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Alasdair - Neurology > Cerebellar syndrome > Flashcards

Cerebellar syndrome Flashcards

1
Q

Cerebellar gait examination

A 
Walk
Heel-to-toe
On tip toe
On heal
Romberg's
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2
Q

Cerebellar examination with arms outstretched

A

Ataxia

Rebound

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3
Q

Cerebellar signs

A 
DANISH
Dysdiadochokinesia (hands and feet)
Ataxia
Nystagmus + rapid saccades that overshoot
Intention tremor + dysmetria
Slurred speech
Hypotonia
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4
Q

Completion of cerebellar exam

A

Cranial nerves: brainstem stroke, MS, CPA lesion
Peripheral nervous system: MS
Signs of CLD
Drug chart: phenytoin (toxicity causes cerebellar damage)

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5
Q

Causes of cerebellar syndrome

A 
DAISIES
Demyelination
Alcohol
Infarct (brainstem)
SOL e.g. schwannoma + other CPA tumours
Inherited e.g. Wilson's, Friedrich's, Ataxia Telangiectasia, VHL
Epilepsy medications: Phenytoin
System atrophy, multiple
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6
Q

Lateralisation of cerebellar signs

A

Ipsilateral to lesion

Bilateral cerebellar signs more likely to represent a global pathology e.g. alcohol, MS, phenytoin

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7
Q

Presentation of cerebellar vermis lesion

A

Ataxic trunk and gait

Normal arms

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8
Q

Differentiating cerebellar and vestibular nystagmus

A

Vestibular cause: fast phase away from lesion, maximal looking away from lesion
Cerebellar cause: opposite

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9
Q

Specific history for cerebellar syndrome

A

MS: Paraesthesia, visual problems, muscle weakness
Alcohol consumption
Infarct: onset, stroke risk factors
Schwannoma: hearing loss, vertigo, tinnitus, raised ICP
FHx
DHx

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10
Q

Investigations for cerebellar syndrome

A

ECG: arrhythmia (DDx brainstem stroke)
Bloods: EtOH (FBC, U+E, LFTs), thrombophilia (clotting), Wilson’s (low caeruloplasmin)
CSF: oligoclonal bands
Imaging: MRI is best to visualise the posterior cranial fossa
Audiometry: CPA lesion (pure tone audiometry)

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11
Q

General management of cerebellar syndrome

A

MDT
CV risk
Lower EtOH intake

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12
Q

Concise treatment of MS

A

methylprednisolone

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13
Q

Concise treatment of EtOH dependence

A

Pabrinex, tapering course of chlordiazepoxide

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14
Q

Concise treatment of infarct (as cause of cerebellar syndrome)

A

Consider thrombolysis

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15
Q

Concise treatment of Wilson’s

A

Penicillamine

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16
Q

Concise treatment of Schwannoma

A

Gamma-knife, surgery

17
Q

Cause of Lateral Medullary Syndrome AKA Wallenberg’s

A

Occlusion of vertebral artery or PICA

18
Q

Features of Lateral Medullary Syndrome AKA Wallenberg’s

A

All ipsilateral except pain anaesthesia
DANVAH
Nucleus ambiguus(motor to CN9/10): Dysphagia
Inferior cerebellar peduncle: Ataxia, Nystagmus
Vestibular (CN8) nucleus: Vertigo
[Anaesthesia:]
Spinothalamic tract: reduced pain sensation contralaterally
Spinal trigeminal nucelus: reduced pain sensation ipsilaterally
Sympathetic fibres: Horner’s

19
Q

Pathophysiology of vestibular Schwannoma

A

Benign, slow-growing tumour of superior vestibular nerve
SOL leads to cerebellopontine angle (80% of CPA tumours are Schwannomas)
Associated with NF2

20
Q

Presentation of vestibular Schwannoma

A 
Unilateral SNHL, tinnitus, vertigo
Raises ICP: headache
Ipsilateral CN5,6,7,8 palsies and cerebellar signs:
Facial anaesthesia + absent corneal reflex
Lateral rectus (abducens) palsy
LMN facial nerve palsy
SNHL
DANISH
21
Q

Other name for vestibular Schwannoma

A

Acoustic neuroma

22
Q

Investigations for vestibular Schwannoma

A

MRI of CPA

23
Q

Treatment of vestibular Schwannoma

A

Gamma-knife

Surgery

24
Q

CPA tumour differential

A

Vestibular Schwannoma (AKA acoustic neuroma)
Meningioma
Cerebellar astrocytoma
Metastases

25
Q

Features of Von-Hippel Lindau syndrome

A 
Renal cysts
Bilateral RCC
Haemangioblastoma (often in cerebellum: cerebellar signs)
Phaeochromocytoma
Islet cell tumours
26
Q

Pathophysiology of Friedrich’s Ataxia

A

Autosomal recessive mitochondrial disorder
Progressive degeneration of: dorsal column, spinocerebellar tracts and cerebellar cells
Corticospinal tracts

27
Q

Associations of Friedrich’s ataxia

A

HOCM and mild dementia

28
Q

Age of onset of Friedrich’s ataxia

A

teenage years

29
Q

Features of Friedrich’s ataxia

A 
Pes cavus
Bilateral cerebellar ataxia
Leg wasting + areflexia but extensor plantars
Loss of vibration and proprioception
High-arched palate
Optic atrophy and retinitis pigments
HOCM
DM in 10%
30
Q

Pathophysiology of Ataxia Telangiectasia

A

Autosomal recessive
Defect in DNA repair
Onset in childhood / early adulthood

31
Q

Features of Ataxia telangiectasia

A

Progressive ataxia
Telangiectasia: conjunctivae, eyes, nose, skin creases
Defective cell-mediated immunity and antibody production: infections
Lymphoproliferative disease

32
Q

Cause of Wilson’s disease

A

Autosomal recessive mutation of ATP7B gene

33
Q

Features of Wilson’s disease

A 
CLANK
Cornea: Kayser-Fleischer rings
Liver: CLD
Arthritis
Neuro: parkinsonism, ataxia, psychiatric problems
Kidney: Fanconi's syndrome

Alasdair - Neurology (16 decks)

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