Cerebellum Examination (Stanford Medicine 25)

Cerebellum Examination (Stanford Medicine 25)



we are now going to demonstrate the cerebellar exam the cerebellum can be affected in many of your patients and you might not recognize that it's effective unless you test the cerebellum the signs of cerebellar dysfunction from head to foot our scanning speech so if you ask the patient to say something with many consonants in it such as the British constitution they might say the burger Tisha Constitution scanning speech breaking it out into individual syllables they might have nystagmus so if I ask the patient to follow my finger they would have a nystagmus with the fast phase pointing to the site of disease I should also say that if they have disease in the vermis and flocculonodular lobe the patient wouldn't even be able to sit up they would have truncal ataxia and you would not even be able to get this far in the testing continuing after doing scanning speech nystagmus we would now look for desmet jia with the finger to nose test the whole idea here is to try and put as many joints in play as we can just count them 1 2 3 4 5 6 as many joints as we can we're agonist antagonist muscles are working together and the great beauty of the cerebellum is that it's able to coordinate all of this in one smooth motion and I'm going to now ask the patient to touch his nose as quickly as you can back and forth if you don't mind excellent and now touch my finger in your nose this task which is not easy comes about because of an intact cerebellum another test that you can do is called the rebound tests it's called the rebound phenomenon or tests of Stuart and Holmes when I ask the patient to pull on my hand pull on my hand if you would when I let go if I were to let go suddenly the hand doesn't go and hit him in the face because the antagonist muscle quickly stops the movement but in cerebellar disease that may not happen so protect the patient by putting a hand across the chest pull on my hand please one more time and again if the patient had cerebellar disease the hand might go flying up there and that is why you need to protect them I'm now going to test for rapid alternating movements so if you can put one hand out like so and with your other hand do this as quickly as you can do it on the other side and this phenomenon if it's abnormal is called dis diet ou doko kinesia the next thing we look for is pendular knee jerks patients with cerebellar disease might have hypotonia but it may not be very evident because we're much more tuned to looking for hypertonia than hypotonia and one manifestation is that when you do the knee reflex in a patient with cerebellar disease in hypotonia the leg will keep swinging three or four or five times after you've done the reflex as an indication of their hypertonia we're now going to step into the hall and do the gait the cerebellar gait is characterized by a broad stand and by a wide staggering quality to it people will tend to fall towards the side of their illness so if the illness is in the cerebellar hemisphere on the left they might fall in that direction when asked to stand still their trunk may sway like this and that is called tissue bation and obviously they would have problems with all the other cerebellar tests one caveat many people think of the Romberg test as being a test of cerebellar disease the Romberg test has nothing to do with the cerebellum the cerebellum is already swing and it gets a lot worse when you have them close their eyes but the Romberg test is really a test of proprioception when you and I are standing like this with our eyes open we are getting signals from our joints to tell us where we are in space if however you have a problem with proprioception because of your peripheral nerves or posterior columns then you're relying on your eyes to tell you where you are in space and therefore the moment you ask the patient to stand still and close their eyes the patient begins to sway and that is a positive Romberg test it has very little to do with the cell button the preceding program is copyrighted by the Board of Trustees of the Leland Stanford junior University please visit us at med.stanford.edu