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S/sx Cerebellar Dise

Clinical S/sx of Cerebellar Dysfunction

What are the functional areas of the cerebellar cortex? Cortex of vermis; Inermediate zone; Lateral zone
What types of movements involve the cortex of the vermis? Long axis movements (neck, shoulders, thorax, abdomen, pelvis/hips)
What movements involve the intermediate cerebellar zone? Controls muscles of the distal parts of limbs, especially hands & feet
What movements involve the lateral zone (highest level) of cerebellum? Planning of sequential movement of entire body; involved in conscious assessment of mvmt errors
What is seen with a midline zone dysfunction? Gait/stance disorders; Titubation; Rotated/tiled head posture (could be to either side); Oculomotor disorders (spontaneous nystagmus); Affective disturbances (flat/blunted emotions)
What is titubation? Rhythmic tremor or head/body that occurs several times/second
Lesion in 1 cerebellar hemisphere gives off s/sx where? Ipsilaterally
Essential function of cerebellum Coordinate all reflex & voluntary muscle activity (doesn't initiate muscle mvmt)
Is there paralysis or sensory change or atrophy with cerebellar injury? No, but there could be hypotonia & incoordination, usually in entire extremity or 1/2 of body (whole body if bilateral cerebellum)
S/sx of acute cerebellar lesion Sudden & severe; Patient can recover completely
S/sx of chronic cerebellar lesion Less severe; due to slowly enlarging tumors, alcohol, etc.
Hypotonia Lose resilience to palpation; Diminished resistance to PROM; Loss of cblr influence on stretch reflex
Postural & Gait Changes Head may be rotated/flexed; Shoulder of side of lesion lower than normal side; Wide gait; Stiff legs as compensation for hypotonia; Walk with lurch/stagger; Loses balance toward affected side
Difference b/t cblr & sensory ataxia Wide based gait & lurching/staggering could occur with both; cerebellar has no sensory issues or muscle weakness
Disturbances of voluntary mvmt (ataxia) Muscles contract irregularly/weakly (but could pass a MMT); Tremor during find mvmts (intention-type); Decomposition of mvmt; Dysmetria (fingers to nose with arms abducted)
Dysdiadochokinesia can't do alternating mvmts rapidly; Ex: couldn't pronate/supinate quickly without decomposition of mvmt
Disturbances of reflexes Pendular knee jerk; Disturbance of tone
Disturbances of Ocular movement Nystagmus; Confined to 1 plane usually (horizontal most commonly)
Disorders of Speech Cerebellar dysarthria (ataxia of laryngeal mm); Articulation is jerky & syllables often separated; Speech may be explosive & slurred
Lateral Zone Dysfunction Decomposition of mvmt; disturbed stance/gait; hypotonia; dysarthria; dysdiadokinesia; ataxia; tremor; oculomotor disorders
Lateral zone- Impaired check & rebound performs MMT normally, but when resistance removed, the body part jerks away quickly
Lateral zone- disturbances of exec functioning poor planning; trouble with working memory (short-term info); decreased verbal fluency (staccato speech, difficulty getting things to flow)
Lateral zone- impaired spatial cgnition can't remember pathway, visual-spatial memory
Lateral zone0 personality changes & linguistic difficulties Intonation when speaking; speech no longer rhythmical
Vermis Syndrome Medulloblastoma in kids; gait/stance disorders; titubation; rotated/tilted head; oculomotor disorders; affective disorders
Medulloblastoma in Children (Vermis Syndrome) in further detail Flocculonodular lobe (vestibular involvement); Mm incoordination involves midline structures (head/trunk); Child falls backward/forward; Difficulty holding head steady; +/- holding trunk steady
Cerebellar Hemisphere Syndrome- more lateral lesion, what happens? More distal limbs are involved
Cerebellar Hemisphere Syndrome s/sx where? Unilateral, involve mm on side of lesion. Muscles of limbs more involved than trunk/head
Cerebellar Hemisphere Syndrome S/sx Sway/fall to side of lesion w/ eyes open; Dysarthria/nystagmus; delayed mvmt initiation; Incoordination; Stance/gait; Low tone; Tremor; Impaired check/rebound; Problems w/ exec fxning; impaired spatial cognition; Linguistic difficulty; Personality change
Spinocerebellar Ataxia- Friedreich's Degeneration of peripheral nn, spinocerebellar paths, dorsal columns, CST tracts in cord; begins in childhood/early teen with ataxia of limb mvmt/gait, + Babinski
What happens as Friedreich's ataxia progresses? Scoliosis, pes cavus, limb weakness, loss of DTRs, position & vibration sense in limbs
Spinocerebellar Ataxia- Sporadic olivopontocerebellar atrophy Loss of nns of inferior olives, pons, & cblr cortex; ataxic gait, dysarthria, cblr tremor of trunk/lumbs; incoordinated limb mvmt; +/- multi-system atrophy
Multiple System Atrophy cblr ataxia with ANS insufficiency & Parkinsonian features
Spinocerebellar Ataxia- Alcoholic Cerebellar Degeneration Affects anterior/superior part of cblr vermis- gait ataxia, but preserved speech & UE coordinated mvmts
Posterior Inferior Cblr Artery Supplies: Most of inferior 1/2 of cblm; Inferior vermis; Central nuclei of cblm (fastigial/globose)
Anterior Inferior Cblr Artery Supplies: Middle cblr peduncle; Strip of ventral cblm b/t territories of PICA & SCA, including flocculus
Superior Cblr Artery Supplies: Superior cblr peduncle; Most of superior 1/2 of cblr hemisphere (includes lateral DCN); Superior vermis
Vascular Syndrome of SCA Most common; Ipsilateral dysmetria; limb ataxia; Horner's sx; contralateral pain/temp loss; contralateral trochlear n palsy
Vascular Syndrome of AICA Ipsilateral ataxia; Horner's sx; facial sensory impairment; contralateral pain/temp loss in limbs, & at times, dysphagia; Nystagmus (from vestibular involvement, not cblr)
Vascular Syndrome of PICA Ataxia; Hypotonia; Loss of pain-temp ssn on face ipsilaterally & loss of blink reflex after ipsilateral stim; Loss of pain/temp to contralateral side of body; Nystagmus (vestibular, not cerebellar); Ipsilateral Horner's sx; Dysphagia; Dysphonia
Cerebellar Hemorrhage usually occurs in patients with? Chronic HTN; Arteriovenous malformation; Hemorrhagic conversion of ischemic infarct; Metastases
S/sx of Cerebellar Hemorrhage Headache; N/V; Ataxia; Nystagmus; early ID is crucial!
Created by: 1190550002