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S/sx Cerebellar Dise
Clinical S/sx of Cerebellar Dysfunction
| Question | Answer |
|---|---|
| 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! |
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