Cerebellar Examination

Cerebellar ExaminationCreated OnJune 1, 2020Last Updated OnJune 1, 2020byadmin You are here: Main Clinical Examination Cerebellar Examination < All Topics Table of Contents Steps Elaboration Introduction Wash hands Introduce yourself Confirm patient’s details Explain Examination and gain consent Achieve appropriate exposure Ask if the patient has pain anywhere before you begin General Inspection The mnemonic “CASHIER” can be used in general observation of a patient to look for any clues suggestive of a neurological disease: Consciousness level – assess using Glasgow Coma Scale (GCS) Asymmetry in posture and facial muscles, truncal ataxia, spasticity and muscle wasting Scars – neurosurgical or traumatic scars Hearing aids Involuntary movements Equipment – mobility aid, wheelchair and assisted devices Rash Gait Observe the patient’s gait Stance a broad-based gait is noted in cerebellar disease Stability May staggering, often slow and unsteady similar to a drunk person walking In unilateral cerebellar disease, the patient can veer towards the side of the lesion Arm swing and clumsiness should also be assessed Tandem (‘heel to toe’) walking Ask the patient to walk in a straight line with their heels to their toes This is a very sensitive test and will exaggerate any unsteadiness. This is the first function to be lost in alcoholic cerebellar cortical degeneration. Romberg’s test – ask the patient to put their feet together, keep their hands by their side and close their eyes Be ready to support them if they are unsteady This is a test of proprioception, not of cerebellar disease. Falling without correction is abnormal and indicates unsteadiness is due to a sensory ataxia from lack of proprioception, rather than a cerebellar ataxia. Swaying with correction is not a positive result (although this may occur in cerebellar disease). Steps Elaboration Speech Ask the patient to repeat the following phrases: ‘Yellow Lorry’ and ‘Baby Hippopotamus’ Slurred, staccato speech is characteristic of cerebellar dysfunction Eyes Look for nystagmus while testing on their oculomotor movement Ask the patient to look straight ahead and examine the eyes in the primary position. Look for any abnormal movement such as nystagmus. Ask the patient to keep their head still and follow your finger with their eyes. Move your finger throughout the various axes of vision If nystagmus is present, note the following: Direction of nystagmus Direction of gaze Look for multiple beats of nystagmus a few beats at the extremes of gaze can be a normal variant and is termed physiological nystagmus In cerebellar lesions, the direction is towards the side of the lesion Arm Assess the tone – hypotonia is noted in cerebellar disease Assess for rebound phenomenon Ask the patient to outstretch their arms with their eyes closed. Ask the patient to keep their arm in that position as you apply downward force on their arm, then release your hand When resistance is suddenly removed, patient with normal cerebellar function will moves a short distance in the desired direction and then rebounds Interpretation of findings: Exaggerated version of the normal response is suggestive of spasticity Absence of rebound is suggestive of cerebellar disease Assess for rapid alternating movement Demonstrate by patting the palm of your hand with the back/palm of your other hand to the patient Ask the patient to...

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