University:
The University of British Columbia
Course:
MEDD 448 | Transition into Postgraduate Education and Practice
Academic year:

2024
Views:

251

Pages:

2
Author:

O. Touhami

‭Cerebellar Dysfunction: Comprehensive Diagnostic Evaluation‬ ‭-‬‭Radiological: x-rays of the spine, brain and spinal cord exploration by MRI.‬ ‭-‬‭Electrophysiological: conduction velocities, EMG.‬ ‭-‬‭Vascular: arterial Doppler of the lower limbs, carotid vessels.‬ ‭-‬ ‭Biological: PL, search for diabetes, measurement of muscle enzymes, vitamin‬ ‭B12 and folate.‬ ‭-‬ ‭B12 deficiency:‬ ‭o‬ ‭Heeling.‬ ‭o‬ ‭Spasticity - pyramidal syndrome.‬ ‭o‬ ‭Lower limbs - medullary.‬ ‭o‬ ‭Additional examination: biology with macrocytic anemia -‬ ‭Biermer's disease causing combined sclerosis of the marrow.‬ ‭-‬‭Ophthalmology and ENT.‬ ‭-‬ ‭All symptoms and signs resulting from damage to the cerebellum itself‬ ‭(hemispheres or vermis) and/or the superior, middle and inferior cerebellar‬ ‭peduncles.‬ ‭Symptoms‬ ‭-‬‭Walking and balance problems (sometimes falls).‬ ‭-‬‭Clumsiness in rapid movements.‬ ‭-‬‭Dysarthria.‬ ‭-‬‭Trembling.‬ ‭Balance and walking disorders: cerebellar ataxia.‬ ‭-‬‭Spontaneously in a standing position: widening of the support polygon.‬ ‭-‬‭Feet together: o‬ ‭In major forms: oscillations in all directions.‬ ‭‬ N o ‭ ot aggravated by occlusion of the eyes (no Romberg sign). In minor‬ ‭o‬ ‭forms: “dance of tendons”. alternate contraction of the extensor and‬ ‭flexor tendons.‬ ‭-‬‭Approach :‬ ‭o‬ ‭Widening of the support polygon, arms separated from the‬ ‭trunk, irregular strides, feet thrown too high.‬ ‭o‬ ‭Lurches: nervous gait.‬ ‭o‬ ‭In minor forms, a cerebellar syndrome can be detected during a sudden‬ ‭stop which unbalances the patient, during a U-turn which will be broken‬ ‭down, or when walking in tandem.‬ ‭Disorders of the execution of rapid voluntary movement‬ ‭-‬‭Dysmetria-hypermetria: this is, with ataxia, THE major cerebellar SIGN. o‬ ‭ he instruction must be to execute the movement as quickly as possible; The‬ T ‭patient misses and/or‬ ‭ xceeds the goal to be achieved and then returns to it.‬ e ‭ ‬ ‭There is sometimes only a discreet "picking" at the end of the‬ o ‭movement (pseudotumor), when the heel descends along the tibial‬ ‭crest of the opposite leg, it is in a zig-zag pattern.‬ ‭-‬‭Asynergy: absence of heel lift in the squatting position.‬ ‭-‬‭Dyschronometria: delay in starting and stopping the movement.‬ ‭-‬‭Adiadochokinesia: disrupted repetitive reciprocating movements (puppets).‬ ‭-‬‭Tremor:‬ ‭o‬ ‭Intentional: worsens as the goal approaches, especially clear at the‬ ‭beginning and end of the voluntary movement.‬