Physical Signs of Cerebellar Disease

The College had asked about this in Question 26.1 from the second paper of 2011 (specifically, they wanted head signs) and Question 12.4 from the second paper of 2009 (specifically, they wanted signs which do not involve the limbs)

For a study resource, if one were to abandon Talley and O'Connor for some reason, one could instead turn to Walker's "The Neurologic System"(1990) which is available for free. It has a nice "Head" section, first up. These two books have been the chief resource for the summary offered below.

Physical signs by body region

Clinical Signs in Cerebellar Disease

Body region

Clinical Signs

Description, interpretation, correlation

Head Nystagmus Jerky horisonal sacchades. Likely, indicates the flocculus is involved.
Titubation Resting tremor of the head. Rotatory, rocking or bobbing movement. This does not seem to have any localising value.
Staccato speech The cerebellar patient will have explosive, monosyllabic speech.
Skew deviation of the eyes A vertical misalignment of the eyes- one points up, and the other points down - resulting in diplopia of vertical gaze. The head ends up being tilted towards the side of the lower eye.
Ocular dysmetria A constant under- or over-shooting of the eyes when attempting to focus gaze on something. Most likely indicates dysfunction of the dorsal vermis and fastigial nuclei
Head deviation A disorder of tone on the affected side.
Impairment of the finger-nose test Wildly inaccurate finger-nose coordination on the affected side
Upper limb Tone There will be hypotonia on the affected side. A sign of lateral lobe dysfunction.
Tremor Coarse, rapid, side-to-side oscillations on the affected side.
A sign of ipsilateral lateral lobe dysfunction.
Drift With the arm outstretched, the arm will drift aimlessly. When its position is changed with a sharp tap, the arm postion will overcorrect, unable to achieve its original position.
Dysdiadochokinesis The patient will be unable to perform rapid alternating movements.
Arrhythmokinesis The patient will be unable to tap out a simple tune on your desk. There will be a disturbance in timing and in the force of tapping.
Arm rebound Ask the patient to flex or extend against resistance, and rapidly release the tested arm. The patient will be unable to arrest the arm's movement on the affected side, and the arm will hit either one of you in the face.
Impairment of the finger-nose test Wildly inaccurate finger-nose coordination on the affected side
Trunk Trunkal ataxia The patient will not be able to sit up straight with their eyes closed. They may even fall over. A sign of flocculonodular lobe dysfunction.
Lower limb Gait The classical cerebellar gait at rest is a wide-based stance.
Tandem gait The cerebellar patient will not be able to walk heel-to-toe. A sign of anterior cerebellar lobe dysfunction.
Gait ataxia without limb impairment indicates damage to the anterior superior vermis.
Heel-shin test The cerebellar patient will not be able to smoothly run their heel along their shin.
Stagger The cerebellar patient will stagger drunkenly to the side of the lesion. A sign of flocculonodular lobe dysfunction.

 

 

References

Schmahmann JD (2004). "Disorders of the cerebellum: ataxia, dysmetria of thought, and the cerebellar cognitive affective syndrome"J Neuropsychiatry Clin Neurosci 16 (3): 367–78

Clinical Examination of the Critically Ill Patient, 3rd edition by L.I.G. Worthley - which can be ordered from our college here.

Clinical Examination: whatever edition, by Talley and O'Connor. Can be acquired any damn where.

My own gibberish notes from medical school.

Walker, H. Kenneth, W. Dallas Hall, and J. Willis Hurst. "The Neurologic System." (1990). Specifically: Chapter 69, "The Cerebellum"

Ellenberger, Carl, John L. Keltner, and Malcolm H. Stroud. "Ocular dyskinesia in cerebellar disease: Evidence for the similarity of opsoclonus, ocular dysmetria and flutter-like oscillations." Brain: a journal of neurology (1972).