Lecture 25: Clinical 2: Cerebellar Disease Flashcards
What is the function of the cerebellum?
1) Co-ordinated movements 2) Precision motor movement
What are the neural fibres that go to the cerebellum?
1) Spinal Cord 2) Vestibular nuclei via inferior olivary nucleus 3) Pontine nuclei
What are the neural fibres that go from the cerebellum?
1) UMN via thalamus
2) LMN via vestibular nuclei, reticular formation and red nucleus
What are the Common Symptoms and Signs of Cerebellar Disease?
Cerebellar disease usually present with ataxia (uncoordinated movement).
Symptoms reflects disease of cerebellar hemispheres, and it is on the same side as the affected cerebellar hemisphere.
1) Dysarthria (Part of Orobuccal Ataxia)
Symptoms:
- Loss of articulation (‘drunk’) -> laboured, slurred, staccato (words are broken up into separate syllables) speech
- Difficulty making self understood
Signs:
- Rapid tongue movements are slowed
- Dysarthria is a condition in which the muscles you use for speech are weak or you have difficulty controlling them.
2) Dysphagia (Part of Orobuccal Ataxia)
Symptoms:
- Difficulty swallowing, specially with particular textures
- Possibly chocking due to uncoordinated muscles
- Having pain while swallowing (odynophagia) Being unable to swallow. Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum)
3) Limb ataxia
- Symptoms:*
- Clumsiness, slow movement, e.g. difficulty with writing
- Signs:*
- Abnormal drift of outstretched arms
- Rebound after sudden displacement of outstretched limb
- Dysmetria (intention tremor): amplitude of tremor gets larger as you move towards target
- Past pointing test (finger-nose-finger, heel-knee-shin): problems with horizontal movements
- Dysdiadochokinesia (impaired rapid alternating movements): inability to make timed regular movement
4) Truncal and gait ataxia
Symptoms:
- Problems with sitting unsupported
- Stands and walks unsteadily with broad based gait, falls are common
Signs:
- May be only sign of cerebellar disease
- Sways to one or both sides
- Irregular steps in timing, distance and side-to-side
- Exaggerated with heel-toe walking (tandem gait) or on heels
- Reflects disease of midline cerebellar structures
• ___________is a condition in which the muscles you use for speech are weak or you have difficulty controlling them.
• Dysarthria is a condition in which the muscles you use for speech are weak or you have difficulty controlling them.
What is the name of the disorder when you have pain while swallowing?
Being unable to swallow. Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum).
Dysphagia
What are some visual-related symptoms and signs in people with cerebellar disorders? (An associated symptom/sign)
• Oscillopsia: oscillations of the environment in the visual field (Oscillopsia refers to a visual disturbance where those affected experience swinging or oscillating vision)
• Diplopia: double vision
Signs of abnormal eye movements:
- Nystagmus: rhythmic oscillatory movements of one or both eyes
- Square wave jerks: inappropriate saccades that take the eye off the target, followed by a nearly normal intersaccadic interval, and then a corrective saccade that brings the eye back to the target
Describe Dysdiadochokinesia
A demonstration and explanation of Dysdiadochokinesia. This is this inability to perform rapid alternating movements.
e.g. supinating and pronating the hand rapidly.
What is Nystagmus?
Nystagmus: rhythmic oscillatory movements of one or both eyes
Nystagmus is an involuntary, rapid and repetitive movement of the eyes — either horizontal (side-to-side), vertical (up and down) or rotary (circular).
________: double vision
Diplopia: double vision
_________is an involuntary, rapid and repetitive movement of the eyes — either horizontal (side-to-side), vertical (up and down) or rotary (circular).
Nystagmus is an involuntary, rapid and repetitive movement of the eyes — either horizontal (side-to-side), vertical (up and down) or rotary (circular).
_________ inappropriate saccades that take the eye off the target, followed by a nearly normal intersaccadic interval, and then a corrective saccade that brings the eye back to the target
Square wave jerks: inappropriate saccades that take the eye off the target, followed by a nearly normal intersaccadic interval, and then a corrective saccade that brings the eye back to the target
What are some associated symptoms and signs with cerebellar diseases?
-Many cerebellar diseases also affect other parts of the the nervous system.
1) Visual problems
Symptoms:
- Oscillopsia: oscillations of the environment in the visual field (Oscillopsia refers to a visual disturbance where those affected experience swinging or oscillating vision)
- Diplopia: double vision
Signs of abnormal eye movements:
- Nystagmus: rhythmic oscillatory movements of one or both eyes
- Square wave jerks: inappropriate saccades that take the eye off the target, followed by a nearly normal intersaccadic interval, and then a corrective saccade that brings the eye back to the target
2) Vertigo
Symptoms:
- Sensation of movement (environment is swaying) when the body is still (e.g. like sea sickness)
- Worsen with head activities
3) Nausea and vomiting
4) Limb ataxia
Symptoms:
- Clumsiness, slow movement, e.g. difficulty with writing Signs:
- Abnormal drift of outstretched arms
- Rebound after sudden displacement of outstretched limb
- Dysmetria (intention tremor): amplitude of tremor gets larger as you move towards target (Past pointing test (finger-nose-finger, heel-knee-shin): problems with horizontal movements)
- Dysdiadochokinesia (impaired rapid alternating movements): inability to make timed regular movement
5) Truncal and gait ataxia
Symptoms:
- Problems with sitting unsupported
- Stands and walks unsteadily with broad based gait, falls are common
Signs:
- May be only sign of cerebellar disease
- Sways to one or both sides
- Irregular steps in timing, distance and side-to-side o Exaggerated with heel-toe walking (tandem gait) or on heels
- Reflects disease of midline cerebellar structures
What is Dysmetria
Dysmetria (English: wrong length) refers to a lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye. It is a type of ataxia.
__________ refers to a lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye. It is a type of ataxia.
Dysmetria
What nerves are associated with the different reflexes?
How are reflexes graded?
Grading reflexes allows:
- Comparison between different examiners
- Reflex changes to be followed over time
If normal, relaxed shows +, reinforcement (clench teeth) shows ++.
What sort of change in tone is associated with damage to lesion in what area?
↓ “hypotonia”
Lower motor neuron
↑ “spasticity”
Upper motor neuron
↑ “rigidity”
Basal ganglia (extrapyramidal)
