1. Cerebellar Examination
By Stas Makaranka

2. Outline: Causes of cerebellar dysfunction
Run through cerebellar examination
Examination Practice
Practice Questions

3. Differential Diagnosis
Stroke/TIA
Alcohol (Intoxication/Wernicke-Korsakoff)
SOL - Tumour in posterior fossa/Hydrocephalus
Multiple Sclerosis
Drugs (e.g. Phenytoin toxicity)
Endocrine (Hypothyroidism)
Infections (Meningo-encephalitis, intracranial abscess)
Trauma
Paraneoplastic cerebellar degeneration
Genetic/Congenital

4. DANISH Dysdiadokinesia Ataxia (Romberg’s) Nystagmus (Draw H)
Intention Tremor (Touch nose and pen)
Slurred, Stacatto Speech
Hypotonia/Heel-shin Test

5. Blueprint: Introduction General Inspection Gait Head Arms Legs Summary
DANISH

6. Wash Hands Introduce Yourself Confirm Name/DOB Explain Examination
Gain Consent
Appropriate Exposure
Pain Anywhere?
Introduction
General Inspection
Gait
Head
Arms
Legs
Summary
DANISH

7. Around The Bed (walking aids) Posture – Truncal Ataxia?
Appearance – Signs of Neglect (alcoholism?)
Introduction
General Inspection
Gait
Head
Arms
Legs
Summary
DANISH

8. Walking In A Straight Line (broad based gait?) Heel To Toe Walking
Romberg’s Test (proprioception)
Introduction
General Inspection
Gait
Head
Arms
Legs
Summary
DANISH

9. Speech – ask to say British Constitution/Baby Hippopotamus (slurred staccato speech in cerebellar disease)
Nystagmus
Introduction
General Inspection
Gait
Head
Arms
Legs
Summary
DANISH

10. Co-ordination (finger to nose, dysdiadokinesia)
Pronator Drift
Rebound Phenomenon
Tone
Reflexes - Biceps – C5,C6, Triceps – C7, Supinator – C6 (hyporeflexia in cerebellar disease)
Co-ordination (finger to nose, dysdiadokinesia)
Introduction
General Inspection
Gait
Head
Arms
Legs
Summary
DANISH

11. Tone (leg roll, leg lift)
Reflexes (knee jerk – L3, L4, ankle jerk – L5, S1)
Co-ordination (heel to shin)
Introduction
General Inspection
Gait
Head
Arms
Legs
Summary
DANISH

12. Thank Patient Wash Hands Summarise Findings
Say would perform cranial nerve exam/upper and lower limb nerve exams and appropriate imaging (CT/MRI) if indicated
Introduction
General Inspection
Gait
Head
Arms
Legs
Summary
DANISH

13. Slurred, Staccato Speech Hypotonia/Heel-shin test
Dysdiadokinesia
Ataxia
Nystagmus
Intention Tremor
Slurred, Staccato Speech
Hypotonia/Heel-shin test
Introduction
General Inspection
Gait
Head
Arms
Legs
Summary
DANISH

14. Questions? Introduction General Inspection Gait Head Arms Legs Summary
DANISH

15. Practice Examination
1 Volunteer Please

16. Practice Examinations
Get into pairs
One perform the complete examination on the other
Ask if you’re not sure how to do something

17. Practice Questions (1)
What are the features of Wernicke’s encephalopathy and what deficiency is present?

18. Practice Questions (1)
What are the features of Wernicke’s encephalopathy and what deficiency is present?
Confusion, ataxia, ophthalmoplegia.
Thiamine

19. Practice Questions (2)
A positive Romberg’s test is indicative of damage where?

20. Practice Questions (2)
A positive Romberg’s test is indicative of damage where?
Dorsal columns of the spinal cord – sensory ataxia
If patient ataxic and Romberg’s test is negative, it suggests that the ataxia is cerebellar in nature

21. Practice Questions (3)
Your 27-year old patient displays ataxia when asked to walk across the examination room. You ask him to stand still with his eyes closed and note marked swaying back and forth. When he opens his eyes the swaying persists. Vibration sense is normal on all four limbs. Given the clinical picture in this case, such ataxia is likely due to damage to which of the following structures?
A. Dorsal Columns
B. Cerebral Peduncles
C. Posterior limb of the internal capsule
D. Ventral horns of the spinal cord
E. Cerebellum

22. Practice Questions (3)
E. Cerebellum

23. Thanks for coming! Some helpful links: Some helpful resources:
Some helpful resources:
Unofficial guide to passing OSCEs