Lecture 14: Cerebellar Disease

Question 1

What is the function of the cerebellum?

Answer 1

• Coordination of motor system to allow precision motor movements
• Coordination of motor system to allow accurate timing of coordinated movement

Question 2

Describe the motto of lesions to the cerebellum;

Answer 2

Ipsilateral lesions = ipsilateral problems in the cerebellum

Question 3

What are the afferents to the cerebellum?

Answer 3

Afferents from:

• Spinal cord
• Vestibular nuclei via inferior olivary nucleus
• Pontine nuclei

Question 4

What are the efferents to the cerebellum?

Answer 4

Efferents to;

• Upper motor neurons via thalamus
• Lower motor neurons via vestibular nuclei, reticular formation and red nucleus

Question 5

What are symptoms vs signs?

Answer 5

Symptoms are what the pt says, signs are what the dr observes

Question 6

What are the symptoms of cerebellar disease?

Answer 6

Ataxia
Dysarthria
Dysphagia
Limb Clumsiness
Gait

Question 7

What is ataxia?

Answer 7

Incoordinated movement:

• Eye movements (oscillopsia/blurring)
• Orobuccal (speech/swallowing difficulties)
• Limbs (clumsy)
• Truncal (Problems sitting)
• Gait (Unsteadiness)

Question 8

What are dysarthria?

Answer 8

Slurred speech

• “drunk accusations’
• Difficulty making self understood

Question 9

How can cerebellar disease alter gait?

Answer 9

Falls common

Question 10

What are the associated symptoms of cerebellar disease?

Answer 10

• Visual symptoms (diplopia / hemianopia)
• Vertigo
• Nausea and vomiting
• Impaired consciousness

Question 11

What are the signs of cerebellar disease?

Answer 11

Abnormal eye movements
Dysarthria
Limb ataxia
Truncal and gait ataxia

Question 12

Describe the abnormal eye movement as a sign of cerebellar disease;

Answer 12

Nystagmus; Rythmic oscillatory eye movements - slow (abnormal, drift) and fast (corrective) phase

Square wave jerks

Question 13

Describe dysarthria as a sign of cerebellar disease:

Answer 13

• Labored / slurred speech
• Staccato (one syllable at a time)
• Rapid tongue movements slowed

Question 14

Describe the limb ataxia as a sign:

Answer 14

• Intention tremor
• Past pointing (dysetria)
• Impaired rapid alternating movements

Question 15

Describe the truncal and gait ataxia as a sign of cerebellar ataxia:

Answer 15

Truncal and gait ataxia

• May be the only sign
• Broad based gait
• Sways to either side
• Irregular steps in time/distance
• Exaggerated with heel/toe walking

Question 16

What happens to sensation/spinal reflexes, muscle tone, strength in cerebellar disease?

Answer 16

• No weakness
• Tone is normal to decreased
• Reflexes normal
• Sensation is normal

Question 17

What are some causes of cerebellar disease?

Answer 17

• Metabolic disorders/toxins i.e alcohol
• Congenital abnormalities i.e arnold chiari
• Vascular disease i.e strokes
• Inflammation / demyelination
• Tumours
• Infections
• Degenerative diseases of the cerebellum - acquired/genetic

Question 18

What are some final notes on cerebellar disease?

Answer 18

• May be less obvious
• Requires a dr to think about it
• Consider it when symptoms are greater than weakness would suggest
• Or if other brainstem symptoms/signs