Cerebellar Syndrome

Question 1

Cerebellar syndrome presentation

Answer 1

This 37‐year‐old woman has noticed increasing problems with her coordination. Please examine her and suggest a diagnosis.

Question 2

Clinical signs of Cerebellar syndrome

Answer 2

1. Brief conversation: Scanning dysarthria
2. Outstretched arms: Rebound phenomenon
3. Movements:
   ⚬⚬Upper limbs: Finger–nose incoordination, Dysdiadochokinesis, Hypotonia, Hyporeflexia
   ⚬⚬Eyes: Nystagmus
   ⚬⚬Lower limbs: Heel–shin, Foot tapping, Wide‐based gait
4. Direction of nystagmus: clue to the site of the lesion??
5. Cerebellar vermis lesions produce an ataxic trunk and gait but the limbs are normal when tested on the bed
6. Cerebellar lobe lesions produce ipsilateral cerebellar signs in the limbs

Question 3

Direction of nystagmus: clue to the site of the lesion in Cerebellar syndrome??

Answer 3

The direction of the fast phase determines the direction of the nystagmus.
1. Cerebellar lesion: The fast-phase direction is TOWARDS the side of the lesion, and is maximal on looking TOWARDS the lesion.
2. Vestibular nucleus/VIII nerve lesion: The fast-phase direction is AWAY FROM the side of the lesion, and is maximal on looking AWAY FROM the lesion.
In case that the fast phase of nystagmus is to the left so it could be due to
1. A LEFT cerebellar lesion or 2. A RIGHT vestibular nucleus lesion.

Question 4

Mnemonic for signs of Cerebellar syndrome

Answer 4

**DANISH**

1. Dysdiadochokinesis 
2. Ataxia 
3. Nystagmus 
4. Intention tremor 
5. Scanning dysarthria 
6. Hypotonia/hyporeflexia

Question 5

Mnemonic for causes of Cerebellar syndrome

Answer 5

PASTRIES

1. Paraneoplastic cerebellar syndrome
2. Alcoholic cerebellar degeneration
3. Sclerosis (MS)
4. Tumour (posterior fossa SOL)
5. Rare (Friedrich’s and ataxia telangiectasia)
6. Iatrogenic (phenytoin toxicity)
7. Endocrine (hypothyroidism)
8. Stroke (brain stem vascular event)

Question 6

Aetiological clues for the cause of Cerebellar syndrome

Answer 6

1. Internuclear opthalmoplegia, spasticity, female, younger age ====> MS
2. Optic atrophy ====> MS and Friedrich’s ataxia
3. Clubbing, tar‐stained fingers, radiotherapy burn ====> Bronchial carcinoma
4. Stigmata of liver disease, unkempt appearance ====> EtOH
5. Neuropathy ====> EtOH and Friedrich’s ataxia
6. Gingival hypertrophy ====> Phenytoin