Cerebellar disorders
Description
- Cerebellar signs are IPSILATERAL - the output decussates twice
- DANISH: Dysdiadochokinesia | Ataxia | Nystagmus | Intention tremor | Scanning dysarthria | Hypotonia + hyporeflexia (pendular)
Anatomy determines the syndrome
| Region | Signs |
|---|---|
| Cerebellar hemisphere | Ipsilateral limb ataxia, dysmetria, intention tremor, dysdiadochokinesia, rebound |
| Vermis / midline | Truncal and gait ataxia with relatively normal limb coordination; titubation |
| Rostral (anterior superior) vermis | Gait ataxia confined to the legs, arms spared - the alcohol signature |
| Flocculonodular | Nystagmus, vertigo, gaze-holding failure, imbalance |
Individual signs
- Nystagmus - jerky, horizontal, fast phase towards the side of the lesion, amplitude greater on gaze to that side
- Saccades - hypermetric/hypometric, overshoot; broken (saccadic) smooth pursuit
- Dysarthria - explosive, irregular, scanning; test with "British constitution", "West Register Street", "hippopotamus"
- Dysmetria + intention tremor on finger-nose (worse the closer to the target); past-pointing; positive rebound
- Heel-shin ataxia; broad-based, veering gait; unable to tandem walk
- Hypotonia and pendular reflexes
- Romberg is negative in pure cerebellar disease - Romberg tests proprioception, not the cerebellum
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