Cerebellar examination

I would like to direct my further examination to find the cause of cerebellar ataxia…

Unilateral lesion (appendicular signs – e.g. finger nose test, intention tremor) – examine cranial nerves for cerebellopontine angle tumour (CN V, VII, VIII).

Midline vermis lesion is suggested by truncal ataxia, abnormal heel-toe, abnormal speech.

Remember:

• Cerebellar signs – signs are ipsilateral to side of lesion
• Hypotonia in cerebellar disease is due to loss of facilitatory influence on spinal neurons
• Dysmetria = lack of coordination of movement typified by under/over shoot of arm/leg/eye
• Dysdiadochokinesis = inability to perform rapidly alternating movements