Cerebellar syndrome

Question 1

What is ataxia?

Answer 1

Term for a group of disorder that affect coordination, balance and speech

Question 2

What can cause acute onset cerebellar syndrome?

Answer 2

Stroke

Haemorrhage

Cerebral oedema

Question 3

What causes chronic onset cerebellar syndrome?

Answer 3

TAP

Tumours

Alcohol: characterised by vermian atrophy, occurs dur to alcohol abuse and malnutrition (thiamine/ B1 deficiency)

Paraneoplastic syndrome

Question 4

What does a brain MRI of an chronic alcohol user show?

Answer 4

Cerebellar atrophy

Question 5

Clinical features of cerebellar syndrome

Answer 5

VANISHED

Vertigo

Ataxia

Nystagmus

Intention tremor

Slurred speech

Hypotonia

Exaggerated borad based gait

Dysdiadochokinesia

Question 6

Examination in patient with cerebellar syndrome

Answer 6

Look for walking aids

Look for truncal ataxia

Hearing aids: acutsic neuromas can cause cerebellar compression + hearing loss

Assess gait: broad based, staggering, slow, unsteady, turning is difficult, heel-to-toe gait

Romberg: falling without correction is a positive Romberg sign as this is abnormal

Speech: slurred

Eyes: nystagmus

Question 7

What determines the direction of nystagmus?

Answer 7

The direction of the fast phase

Te direction of the fast phase indicates the side of the lesion

Question 8

What can cause a positive Romberg test?

Answer 8

Sensory ataxia

Patient falls when they do not have any visual sensory input

It is not a cerebellar test - it is a test of peripheral neuropathy/ proprioception via the dorsal columns