Signs of Cerebellar Pathology

Signs of a cerebellar lesion include:

Dysdiadochokinesia
Ataxia (lower limbs ? impaired heel-shin)
Nystagmus (ipsilateral)
Intention tremor (on finger-nose test)
Staccato speech (slurred)
Heel-toe walking impaired

Introduction

Wash your hands, introduce yourself and ask permission (consent) to examine. Always ask if the patient has any pain.

Gait

Observe the patient walking and look for:

• An ataxic gait (ask the patient to walk to other side of room and back - gait is broad based & uncoordinated)
• Heal-toe walking impaired (patient cannot walk in a line - i.e. putting one foot in front of the other, then repeating)
• Romberg's test: Get patient to stand with legs close together and arms by side, then ask patient to close their eyes. A positive test is when they are more unstable upon closing their eyes, and is a sign of peripheral proprioceptive failure - NOT cerebellar pathology, which is a common misconception. With cerebellar pathology, there is 'Rombergism' (ie. patient is unstable with and without eyes closed).

Remember: Always stand next to the patient and remain by their side to support them if they become unsteady.

Face

Look for:

• Eye movements (nystagmus will be seen upon making patient slowly alternate gaze from side to side)
• Speech (slurred / staccato) - get the patient to say "university" or "British constitution" and then ask them to speak - for example, by describing your clothes etc.

Arms

Look for:

• Mildly decreased tone
• Past pointing / intention tremor (finger-nose test - "touch my finger then your nose, then repeat as fast as you can". Make sure you keep your finger at an arm's length away, and move the position of your hand from time to time.)
• Dysmetria (arms out with flat palms + eyes closed, then push down on an arm suddenly. If it suddenly springs upwards then this test is +ve)
• Dysdiadochokinesia (make big movements starting at shoulder - not small movements with hand only as you are testing the big proximal muscle groups that the cerebellum controls.)

To complete: Thank the patient.