Cerebellar syndrome Flashcards Preview

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Flashcards in Cerebellar syndrome Deck (33):
1

Cerebellar gait examination

Walk
Heel-to-toe
On tip toe
On heal
Romberg's

2

Cerebellar examination with arms outstretched

Ataxia
Rebound

3

Cerebellar signs

DANISH
Dysdiadochokinesia (hands and feet)
Ataxia
Nystagmus + rapid saccades that overshoot
Intention tremor + dysmetria
Slurred speech
Hypotonia

4

Completion of cerebellar exam

Cranial nerves: brainstem stroke, MS, CPA lesion
Peripheral nervous system: MS
Signs of CLD
Drug chart: phenytoin (toxicity causes cerebellar damage)

5

Causes of cerebellar syndrome

DAISIES
Demyelination
Alcohol
Infarct (brainstem)
SOL e.g. schwannoma + other CPA tumours
Inherited e.g. Wilson's, Friedrich's, Ataxia Telangiectasia, VHL
Epilepsy medications: Phenytoin
System atrophy, multiple

6

Lateralisation of cerebellar signs

Ipsilateral to lesion
Bilateral cerebellar signs more likely to represent a global pathology e.g. alcohol, MS, phenytoin

7

Presentation of cerebellar vermis lesion

Ataxic trunk and gait
Normal arms

8

Differentiating cerebellar and vestibular nystagmus

Vestibular cause: fast phase away from lesion, maximal looking away from lesion
Cerebellar cause: opposite

9

Specific history for cerebellar syndrome

MS: Paraesthesia, visual problems, muscle weakness
Alcohol consumption
Infarct: onset, stroke risk factors
Schwannoma: hearing loss, vertigo, tinnitus, raised ICP
FHx
DHx

10

Investigations for cerebellar syndrome

ECG: arrhythmia (DDx brainstem stroke)
Bloods: EtOH (FBC, U+E, LFTs), thrombophilia (clotting), Wilson's (low caeruloplasmin)
CSF: oligoclonal bands
Imaging: MRI is best to visualise the posterior cranial fossa
Audiometry: CPA lesion (pure tone audiometry)

11

General management of cerebellar syndrome

MDT
CV risk
Lower EtOH intake

12

Concise treatment of MS

methylprednisolone

13

Concise treatment of EtOH dependence

Pabrinex, tapering course of chlordiazepoxide

14

Concise treatment of infarct (as cause of cerebellar syndrome)

Consider thrombolysis

15

Concise treatment of Wilson's

Penicillamine

16

Concise treatment of Schwannoma

Gamma-knife, surgery

17

Cause of Lateral Medullary Syndrome AKA Wallenberg's

Occlusion of vertebral artery or PICA

18

Features of Lateral Medullary Syndrome AKA Wallenberg's

All ipsilateral except pain anaesthesia
DANVAH
Nucleus ambiguus(motor to CN9/10): Dysphagia
Inferior cerebellar peduncle: Ataxia, Nystagmus
Vestibular (CN8) nucleus: Vertigo
[Anaesthesia:]
Spinothalamic tract: reduced pain sensation contralaterally
Spinal trigeminal nucelus: reduced pain sensation ipsilaterally
Sympathetic fibres: Horner's

19

Pathophysiology of vestibular Schwannoma

Benign, slow-growing tumour of superior vestibular nerve
SOL leads to cerebellopontine angle (80% of CPA tumours are Schwannomas)
Associated with NF2

20

Presentation of vestibular Schwannoma

Unilateral SNHL, tinnitus, vertigo
Raises ICP: headache
Ipsilateral CN5,6,7,8 palsies and cerebellar signs:
Facial anaesthesia + absent corneal reflex
Lateral rectus (abducens) palsy
LMN facial nerve palsy
SNHL
DANISH

21

Other name for vestibular Schwannoma

Acoustic neuroma

22

Investigations for vestibular Schwannoma

MRI of CPA

23

Treatment of vestibular Schwannoma

Gamma-knife
Surgery

24

CPA tumour differential

Vestibular Schwannoma (AKA acoustic neuroma)
Meningioma
Cerebellar astrocytoma
Metastases

25

Features of Von-Hippel Lindau syndrome

Renal cysts
Bilateral RCC
Haemangioblastoma (often in cerebellum: cerebellar signs)
Phaeochromocytoma
Islet cell tumours

26

Pathophysiology of Friedrich's Ataxia

Autosomal recessive mitochondrial disorder
Progressive degeneration of: dorsal column, spinocerebellar tracts and cerebellar cells
Corticospinal tracts

27

Associations of Friedrich's ataxia

HOCM and mild dementia

28

Age of onset of Friedrich's ataxia

teenage years

29

Features of Friedrich's ataxia

Pes cavus
Bilateral cerebellar ataxia
Leg wasting + areflexia but extensor plantars
Loss of vibration and proprioception
High-arched palate
Optic atrophy and retinitis pigments
HOCM
DM in 10%

30

Pathophysiology of Ataxia Telangiectasia

Autosomal recessive
Defect in DNA repair
Onset in childhood / early adulthood

31

Features of Ataxia telangiectasia

Progressive ataxia
Telangiectasia: conjunctivae, eyes, nose, skin creases
Defective cell-mediated immunity and antibody production: infections
Lymphoproliferative disease

32

Cause of Wilson's disease

Autosomal recessive mutation of ATP7B gene

33

Features of Wilson's disease

CLANK
Cornea: Kayser-Fleischer rings
Liver: CLD
Arthritis
Neuro: parkinsonism, ataxia, psychiatric problems
Kidney: Fanconi's syndrome