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Patient Assessment Methods I > Cerebellum > Flashcards

Cerebellum Flashcards

1
Q

What are the neurologic evaluations for muscular hypotonia related to the cerebllum?

A
  • Pendular reflex
  • Rag doll posture
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2
Q

What are the neurologic evaluations for ataxia related to the cerebellum?

A
  • Observation
  • Tandem gait
  • Babinski Weil
  • Romberg’s position
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3
Q

What are the neurologic evaluations for rebound phenomenon related to the cerebellum?

A
  • Stewart-Holmes test
  • Andre Thomas test
  • Rebound checking
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4
Q

What are the neurologic tests for dysmetria related to the cerebellum?

A
  • Finger to nose
  • Patient’s finger from their nose to doctor’s finger (reflex hammer or pen)
  • Patient’s toe to doctor’s finger (reflex hammer or pen)
  • Heel to shin (or knee)
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5
Q

What are the neurologic tests for dysdiadochokinesia related to the cerebellum?

A
  • Finger tapping/piano playing
  • Hand slapping
  • Alternating hand slap
  • Foot tapping
  • Seated marching
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6
Q

How is rag doll posture performed?
What is a positive finding?
What does this indicate?

A
  • Observation, may pick up an infant
  • Positive finding is very hypotonic posture, like limbs are sewn on with thread
  • Indicates cerebellar dysfunction, normal muscle tone diminished
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7
Q

How is the deep tendon reflex (pendular reflex) performed for cerebellum?
What is a positive finding?
What does this indicate?

A
  • Upper extremity triceps reflex (forearm dangling)
  • Lower extremity patellar reflex
  • Positive finding is swinging pendular limb
  • Indicates hypotonia secondary to cerebellar dysfunction
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8
Q

What do we investigate if we hypothesize a cerebellar dysfunction?

A
  • Hypotonia
  • Dysmetria
  • Ataxia
  • Pendular reflexes
  • Repeated motions
  • Rebound phenomenon
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9
Q

What are the three major arteries supplying the cerebellum?

A
  • Posterior inferior cerebellar arteries
  • Anterior inferior cerebellar arteries
  • Superior cerebellar artery
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10
Q

What are the main functions of the cerebellum?

A
  • Motor memory
  • Check point for frontal lobe in planning movement
  • Fine motor control of all skeletal muscles (agonist-antagonist balance)
  • Reflexive control of eye movement
  • Reflexive control of intrinsic spinal muscles
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11
Q

With cerebellar dysfunction, symptoms will present ___-lateral to lesion, specific to the area affected (somatotopic organization)

A

ipsilateral

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12
Q

What position should the patient be in during cerebellar examination?

A

Standing whenever possible, with bare feet as close together as possible without touching

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13
Q

The anterior lobe of the cerebellum is in control of…

A

the torso in relation to lower extremities

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14
Q

The posterior lobe of the cerebellum is in control of…

A

the head relative to the torso

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15
Q

Why should the patient be in a standing position for cerebellar testing?

A

Standing forces both anterior and posterior lobes to work harder during testing; sitting allows the anterior lobe to work less

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16
Q

How is blood pressure taken when hypothesizing a cerebellar problem?
What finding may indicate a problem?

A

Bilaterally on the left side first
A difference of 10mmHg or more may indicate a cerebellar problem

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17
Q

Blood pressure differential of 15mmHg or more between the right and left arm also points to a ___ likelihood of dying from any cause

A

60% higher likelihood

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18
Q

How is the intermediolateral nucleus affected by increased parasympathetic nuclei activity in the brain stem?

A

Decreased sympathetic activity at the intermediolateral nucleus

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19
Q

What is the intermediolateral nucleus?

A

Sympathetic preganglionic neurons; columnar grouping of cells running longitudinally in the lateral horn of the spinal grey

20
Q

In humans, intermediolateral nucleus cells are found between the ___ segment and the ___ segment

A

T1 and L3

21
Q

Babinski Weil will help to differentially diagnose ___ from ___

A

cerebellar from vestibular ataxia

22
Q

How is the tandem gait test performed?
What is a positive finding?
What does this indicate?

A
  • Patient walks along a straight line, heel to toe 5-7 steps; examiner stays with patient for safety
  • Positive if balance is lost
  • Indicates ataxia due to cerebellar dysfunction
23
Q

How is the truncal ataxia test performed?
What is a positive finding?
What does this indicate?

A
  • Observation
  • Difficulty maintaining balance/inability to stabilize trunk is positive finding
  • Indicates cerebellar dysfunction specifically in the vermis
24
Q

How is Babinski-Weil performed?
What is a positive finding?
What does this indicate?

A
  • Patient barefoot, patient walks forward with normal gait 5-7 steps, then backward with eyes open, examiner close for safety
  • Positive finding is drifting or head tilt when walking forward and back
  • Indicates cerebellar dysfunction OR vestibular issue
25
Q

During the Babinski-Weil test, a patient walks forward and drifts to one side, then drifts to the same side walking backwards
Where is the issue in the brain?

