The Stanford 25

An Initiative to Revive the Culture of Bedside Medicine

Cerebellar Exam

Introduction: The cerebellum coordinates unconscious regulation of balance, muscle tone, and coordination of voluntary movements. Therefore, signs suggesting cerebellar disease occur in several different aspects of the body.

Technique:

Signs of cerebellar disease, from head to foot

  • Speech: “Scanning speech” causes enunciation of individual syllables: “the British parliament” becomes “the Brit-tish Par-la-ment.”
  • Nystagmus: fast phase toward side of cerebellar lesion.
  • Finger to nose: must be done at full arm’s extension.
  • Rapid alternating movements (if abnormal, this is called dysdiadochokinesia).
  • Rebound phenomenon.
    • Have patient pull on your hand and when they do, slip your hand out of their grasp. Normally the antagonists muscles will contract and stop their arm from recoiling. In cerebellar disease that does not happen and the arm can fling up and hit the patient, so in performing the test, use your other arm to protect the patient—see video.
  • Heel to shin test.
  • Hypotonia: “pendular” knee jerk, leg keeps swinging after knee jerk.
  • Gait: commonly wide based and staggering.
    • They may fall to the side of the lesion.
    • Of historical interest is the “compass test”: you  have patient close eyes and take two steps forward and two steps back; patient will turn toward side of lesion supposedly. Of course they must be capable of standing in the first place with eyes closed.
  • NOTE: patients with disease of the vermis and flocculonodular lobe will be unable to stand at all as they will have truncal ataxia–they may not be able to sit.
  • NOTE: THE ROMBERG TEST IS NOT A SIGN OF CEREBELLAR DISEASE.
    • It is a sign of a disturbance of proprioception, either from neuropathy or posterior column disease. The patient does not know where their joint is in space and so uses their eyes. In the dark or with eyes closed they have problems.

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Written by stanford25admin

June 7, 2010 at 3:12 pm

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