Cerebellar Pathologies

Question 1

List possible causes of cerebellar dysfunction

Answer 1

1. Stroke (<5% of all strokes)
2. Tumors
3. Structural (Chiari malformation)
4. Toxicity
5. Trauma
6. Infection
7. Immune mediated
   
   • MS, Miller-Fisher Syndrome
8. Endocrine
9. Multiple Systems Atrophy
10. Idiopathic ataxia
11. Hereditary disorders

Question 2

Match cerebellar disorders to their rate/progression

Answer 2

1. Acute/abrupt onset:
   
   • CVA, brain lesions
2. Rapid progression (hours to days):
   
   • infarcation, immune-mediated disorders
3. Slower progression (weeks to months):
   
   • paraneoplastic disorders
   • encephalopathy
   • vitamin deficiency states
   • general med conditions
4. Chronic (months to years):
   
   • genetic ataxias, toxins (alcohol)

Question 3

how are cerebellar dx primarily made?

Answer 3

brain and brainstem MRIs

Question 4

What is alcoholic ataxia?

Answer 4

chronic alcohol use leading to Thiamine (vit B1) deficiency causing cerebellar death.

Wernicke-Korsakoff Syndrome

Question 5

What is Wernicke-Karsakoff syndrome

Answer 5

1. Korsakoff’s Psychosis
   
   • severe impairments in immediate recall
   • anterograde/retrograde amnesia
   • disorientation
   • emotional changes
   • confabulation
2. Wernicke’s Encephalitis
   
   • confusion
   • ataxia
   • opthalmoplegia
   • aniscoria
   • nystagmus

Question 6

List the S/S of alcholic ataxia

Answer 6

1. wide-footed, unsteady gait
2. dysarthria
3. clumsiness of their hands
4. diploplia, saccades
5. peripheral neuropathy

Question 7

What is a Chiari Malformation?

Answer 7

congenital condition in which structural abnormalities lead to herniation of cerebellum through foramen magnum, compressing involved structures

Question 8

describe the 3 types of Chiari Malformations

Answer 8

1. Type I → symptoms appear in adolescene or adulthood
2. Type II → symptoms appear in childhood, more severe than Type I
3. Type III → rare, most severe, seen in babies

Question 9

What are the symptoms and treatment for Chiari Malformations?

Answer 9

1. Symptoms:
   
   • can be asymptomatic!
   • neck pain
   • occipital HA
   • hearing or balance problems
   • dizziness
   • vomiting
   • tinnitus
   • incoordination
2. Treatment:
   
   • asymptomatic → monitor
   • symptomatic → surgery

Question 10

List the 2 types of hereditary ataxia

Answer 10

1. Friedreich’s ataxia
2. Spinocerebellar ataxia

Question 11

Describe Friedreich’s ataxia

Answer 11

1. Degeneration of spinal and peripheral nerves, cerebellum
   
   • symptoms onset in childhood, latest mid-20s
   • S/S are progressive in nature
   • prognosis = mortality between 40-60s

Question 12

List the S/S of Fredreich’s ataxia

Answer 12

1. Cereballar symptoms
   
   • imbalance
   • incoordination
   • dysarthria
   • dysphagia
   • weakness
2. Non-cerebellar symptoms:
   
   • scoliosis
   • visual or hearing loss
   • hypertrophic cardiomyopathy

Question 13

Describe spinocerebellar ataxia

Answer 13

1. degeneration of spinal and peripheral nerves, cerebellum
   
   • Over 50 types of genetically ID SCA’s (most common = Type 1)
   • Onset somewhere between childhood and adulthood
   • S/S are progressive in nature, highly variable
   • Prognosis = unknown/variable

Question 14

List S/S of spinocerebellar ataxia

Answer 14

1. Cerebellar symptoms + spasticity
2. muscle atrophy
3. peripheral neuropathy
4. memory loss

Question 15

Name and describe one outcome measure that can be used w/cerebellar pathologies

Answer 15

Scale for Assessment and Rating of Ataxia (SARA)

8-item performance scale

• 0 (no ataxia) to 40 (most severe ataxia)
• evaluates gait, standing, sitting, speech, finger-to-finger, nose-to-finger, RAMs, heel-to-shin
  
  • does not consider oculomotor function

Question 16

T/F: there are many pharmaceutical options for the management of cerebellar disorders just know the AEs

Answer 16

FALSE
limited options w/variable success

(vit E, coenzyme Q10)

Question 17

T/F: cerebellar pts do not respond well to PT

Answer 17

FALSE

pts w/cerebellar dysfunction tend to respond VERY well to PT

Question 18

what are some factors that influence the response to PT a cerebellar pt has?

Answer 18

1. location of damage within cerebellum
   
   • deep nuclear involvement = poorer prognosis for recovery compared to cerebellar cortex
2. if nearby brainstem in injury, pts will likely have more sig and lingering deficits
3. Overall cerebellar CVAs tend to have excellent prognosis