A

Cerebellar issue

26
Q

During the Babinski-Weil test, a patient walks forward and drifts to one side, then drifts to the opposite side walking backwards
Where is the issue in the brain?

A

Vestibulocochlear apparatus or cranial nerve VIII

27
Q

How is Romberg position performed?
What is a positive finding?
What does this indicate?

A
  • Patient stands barefoot, feet close together, examiner close for safety, patient extends arms, eyes open
  • Positive finding is inability to maintain balance
  • Indicates ataxia to cerebellar dysfunction
28
Q

How is rebound checking performed?
What is a positive finding?
What does this indicate?

A
  • Patient stands barefoot, feet close together, arms straight out, examiner sharply moves each arm out of position
  • Positive finding is inability of patient to return to original position maybe with pronator drift
  • Indicates cerebellar dysfunction
29
Q

How is finger tapping/piano playing performed?
What is a positive finding?
What does this indicate?

A
  • Patient repeatedly and rapidly taps each fingertip to the thumb in sequential order
  • Positive finding is difficulty coordinating repeated movements
  • Indicates dysdiadochokinesia due to cerebellar dysfunction
30
Q

How is alternating hand slap performed?
What is a positive finding?
What does this indicate?

A
  • Patient repeatedly and rapidly slaps hands on thigh or table top
  • Positive finding is difficulty coordinating repeated movements
  • Indicates dysdiadochokinesia due to cerebellar dysfunction
31
Q

How is foot tapping performed?
What is a positive finding?
What does this indicate?

A
  • Patient is seated or standing, rapidly and repeatedly dorsiflexing and slapping feet onto floor
  • Positive finding is difficulty coordinating repeated movements
  • Indicates dysdiadochokinesia due to cerebellar dysfunction
32
Q

How is seated marching performed?
What is a positive finding?
What does this indicate?

A
  • Patient is seated, rapidly and repeatedly lifting and stepping alternating legs
  • Positive finding is difficulty coordinating repeated movements
  • Indicates dysdiadochokinesia due to cerebellar dysfunction
33
Q

How is finger to nose performed?
What is a positive finding?
What does this indicate?

A
  • Patient standing barefoot with arms abducted, patient touches their own nose with the fourth or fifth digit
  • Positive finding when the patient demonstrates intention (kinetic) tremor or has difficulty touching the nose with accuracy
  • Indicates dysmetria due to cerebellar dysfunction
34
Q

How is patient’s nose to doctor’s finger performed?
What is a positive finding?
What does this indicate?

A
  • Patient stands barefoot, touches fifth digit on their own nose, then reaches out and touches the doctor’s pen or reflex hammer
  • Positive finding is when the patient demonstrates intention (kinetic) tremor or has difficulty targeting the object (past target)
  • Indicates dysmetria due to cerebellar dysfunction
35
Q

How is patient’s toe to doctor’s finger performed?
What is a positive finding?
What does this indicate?

A
  • Patient is seated and points to object with great toe
  • Positive finding when the patient demonstrates intention (kinetic) tremor or has difficulty targeting the object
  • Indicates dysmetria due to cerebellar dysfunction
36
Q

How is heel to knee performed?
What is a positive finding?
What does this indicate?

A
  • Attempt with patient standing, patient drags the heel of the foot along the opposite shin from knee to ankle (or shin to ankle)
  • Positive finding is poor coordination or not following a straight path along the shin
  • Indicates dysmetria due to cerebellar dysfunction
37
Q

How is assessment for nystagmus performed?
What is a positive finding?
What does this indicate?

A
  • Patient follows an object with eyes laterally and slightly elevated
  • Positive finding is poor coordination between the eyes or “shaking” of the eyes near end of motion
  • Indicates cerebellar dysfunction (specifically vermis)
38
Q

What is dysmetria?

A

Inability to perform accurate and smooth movements

39
Q

What is dysdiadochokinesia?

A

Inability to perform rapid alternating movements

40
Q

What is dysarthria?
What lesion may it indicate?

A

Slurred speech, may be cerebellar vermis

41
Q

Name eight diseases of the cerebellum

A
  • Vascular infarcts
  • Tumors
  • Cerebellar atrophy
  • HIV
  • Multiple sclerosis
  • Chronic alcoholism
  • Arnold Chiari malformation
  • Lyme disease
42
Q

What are two causes of cerebellar dysfunction?

A
  • Tumors (astrocytomas and medulloblastomas in kids: note mild listing, H/A, nausea and vomiting)
  • Inappropriate sensory information form spine gives soft neurological findings
43
Q

A thunderclap or sentinel headache is considered a warning of…

A

an imminent or occurring cerebrovascular accident (stroke)

44
Q

What are the most common symptoms of vertebral artery dissection?

A

Neck pain or stiffness and headache

45
Q

Does a vertebral artery dissection headache respond to NSAIDS?

A

Not usually

46
Q

After a blow to the head, a 42 year old drummer notices his left hand has difficulty maintaining rhythm
What is this an example of?

A

Dysdiadochokinesia

Patient Assessment Methods I (22 decks)

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