Cerebellum

Question 1

How do cerebellar exam? (14)

Answer 1

3 head, 3 ul, 3 ll, 3 gait

Head

• titubation (essential tremor)
• 3 eyes:

→ nystagmus (horizontal + vertical. Take finger to end, wait 3 seconds. If nystagmus, this is physiological. Take finger back 30º. If still present, pathological).
→ Saccades horizontal + vertical. ( Look at finger then pen - Overshoot / undershoot then corrective. )
→ smooth pursuit horizontal + vertical

• Cerebellar dysarthria: say months of the year. + = staccato speech.

Upper limb

• finger to nose: testing dysmetria (overshooting) + intention tremor
• rapid alternating movements: tap then tap + flip. → dysdiadochokinesis
• rebound

Lower limb

• heel knee to shin test: ataxia, intention tremor
• toe to finger: dysmetria, intention tremor
• rapid alternating movements: tap foot

Gait + stance

• stance: broad based
• Romberg test
• gait (broad based ataxic gait with variable steps, loss balance) and tandem gait

Question 2

Name 3 outcomes of the Romberg test

Answer 2

• Normal
• true positive = sensory type ataxia: lose balance as soon as close eyes
• cerebellar dysfunction: lose balance whether eyes open or closed

Question 3

Name 8 causes of ataxia

Answer 3

• Infective: viral cerebellitis ( herpes zoster ), creutzfeld Jacob disease (mad cow disease)
• neoplastic: Met’s, primary brain tumours, paraneoplastic cerebellar degeneration
• drugs: phenytoin
• inflammation: demyelination,sarcoidosis
• toxins: alcohol
• structural: Arnold - chiari malformations
• endo: hypothyroid, vit e and B 1 (thiamine) deficiency
• cerebellar

Question 4

Name 3 types cerebellar ataxia

Answer 4

• Rostral vermis syndrome: wide based stance + gait
• caudal vermis syndrome: axial (trunk) dysequilibrium
• hemispheric: discoordination of ipsilateral limb movements

Question 5

Name 5 causes unilateral cerebellar dysfunction

Answer 5

• Cerebellar astrocytoma
• hemangioblastoma
• infarct / haemorrhage
• abscess
• demyelination

Question 6

Name 9 causes unilateral cerebellar dysfunction

Answer 6

• Drugs: phenytoin overdose
• alcohol
• Ms
• cerebellar tumours: astrocytoma, hemangioblastoma,medulloblastoma, metastases
• disorders of cranio cervical junction: Arnold chiari malformation with herniation of cerebellar tonsils
• cerebellar degenerations
• brainstem infarcts
• arteritis
• Cerebellar abscesses