Cerebellar Presentation

Overview

Signs and symptoms of cerebellar disease presents on the same side (ipsilateral). Symptoms and signs consist of gait impairment, unclear (“scanning”) speech, visual blurring due to nystagmus, hand in-coordination, and tremor with movement.

Cerebellar Examination

General

• Titubation
• Gait - ataxia, unable to tanden gait (heel to shin)
• Intention tremor

Head

• Auscultate over cerebellum for bruits
• Auscultate carotids - lateral medullary syndrome (Wallenburg syndrome)
• Cerebellopontine angle tumour - 5, 7, 8 cranial nerve affected
• Nystagmus
• Speech - explosive, jerky and loud with irregular seperation of syllables

Arms and legs

• Shake hands - tone
• Upward arm drift (due to hypotonia of the agonist muscles)
• Rebound - ask patient to raise arm quickly and stop (incoordination between antagonist and agonist muscles)
• Hypotonia - due to loss of facilitatory muscles
• Coordination
  • Finger to nose - past pointing due to no connection between brainstem and cerebellum
  • Heel-to-shin
• Dysdiadochokinesis - inability to perform rapid alternating movements

Special tests

• Trunkal ataxia (usually assocated with vermis pathology of the cerebellum)
• Reflex - pendular knee

Pathways in the CNS

Pyramidal Pathways (through medulla) 

• Anteriorcorticospinal tract
• Lateralcorticospinal tract

Extrapyramidal Pathways  

• Rubrospinal tract
• Vestibulospinal tract
• Reticulospinal tract
• Tectospinal tract
• Olivospinal tract

Cerebellar Pathway 

• Spinocerebellar tract