A13. Examination of the cerebellar symptoms

Symptoms manifest on the same side as the lesion
Cerebellar ataxia
- Gait ataxia
  - Wide-based, unsteady gait
  - Similar to the gait of drunk people
  - Observe patient’s gait
  - Observe whether the gait worsens or stays the same when patient closes their eyes
    - Worsening with eyes closed suggest sensory ataxia
    - Cerebellar gait ataxia does not worsen with closed eyes
  - Negative/inconclusive Romberg test
  - Positive Unterberger test (topic 6)
- Limb ataxia
  - = uncoordinated movement of the limbs
  - Finger-to-nose test usually positive
  - Heel-to-shin test
    - Procedure
      - Ask patient to lie flat on their back
      - Ask them to place one heel on the opposite knee, and then move the heel smoothly down the shin to the ankle
      - Repeat on the opposite side
    - Negative:
      - Patient can perform the movement smoothly
    - Positive:
      - Patient is unable to perform the movement smoothly. Tremors appear
- Trunk ataxia
  - = inability to sit or stand upright without support
  - Positive Romberg test (topic 6)
Dysmetria
- = overshooting or undershooting the intended movement
- Finger-to-nose test
  - Procedure
    - Hold your finger out in front of the patient
    - Ask the patient to touch their nose, then your finger
    - Repeat this movement as you move your finger to new positions
  - Negative:
    - Patient can do movement normally, touching your finger every time
  - Positive:
    - Patient will miss your finger due to constantly overshooting or undershooting the precise movements
Dysdiadochokinesia
- = alternating antagonistic movements are irregular, uncoordinated
- Ask patient to perform quick, alternating movements
  - Touching thumb and index finger and spreading them again, repeatedly
  - Clenching and opening the fist repeatedly
  - Pronating and supinating the hand repeatedly
  - Dorsiflex and plantarflex the foot repeatedly
- Observe for irregularity and uncoordinated movements
Dysarthria
- = scanning speech
- Words are broken down into separate syllables
- See topic 16
Intention tremor
- = broad, coarse, slow tremor which occurs during purposeful movement
- Tremor is at its worst right before reaching the target
- Observed during finger-to-nose test
- See also topic 33
Examination of nystagmus
- Try to provoke nystagmus by eliciting ocular movements
- Does the patient have nystagmus?
- Describe the type of the nystagmus
  - Horizontal/vertical/rotatory/combined
- Which direction is the nystagmus?
  - The direction is named after the fast component
  - The nystagmus is directed toward the side of the lesion
- Does visually fixating the gaze suppress the nystagmus?
  - Fixation does not improve nystagmus of cerebellar origin
- See also topic 30