Neurology - Cerebellar

Question 1

Signs of cerebellar legion

Answer 1

VANISHED

1. Vertigo
2. Ataxia
3. Nystagmus
4. Intention tremor
5. Slurred speech
6. Hypotonia
7. Elevation on pronation drift
8. Dysdiadokinesia

Question 2

Localising the cerebellar lesion - central

Answer 2

Not always possible

1. Truncal ataxia
2. Poor heel to toe
3. Slurred staccato speech

Question 3

Nystagmus Ddx

Answer 3

1. Congenital - most marked in neutral position
2. Vestibular - unidirectional, fast phase away from side of lesion, nystagmus increases when patient looks in the direction of the fast phase.
3. Central (brainstem or vermis) - bidirectional, direction of fast phase varies with direction of gaze
4. Unilateral cerebellar hemisphere lesion - nystagmus when looking in the direction of the lesion, fast phase toward the lesion

Question 4

Dysarthria Ddx

Answer 4

1. Facial nerve palsy - look for facial weakness
2. Bulbar palsy - look for flaccid, fasiculating tongue (MND, GB, Syringobulbia)
3. Pseudobulbar palsy - look for spastic, contracted tongue (MND, MS, bilateral stroke)
4. Myasthenia gravis
5. Cerebellar disease (Ddx)

Question 5

Wernicke’s encephalopathy

Answer 5

Thiamine deficiency
Most commonly due to alcohol abuse
Clinical triad
1. Acute confusion
2. Opthalmoplegia
3. Ataxia (and other cerebellar signs)
Treat with Iv thiamine

Question 6

Cerebellar disease Ddx

Answer 6

SMART CT

1. Stroke
2. MS
3. Alcohol abuse
4. Rx - anti-epileptic medication
5. Tumour
6. Congenital (Arnold Chiari)
7. Thiamine deficiency