), baby hippopotamus (slurring)
Upper Limb
Tone - hypotonia?
Power - reduced power may cause apparent impairment of coordination even in the absence of a cerebellar lesion
Coordination - rebound test (dysmetria?), finger nose testing (dysmetria, intention tremor?), hand slapping test (dysdiadochokinesis)
Lower Limb
Tone - hypotonia?
Power - as above
Coordination- foot tapping (dysdiadochokinesis), heel shin test (intention tremor, dysmetria)
Posture / gait
Posture: “how stable are you when sitting or standing’, assess stability sitting and standing (truncal ataxia), Romberg’s (sensory ataxia)
Gait: features of cerebellar lesion - wide-based gait, unsteadiness with lateral veering, irregular steps. Ask to walk heel-toe.
Causes of Cerebellar disease
Stroke Tumour MS Congenital Alcohol abuse Friedreich's ataxia Thiamine deficiency Anti-epileptic medication
Classic signs of cerebellar disease
Dysdiadochokinesis Ataxia (limb / trunk) Nystagmus Intention tremor Speech (slurred, staccato) Hypotonia
Feature of cerebellar limb ataxia
Dysmetria
Past-pointing
Intention tremor
Dysdiadochokinesis
Localising the cerebellar lesion
Central (vermis) lesions symptoms tend to cause: truncal ataxia sitting and standing, poor heel-toe, slurred staccato speech
Cerebellar hemisphere lesion symptoms tend to cause: ipsilateral limb ataxia, nystagmus, unsteady gait (falling towards side of lesion whilst walking)
Nystagmus
Congenital (tends to be most marked in neutral position)
Brainstem problem: MS, stroke, tumour
Cerebellar disease (particularly MS)
Vestibular apparatus problem (tends to be worse looking away from side of lesion): labyrinthitis, Ménière’s disease, CN VIII lesion
