Cerebralle Function Test

Question 1

What does the mnemonic DANISH stand for in cerebellar examination?

Answer 1

DANISH stands for Dysdiadochokinesia, Ataxia (gait and posture), Nystagmus, Intention tremor, Slurred, staccato speech, and Hypotonia/Heel-shin test.

Question 2

What should be assessed in a general inspection during a cerebellar examination?

Answer 2

1. Abnormal posture indicating truncal ataxia. 2. Slurred, staccato speech typical of cerebellar disease. 3. Scars from neurosurgery (may be hidden by hair). 4. Gait abnormalities such as broad-based gait or staggering.

Question 3

What equipment might provide clues during a cerebellar examination?

Answer 3

1. Walking aids indicating balance issues (ataxia). 2. Hearing aids suggesting conditions like acoustic neuroma. 3. Prescriptions providing insights into medications.

Question 4

How do you assess gait in cerebellar examination?

Answer 4

1. Observe broad-based, staggering, or unsteady gait. 2. Note if the patient deviates toward one side (unilateral cerebellar lesion). 3. Assess difficulty with turning maneuvers.

Question 5

What does tandem (heel-to-toe) gait test?

Answer 5

It evaluates underlying unsteadiness and is particularly sensitive to dysfunction of the cerebellar vermis (e.g., alcohol-induced degeneration).

Question 6

What is the purpose of Romberg’s test?

Answer 6

To assess for sensory ataxia due to loss of proprioception or vestibular function. It does not assess cerebellar function.

Question 7

What are the three senses required for balance assessed in Romberg’s test?

Answer 7

1. Proprioception (body position awareness). 2. Vestibular function (head position awareness). 3. Vision (visual input for spatial orientation).

Question 8

How is Romberg’s test performed?

Answer 8

The patient is asked to stand still with eyes open, then close their eyes. If they lose balance, it indicates sensory ataxia due to a deficit in proprioception or vestibular function.

Question 9

What speech abnormalities are associated with cerebellar disease?

Answer 9

1. Scanning (staccato) speech: broken into syllables with pauses and varying volume. 2. Slurred speech: often mistaken for intoxication.

Question 10

What is nystagmus and how is it assessed?

Answer 10

Nystagmus is involuntary eye movement. It is assessed by asking the patient to follow a target (e.g., finger) in an ‘H’ pattern while observing for abnormal eye movements.

Question 11

What are the features of nystagmus in cerebellar disease?

Answer 11

1. Jerk nystagmus: direction of fast phase defines the direction (toward the lesion). 2. Can occur in horizontal or vertical gaze. 3. May beat in a horizontal or vertical plane.

Question 12

What are dysmetric saccades?

Answer 12

Overshooting eye movements when shifting gaze between targets, followed by correction, suggesting cerebellar dysfunction.

Question 13

What is impaired smooth pursuit?

Answer 13

When tracking a moving target, the eyes move jerkily or saccadically instead of smoothly, indicating cerebellar pathology.

Question 14

How is the finger-to-nose test performed?

Answer 14

The patient alternates between touching their nose and the examiner’s finger. Dysmetria (overshoot/undershoot) and intention tremor indicate cerebellar dysfunction.

Question 15

What is intention tremor?

Answer 15

A coarse tremor that appears as a limb approaches a target, suggestive of ipsilateral cerebellar pathology.

Question 16

What is the rebound phenomenon?

Answer 16

An inability to control limb movement when resistance is suddenly removed, indicating cerebellar disease if exaggerated or absent.

Question 17

How is rebound phenomenon assessed?

Answer 17

The patient resists downward pressure on their outstretched arms. On release, normal response involves slight upward motion followed by stabilization. Cerebellar lesions cause exaggerated or absent response.

Question 18

What is dysdiadochokinesia?

Answer 18

The inability to perform rapid, alternating movements, indicating ipsilateral cerebellar dysfunction.

Question 19

How is dysdiadochokinesia assessed?

Answer 19

The patient alternates flipping their hand on the opposite palm as quickly as possible. Slow or irregular movements suggest cerebellar disease.

Question 20

What is the heel-to-shin test, and how is it performed?

Answer 20

A test for lower limb coordination. The patient runs their heel down the opposite shin in a straight line and repeats. Dysmetria indicates ipsilateral cerebellar dysfunction.

Question 21

What are pendular reflexes?

Answer 21

Slower and less brisk reflexes in cerebellar disease, with slower rise and fall compared to normal reflexes.

Question 22

What tone abnormalities are associated with cerebellar disease?

Answer 22

Hypotonia, though it can often appear normal. Tone abnormalities are subjective and less reliable for diagnosis.

Question 23

What is ataxic gait and what causes it?

Answer 23

A broad-based, staggering, or drunken gait caused by midline cerebellar pathology, such as vermis degeneration or multiple sclerosis.

Question 24

Why is tandem gait testing useful?

Answer 24

It exacerbates underlying unsteadiness, making cerebellar ataxia more apparent, especially in vermis dysfunction.

Question 25

How does unilateral cerebellar disease affect gait?

Answer 25

Patients tend to deviate toward the side of the lesion during walking.

Question 26

What are common causes of cerebellar speech abnormalities?

Answer 26

Cerebellar lesions causing scanning or slurred speech, often referred to as ‘slurred staccato speech.’

Question 27

How are reflexes assessed in cerebellar examination?

Answer 27

Check for pendular knee-jerk reflexes, characterized by slower rise and fall in cerebellar disease.

Question 28

What are clinical signs observed in general inspection of a cerebellar examination?

Answer 28

1. Abnormal posture (truncal ataxia). 2. Slurred speech. 3. Gait abnormalities. 4. Surgical scars indicating prior neurosurgery.