Cerebellar syndromes

Question 1

anatomy of cerebellum

Answer 1

located in the posterior cranial fossa
has connections to the brainstem, basal ganglia and cerebral cortex
plays a vital role in motor equilibrium and coordination of movements
subdivides into two hemispheres connected by the vermis, a central midline part

Question 2

what do midline cerebellar lesions manifest as

Answer 2

imbalance

Question 3

what do hemispheric cerebellar lesions result in

Answer 3

incoordination

Question 4

vascular causes of cerebellar syndromes

Answer 4

stroke (infarct or haemorrhage)
transient ischaemic attack

Question 5

what are inflammatory causes of cerebellar syndromes

Answer 5

multiple sclerosis

Question 6

what are neoplastic causes of cerebellar syndromes

Answer 6

primary tumours (astrocytomas, medulloblastoma, hemangioblastoma)
secondary tumours (metastases, commonly lungs, breast and GI tract)
paraneoplastic phenomena (anti Hu antibodies in small cell lung cancer, rare)

Question 7

metabolic causes of cerebellar syndromes

Answer 7

hypoglycaemia
hypoxia
hypothyroidism
thiamine deficiency

Question 8

infectious causes of cerebellar syndrome

Answer 8

bacterial (meningoencephalitis, intracranial abscess)
viral (varicella, HIV)
parasitic infections (rare, toxoplasma, falciparum malaria)

Question 9

congenital causes of cerebellar syndromes

Answer 9

agenesis
dandy-walker malformation
Arnold-Chiari malformation (rare)

Question 10

inherited causes of cerebellar syndromes

Answer 10

Friedrich’s ataxia
spinocerebellar ataxias

Question 11

degenerative causes of cerebellar syndromes

Answer 11

multisystem atrophy
spinocerebellar ataxias
prion disease (rare)

Question 12

other causes of cerebellar syndromes

Answer 12

toxic/trauma (alcohol)
drugs - barbituates, phenytoin and other anticonvulsants, anti-neoplastic drugs

Question 13

acute onset cerebellar syndromes

Answer 13

seconds to minutes
usually cerebellar infarction or haemorrhage
may be associated with headache, vertigo, vomiting and altered consciousness

Question 14

sub acute cerebellar ataxias

Answer 14

hours to days
inflammatory causes
viral (more common in children), associated with pyrexia, dysarthria, limb and gait ataxia
paraneoplastic cerebellar degeneration (particularly carcinomas of ovaries and lungs)
alcohol excess
hydrocephalus
posterior fossa tumours
abscesses
parasitic infection
toxins

Question 15

episodic cerebellar ataxias

Answer 15

usually transient snd last minutes to hours
can be caused by drugs and other anticonvulsants
transient posterior cerebral circulation ischaemic attacks
foramen magnum compression
inherited episodic ataxias

Question 16

chronic progressive cerebellar ataxias

Answer 16

months to years
chronic alcohol excess
malnutrition
drugs (may reverse once withdrawn)
structural lesions (slowly progressive tumours or vascular malformations)
inherited
degenerative
rarer causes are chronic solvent abuse, heavy metal exposure, prion disease

Question 17

what do cerebellar disorders result in

Answer 17

difficulties with the rate, rhythm and force of limb movements, gait and speech

Question 18

what does DANISH stand for

Answer 18

Dysdiadochokinesis (inability to perform rapid alternating movements)
Ataxia (incoordination of voluntary movements)
Nystagmus (rapid involuntary movement of the eye)
Initiation tremor ( tremor exacerbated by voluntary, goal-directed movements)
Scanning dysarthria (jerky sometimes explosive slurred speech)
Heel-shin ataxia