Medically Fit For Exams
Medically Fit For Exams

Cerebellar examination

  • Wash your hands and introduce yourself
  • Check the name and date of birth of the patient
  • Explain the examination and gain consent

Causes of a cerebellar syndrome

Alcohol

Drugs, eg phenytoin

Multiple sclerosis

Hereditary ataxias

Tumour of posterior fossa

Metastatic disease, eg breast, lung

Infection, eg varicella zoster, legionella

 

 

 

 

 

 

 

 

 

 

 

 

 

GENERAL INSPECTION

  • Look for walking aids
  • Look for signs of alcoholism/liver damage
    • Jaundice
    • Palmar erythema
    • Dupytron’s contracture
    • Spider naevi
    • Dishevelledness

 

GAIT

  • Ask the patient to walk away from you, turn around and walk back
  • Observe for cerebellar ataxic gait
  • If no abnormality, ask the patient to walk with one foot in front of the other, as if on a tightrope
  • This may bring out an ataxic gait

 

EYES

  • Carry out the ‘H test’ of eye movements
    • Ask the patient to keep their head still and facing towards you
    • Ask them to follow your finger with their eyes as you move it in an H shape
    • Hold at the lateral points to assess for nystagmus
  • Test for rapid eye movements
    • Make one hand into a fist, and the other an open palm and hold in front of the patient
    • Ask the patient to look at whichever you instruct, as quickly as possible
    • Randomly and rapidly say ‘fist’ or ‘palm’
    • Observe the speed and accuracy at which the patient can shift their gaze
    • Look for saccadic intrusions – inappropriate eye movements away from the target
    • Look for square-wave jerks – an inappropriate saccade, followed by a pause and then return to target

 

SPEECH

  • Ask the patient to repeat after you, observing for slurring:
    • Red lorry, yellow lorry
    • Baby hippopotamus
    • She sells sea shells on the sea shore
  • Ask the patient to tell you in a few sentences how to make a cup of tea
  • Listen for staccato sounds/lack of fluency

 

UPPER LIMBS/COORDINATION

  • Cerebellar rebound
    • Ask the patient to hold their arms out straight in front of them
    • Tell them you are going to press down on their arms and let go, they should bring their arms back to the original position
    • Look for overshoot (arms coming up too high)
  • Finger-nose test
    • Hold your finger out in front of the patient
    • Ask the patient to rapidly touch their nose and then touch your finger
    • Move your finger slightly each time
    • Observe for unsteady movements, intention tremor or missing targets
  • Dysdiadochokinesis
    •  Ask and show the patient to hold out one hand, and slap it alternatively with the palm and back of the other hand as quickly as possible
    •  Repeat on the other side

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