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