Decoding cerebellar signs: best 5

Unlocking the Secrets of Cerebellar Signs: Mnemonics for Mastery


CEREBELLAR SIGNS
Cerebellar signs are partially discussed along with the examination of motor system. In cerebellar disease, the side of the lesion is the same as that having the deficit (i.e., a left-sided lesion produces left-sided deficit).

Cerebellar signs are listed below (arranged from  head to foot):


Nystagmus, gaze evoked. The fast component is towards the side of lesion.

Dysarthria (staccato, slurred, or scanning speech): Scanning is slow dragged out speech as though scanning. Staccato speech has undue stresses at points where stress is not to be used .
Titubation or head nodding (rhythmic oscillation of head on trunk).

Upper Limb


Finger-nose test (dysmetria)
, can use finger- to-finger test also.


Dysdiadochokinesia (inability to carry out rapidly alternating movements):
This may be tested by  asking the child to put one hand with the other hand with rapidly alternating supination pronation movements.


Rebound phenomenon:
The patient pulls the forearm against resistance from the examiner. The examiner suddenly releases his resistance keeping his other hand near the face of the child to prevent the rebound of the child’s hand injuring the child’s own face. In cerebellar disease, the child’s hand fails to get arrested immediately after release of resistance and flies up with considerable force.

Intention tremor:
May be tested by the finger-nose test. As the fingers are nearing the target, there is exaggerated tremor. The child should fully extend and abduct the arms to about 90° and then touch the tip of his nose with the finger and then the examiner’s finger.
Intention tremor can be made out in the heel-knee test also (place heel over the opposite knee and slide down along the shin).

Dysmetria and past-pointing (inability to stop intended movement at the correct place):
This is tested by the finger-nose test where the finger may overshoot the nose or strike the nose with undue force because the distance is wrongly assessed by the child.
Dyssynergia (incoordination): There is difficulty in smoothly carrying out complex movements. Rather the movement will have to be broken down into individual components for the child to perform it.

Trunk:

Truncal ataxia (ataxia in sitting position, cannot sit without support).
Truncal ataxia is seen in lesions of midline cerebellar structures.

Lower Limb


Gait ataxia
(swaying to either side which is better appreciated on tandem walking).

Limb ataxia can be made out with the child standing with outstretched arms. Limb ataxia is seen in lesions of cerebellar hemispheres.

Tandem walking:
The patient is asked to walk normally and in tandem. In the latter, the patient is asked to walk in straight line placing one foot immediately in front of the other (i.e., heel to toe). A tendency to sway or fall to one side indicates ataxia, suggesting cerebellar dysfunction.
In sensory ataxia, the child walks fairly well with the eyes open but sways to fall when the eyes are closed as sensory input from eyes no longer compensates for the loss of posterior column sensations like position sense. In unilateral cerebellar disease, the patient sways towards the side of lesion.

Heel-knee test:
The child is asked to place the heel of one foot on the knee of the other leg and then to move the heel down over the tibia.

Pendular knee jerk: The jerk elicited (with the child sitting in a chair with legs hanging) does not stop soon but goes on oscillating.Usually more than 3 swings are taken as significant to call it is pendular.

Hypotonia with retained reflexes
The Romberg test evaluates the proprioceptive deficiency (posterior column sensation);it is not a test for cerebellar function

FAQ

What are cerebellar signs?
What does a positive cerebellar sign mean?
How do you check for cerebellar signs?
आप अनुमस्तिष्क संकेतों की जांच कैसे करते हैं?
What are the 3 types of ataxia?
What are the cerebellar signs of a stroke?

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