Cerebellar Disease Flashcards Preview

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Flashcards in Cerebellar Disease Deck (31):
1

What does the cerebellum do

It is responsible for the coordination of skilled voluntary movement, gait and posture

2

What are some causes of cerebellar disease

DISBIT

Demyelination - MS
Inherited - Friedrich's ataxia, spinocerebellar ataxias
Space-occupying lesions in posterior fossa - cerebellopontine angle tumour, medulloblastoma
Brainstem vascular disease - vertebrobasilar stroke
Infection - HIV, abscesses
Toxicity - alcohol, anti-convulsants

3

What is the imaging modality of choice in cerebellar disease

MRI - CT scans are not good at looking at the posterior cranial fossa

4

What other examinations would you ask to do to a patient with cerebellar disease

COP

Corneal reflex - loss of this reflex in cerebellopontine angle tumours
Optic atrophy - occurs in MS
Pes cavus - Freidrich's ataxia and Charcot-Marie Tooth

5

Why is testing the corneal reflex useful in a patient with cerebellar disease

Loss of this reflex is the earliest sign of a cerebellopontine angle tumour

Due to the proximity of the cerebellopontine angle to cranial nerves

6

Why would you examine for optic neuritis in cerebellar disease

Cerebellar problems may be cause by MS. MS also causes optic neuritis which leads to optic atrophy

7

What are the signs of cerebellar disease

DANISH T

Dysdiadochokinesis
Ataxia - broad based gait falling to side of lesion
Nystagmus - fast beat towards side of lesion
Intention tremor
Staccato speech - cerebellar dysarthria
Hypotonia
Titubation - rhythmic nodding of head

8

Are signs ipsilateral or contralateral to the lesion in cerebellar syndrome?

Ipsilateral

9

When is dysmetria seen?

At the extreme of arm length.

10

What is dysmetria?

The incorrect velocity and amplitude of a planned movement

11

What is another example of dysmetria?

The rebound phenomenon

12

How is tone affected in cerebellar syndrome?

May be slightly hypotonic

13

In what direction is the fast phase of the nystagmus in cerebellar syndrome?

Towards lesion side

14

Is Romberg's test positive in cerebellar disease?

No- differentiates a cerebellar broad based gait from a sensory broad based gait.

15

How is the speech in cerebellar syndrome described?

Scanning, slurred with an explosive character.

16

What are the common causes of cerebellar syndrome?

PASTRIES:
Paraneoplastic cerebellar syndrome
Alcoholic cerebellar degeneration
Sclerosis (MS)
Tumour (posterior fossa SOL)
Rare (Freidrich's ataxia and ataxia telangiectasia)
Iatrogenic (Phenytoin toxicity)
Endocrine (hypothyroidism)
Stroke (brainstem vascular event)

17

What drugs cause a cerebellar syndrome?

Phenytoin
Lithium
Carbamazepine
Chemotherapeutic agents

18

How could you differentiate a lesion of the vermis and a lesion of the cerebellar hemispheres?

Vermis- trunk and axial muscles affected
Hemispheres- ipsilateral limb ataxia

19

What malignancies are associated with paraneoplastic cerebellar degeneration?

Cancers of the ovary, lung, breast, uterus and Hodgkin's lymphoma.

Neuro sx may precede tumour diagnosis

Can detect antibodies in serum.

20

What features would got against a diagnosis of paraneoplastic cerebellar degeneration?

Unilateral cerebellar dysfunction

Paraneoplastic = bilateral rapid onset.

21

What is lateral medullary syndrome?

Occlusion of vertebral artery or posterior inferior cerebral artery (PICA)

22

What are the symptoms of lateral medullary syndrome?

DANVAH:
Dysphagia
Ataxia
Nystagmus
Vertigo
Anaesthesia: dissociated pain loss
Horner's syndrome
Body anaesthesia to pain

Variable presentation

23

Are the signs in lateral medullar syndrome ipsilateral or contralateral?

Ipsilateral apart from body anaesthesia to pain (spinothalamic tracts- contralateral)

NB also CNV pain and temperature sensation lost

24

What may be found on examination of a patient with a cerebellopontine angle lesion?

VI nerve palsy (in some)
LMN facial weakness- VII nerve palsy
Loss of corneal reflex, CNV sensory loss and muscle wasting
Sensorineural hearing loss
If large- may involve bulbar nerves (tongue and uvula deviation to affected side)

Ipsilateral cerebellar signs

25

What CNs are most often affected by a cerebellopontine angle lesion?

V, VII and VIII

26

What are the causes of a cerebellopontine angle lesion?

Acoustic neuroma
Meningioma
Cholesteatoma
Basilar artery aneurysm

27

What are the common causes of a cerebellopontine angle lesion?

Acoustic neuromas
Meningiomas 2nd

28

What is an acoustic neuroma?

Benign, slow-growing tumour of superior vestibular nerve.

Surgically excise to remove

29

What condition is acoustic neuroma associated with?

Neurofibromatosis II

30

How would an cerebellopontine angle lesion present?

Unilateral sensorineural hearing loss
Tinnitus, vertigo
Headache (raised ICP)
Signs CPA lesion

31

What is Von-Hippel-Lindau syndrome?

Condition characterised by:
Renal cysts,
Bilateral renal cell carcinoma,
Phaeochromocytomas,
Islet cell tumours
Haemangioblastomas- often in cerebellum --> cerebellar signs