A13. Examination of the cerebellar symptoms

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  • 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