13 terms

MSAT - Cerebellar Examination

STUDY
PLAY

Terms in this set (...)

Opening introduction
HELPP:
H: 'Hello' (introduction & consent)
E: Exposure (underwear)
L: Lighting
P: Positions correctly (standing)
P: Patient in any pain
Wash hands
General inspection of the room
Inspect the room for:
• Railings
• Walking aids
• Catheter
• Wheel chair
• Medications
General inspection from foot of the bed
Inspect patient for:
- Truncal instability
- Titubation of the head
- Stiffness of neck
- Level of consciousness
Inspect the eyes
Ask the patient to follow your finger far left and as far right (keeping their head still)
Inspect for:
- Nystagmus
N.B. Usually it is jerky horizontal nystagmus with increased amplitude on looking towards the side of the lesion
Assesses articulation (dysarthria)
Examine the patient SPEECH by asking them various questions. Start off by asking which is the dominant hand (this will come in handy later)
Ask them to repeat "British Constitution".
Examining for:
- Dysarthria
- Staccato
- Jerkiness
- Rapid changes in volume
Assess the patient's upper limb
Assess for:
- Tone (shake hands)
- Arm drift (agonist muscle hypotonia)
- Arm rebound
- Dysdiadochokinesis (rapid alternating)
- Precision movements ("playing piano")
- Finger-nose
Assess the patient's lower limb
Assess for:
- Tone (atonia?)
- Heel-Shin test (tests ataxia)
- Dysdiadochokinesis (foot tapping)
- Pendulum knee jerks
- Toe-finger test for dysmetrias (past pointing) or intention tremor
See if they can sit up and get off the bed from lying position. Examine their movements
Examine for:
- Truncal Ataxia
A loss of coordinated muscle movements for maintaining normal posture of the trunk.
Ask the Patient to stand up and get them to walk a few passes up and down the room. Assess their GAIT
Assess gait for:
- Ataxic gait (wide base)
- Antalgic Gait
- Walking aids
- Heel-toe (tandem) gait "tightrope walk"
N.B. Notes which direction patient deviates towards (falls towards side of lesion in cerebellar disease)
Romberg's test
Differentiate between sensory and cerebellar ataxia:
- Sensory ataxia: Stabilises when eyes are opened
- Cerebellar ataxia: Unstable with the eyes open)
Finish off examination
Finish off the examination with:
- Thanking patient
- Offer to help patient get dressed
- Wash hands
- Presents findings
- Offer appropriate differential
- Suggests relevant investigations
- Suggest management
Mnemonic to remember signs and causes of cerebellar disease
"DANISH PASTRIES"
Mnemonic for signs of cerebellar disease:
D: Dysmetria & dysdiadochokinesis
A: Ataxia
N: Nystagmus
I: Intention tremor
S: Slurred/staccato speech
H: Hypotonia

Mnemonic for causes of cerebellar disease:
P: Posterior fossa tumour
A: Alcohol
S: Multiple sclerosis
T: Trauma
R: Rare
I: Inherited (e.g. Friedreich's ataxia)
E: Epilepsy medication (carbamazepine, phenytoin toxicity)
S: Stroke
If the person has alcohol induced cerebellar dysfunction, what part of their body is usually spared?
Alcohol tends to spare the upper limbs.