Cerebellar Examination

Introduction

  • Rapport

General inspection

  • Craniotomy scars
  • Trauma

CEREBELLAR EXAMINATION:

  • SIGNS = SAME SIDE AS LESION
  • (fibres cross twice)

NYSTAGMUS

  • Horizontal
  • ↑ on looking to side of lesion

SPEECH: explosive & loud

  • Irregular separation of syllables

ARMS:

  • DRIFT
  • HYPOTONIA
  • FINGER-NOSE (eyes open & closed)
    • Intention tremor
    • Past-pointing
  • DYSDIADOCHOKINESIS
  • REBOUND: lift arms quickly & stop

LEGS

  • HYPOTONIA
  • HEEL-SHIN
  • TOE-FINGER
    • Intention tremor
    • Past pointing
  • TOE-TAP

TRUNCAL ATAXIA

  • Do a “sit-up” (sit up with arms folded)

WHILE SITTING:

  • Pendular knee jerks = hypotonia

GAIT

  • Fall to side of lesion
  • Heel toe

IF OBVIOUS UNILATERAL CEREBELLAR LESION

  • TEST: CN 5, 7, 8
    • Cerebellopontine angle tumor
  • Lateral medullary syndrome
    • Ipsilateral Horners, V, IX-XI

EXTRAS:

  • Fundoscopy for papilloedema
  • Peripheral signs of:
    • Malignancy
    • Vascular disease

IF BILATERAL DISEASE:

  • Look for signs of:
  • MS
  • Hypothyroidism
  • Friedrich’s ataxia (pes cavus)
  • NB ALCOHOLIC CEREBELLAR DEGENERATION
    • Typically SPARES THE ARMS

NB IF UMN & CEREBELLAR SIGNS COSNIDER:

  • 1)In adolescence
    • a.Spinocerebellar degeneration
  • 2)Young Adults
    • a.MS
    • b.Spinocerebellar degeneration
    • c.Syphilitic meningo-myelitis
    • d.Arnold Chiari malformation/other cranio-spinal junction lesion
  • 3)Later Life
    • a.MS
    • b.Synringomyelia
    • c.Infarction
      • i.Upper pons or internal capsule on one side
      • 1.“Ataxic hemiparesis)
    • d.Cranio-spinal lesion: meningioma

NB MAY SEE SIMILAR SIGNS IN

  • ALCOHOLIC
  • CERVICAL SPONDYLOSIS

Causing cerebellar damage

FRIEDRICH’S ATAXIA:

  • Autosomal recessive
  • Usually young person
  • Bilateral cerebellar signs
    • a.Including nystagmus
  • Pes cavus, hammer toes, kyphoscoliosis
  • UMN signs in limbs
    • BUT: ABSENT REFLEXES
  • Peripheral neuropathy
  • Dorsal column loss in limbs
  • Cardiomyopathy
  • Diabetes
  • Optic atrophy
  • Normal mentation
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