Cerebellar Examination

Cerebellar Examination The cerebellar examination is performed in patients with neurologic neurological al signs or symptoms of cerebellar pathology pathology e.g dizziness, loss of balance or poor co-ordination. co-ordination. There are many causes of cerebellar dysfunction and include vascular e.g. stroke, space-occupying lesions, multiple sclerosis and genetic conditions such as Friedreich Friedreich’s ’s Ataxia Ataxia,, to name a few. The cerebellar examination needs to reflect these symptoms and as such involves examining the gait, balance and co-ordination.

Subject steps 1. Wash your hands, introduce introduce yourself yourself to the patient and clarify their their identity. Explain what you would like to do and obtain consent 2.

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Gait:

 Ask the patient to stand up. Observe Observe the patient’s patient’s posture and and whether they they are steady on their feet.  Ask the patient to walk, e.g. to the the other side of the room, and back. back. If the patient normally uses a walking aid, allow them to do so.

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 Ask the patient to walk walk

3. Observe the different gait components components (heel (heel strike, toe lift off). Is the the gait shuffling/waddling/scissori shuffling/wad dling/scissoring/ ng/ swinging? Observe the patients arm swing and take note how the patient turns around as this involves good balance and co-ordination.  Ask the patient to walk heel-to-toe heel-to-toe to assess balance. balance.

Heel-to-toe test

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4. Perform Romberg’s test by asking the patient to stand unaided with their eyes closed. If the patient sways or loses balance then this test is positive. Stand near the patient in case they fall.

Romberg's test

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5. Check for a resting tremor in the hands by placing a piece of paper on the patient’s outstretched hands.

Look for a resting tremor in the

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hands 6. Test tone in the arms (shoulder, elbow, wrist).

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Test tone in the shoulder

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Test tone in the elbow

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Test tone in the wrist

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Co-ordination:

Test for dysdiadochokinesis by showing the patient how to clap by alternating the palmar and dorsal surfaces of the hand. Ask them to do this as fast as possible and repeat the test with the other hand.

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Palm up

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Palm down

8. Perform the finger-to-nose test  by placing your index finger about two feet from the patients face. Ask them to touch the tip of their nose with their index finger then the tip of your finger. Ask them to do this as fast as possible while you slowly move your finger. Repeat the test with the other hand.

Finger-to-nose test

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9. Perform the heel-to-shin test . Have the patient lying down for this and get them to run the heel of one foot down the shin of the other leg, and then to bring the heel back up to the knee and start again. Repeat the test with the other leg.

Heel-to-shin test

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10. Finish by washing your hands and thanking the patient. Summarise your findings to the examiner and offer a differential diagnosis. Common conditions include Parkinson - See more at: http://www.osceskills.com/e-learning/subjects/cerebellar examination/#sthash.McfXmV0p.dpuf