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Cerebellar Syndrome (Examination (Completion (Cranial nerves: brainstem…
Cerebellar Syndrome
Examination
Gait
- Walk
- Heal-to-Toe
- On tip toes
- On heal
- Romberg’s
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DaNISh
Dysdiadochokinesia: hands and feet
Nystagmus + Rapid Saccades = overshoot
Intention tremor and dysmetria
Slurred speech
Completion
Cranial nerves: brainstem stroke, MS, CPA lesion
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Neurophysiology
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Bilateral cerebellar signs more likely to represent a global pathology
Cerebellar vermis lesion
- Ataxic trunk and gait
- Normal arms
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Viva
Hx
MS: paraesthesia, visual problems, muscle weakness
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Infarct: onset, stroke risk factors
Schwannoma: hearing loss, vertigo, tinnitus, ↑ICP
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Ix
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Bloods
- EtOH: FBC, U+E, LFT
- Thrombophilia: clotting
- Wilson’s: ↓ caeruloplasmin
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Mx
General
- MDT: GP, neurologist, radiologist, neurosurgeon, specialist nurses, physio, OT
- CV Risk
- ↓ EtOH
Specific
- MS: methylprednisolone
- EtOH: Pabrinex, tapering course of chlordiazepoxide
- Infarct: consider thrombolysis
- Schwannoma: gamma-knife, surgery
- Wilson’s: penicillamine
Causes: DAISIES
- Demyelination
- Alcohol
- Infarct: brainstem stroke
- SOL: e.g. schwannoma + other CPA tumours
- Inherited: Wilson’s, Friedrich’s, Ataxia Telangiectasia, VHL
- Epilepsy medications: phenytoin
- System atrophy, multiple
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