Cerebellar exam

Question 1

How do you asses gait in a cerebellar exam?

Answer 1

Ask them to walk normally and heel-to-toe, looking for…
- stability (truncal ataxia seen in posture)
- turning difficulties
- stance (board base)

Question 2

How do you perform Romberg’s test for a cerebellar exam?

Answer 2

• Ask the patient to stand with their feet together, arms stretched in front of them with hands supinated
• Stand within arms reach to support them if they fall
  
  • if a patient loses balance with their eyes open, this suggests cerebellar dysfunction
  • if a patient can maintain the position with their eyes open but lose balance with them closed, this suggests a loss of proprioception (positive Romberg’s sign)

Question 3

How do you assess speech in a cerebellar exam?

Answer 3

• Ask the patient to repeat “British constitution” and “baby hippopotamus”
• Staccato and/or slurred speech (ataxic dysarthria) can be due to cerebellar lesions

Question 4

How do you assess for nystagmus in a cerebellar exam?

Answer 4

• Ask the patient to look ahead and examine for nystagmus in the primary position
• Ask them to follow your finger in a ‘H’ pattern, looking for multiple beats of nystagmus (most noticeable towards the side of the lesion)
• If nystagmus is present, note the direction of gaze and the direction of the nystagmus

Question 5

How do you assess for dysmetria in the upper limbs in a cerebellar exam?

Answer 5

Check for past-pointing:
- ask the patient to touch their nose then your finger repeatedly while you move your finger
- incoordination = dysmetria
- a tremor as the limb reaches the endpoint of a deliberate movement is an intention tremor
Check for dysdiadochokinesia:
- ask the patient to alternatively tap the palm and dorsum of one hand to the other
- difficulty completing these movements rapidly and regularly suggests cerebellar ataxia

Question 6

How do you assess dysmetria in the lower limbs in a cerebellar exam?

Answer 6

Heel-to-shin test:
- ask patient to place heel on opposite knee and run down shin in a straight line
- then return to knee and repeat in a smooth motion
*incoordination suggests cerebellar pathology

Question 7

What reflexes should be examined in a cerebellar exam?

Answer 7

Knee and/or elbow

Question 8

How is hypotonia assessed in a cerebellar exam?

Answer 8

• At the shoulder, elbow, and wrist
• At the hip, knee, and ankle
  *hypotonia can be caused by ipsilateral cerebellar lesions