Cerebellar Examination

Intro

  • Wash hands, Introduce self, Check patient name and DOB/CHI, Explain procedure and gain consent

General Observation and Gait

  • Look for any walking aids, posture, signs of neglect (alcoholism), resting tremor
  • Gait
    • Ask the patient to walk from one side of the room to the other (walk with them if necessary)
      • Look for ataxia or other gait abnormality
    • Ask the patient to walk heel-toe
  • Posture and Romberg’s test
    • Ask the patient to stand up with their hands across their chest
    • Ask them to close their eyes and look for any unsteadiness (make sure you are there to support them)
      • NB A positive Romberg’s test is NOT a lateralising sign of a cerebellar lesion.  It is suggestive of a sensory ataxia i.e. proprioceptive deficit or vestibular deficit (rarely it can be a midline cerebellar lesion)

Start at the top and work down

Face

  • Test eye movements with H formation, stopping at lateral gaze; looking for saccades and nystagmus
  • Test speech by asking the patient to say “baby hippopotamus” or something similar- looking for slurring or staccato speech
    • You may also want to check tongue movements

Upper limbs

  • Look for resting tremor
  • Ask the patient to stretch out their arms in front of them- look for positional tremor
    • Ask them to close their eyes- looking for any pronator drift
      • Check the rebound test by lightly pushing on their outstretched arms, looking for any accentuated upward reaction
  • Check tone (usually hypotonia in cerebellar disease)
  • Coordination
    • Finger nose test (intention tremor and past pointing)
    • Hand slapping (dysdiadochokinesia)

Lower limbs

  • Check tone
  • Coordination
    • Heel-shin test

NB A useful acronym is DANISH (Dysdiodochokinesia, Ataxia, Nystagmus, Intention tremor, Slurred or Staccato Speech, Hypotonia)

Also remember that the cerebellum produces ipsilateral signs

Finish

  • Say that you would want to check the fundi for papilloedema, perform a full neurological examination (particularly CNV, VII, VIII to exclude cerebellar pontine lesion)
  • Thank patient and wash hands
  • Summarise to supervisor/Record in notes – try and describe where the lesion possibly is and suggest further investigation/management as appropriate

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