Cerebellar Exam

Question 1

Generic inspection

Answer 1

• Dysdiadochokinesia
• Ataxia (gait and posture)
• Nystagmus
• Intention tremor
• Slurred, staccato speech
• Hypotonia/heel-shin test

Question 2

General inspection

Answer 2

Abnormal posture
Speech abnormalities
Scars
Gait
Truncal ataxia
Appendicular ataxia

Question 3

Gait

Answer 3

Stance
Stability
turning
Tandem gait

Question 4

Special tests

Answer 4

Rombergs

Question 5

Speech

Answer 5

• “British constitution”
• “Baby hippopotamus”

Question 6

Types of speech disorder

Answer 6

• Scanning speech (also known as staccato speech):words are broken down into separate syllables, often separated by pauses and spoken with varying volume.
• Slurred speech:patients are often mistaken for being intoxicated as a result.

Question 7

Eyes

Answer 7

• Nystagmusinvolves repetitive, involuntary oscillation of the eyes and can be either physiological (i.e. benign) or associated with cerebellar pathology.
• Direction of nystagmus:most nystagmus has a fast phase and a slow phase (termed “jerk” nystagmus). By convention, the direction of the nystagmus is defined by the direction of the fast phase. In cerebellar lesions, the direction is towards the side of the lesion.
• Direction of gaze:note if nystagmus is present on horizontal or vertical gaze.
• Plane of nystagmus:note if nystagmus beats in a horizontal or vertical plane.

Question 8

What is dysmetric saccades

Answer 8

1.Position your hand approximately 30cm to the side of your head.

2.Ask the patient to look at your hand, then back to your nose. Repeat this assessment on both sides.

The movement of the patient’s eyes should be quick and accurate. In cerebellar lesions, there will often be overshoot (i.e. the eyes will go too far past the target, then correct themselves back to the target). This overshoot and subsequent correction are known as dysmetric saccades.

Question 9

Upper limb

Answer 9

Co-ordination
Tone
Intention tremor
Rebound phenomenon
Dysdiadochokinesia

Question 10

Lower limb

Answer 10

Co-ordination
Tone
Tremor
Knee jerk
Heel to shin
Dysmetria

Question 11

Further investigations

Answer 11

Full neuro
Neuroimaging
formal hearing assessment

Question 12

Relevant pathologies

Answer 12

• Cerebellar Degeneration
• Alcohol abuse
• Drug abuse - phenytoin
• Hereditary ataxias
• Tumours of posterior fossa
• Metastatic disease - lung / breast primary
• Infection - VZ and legionella.