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

2024
Views:

52

Pages:

2
Author:

O. Touhami

‭Cerebellar Syndrome: Clinical Features and Diagnosis‬ ‭-‬ ‭The‬ ‭amplitude‬ ‭of‬ ‭movements‬ ‭imparted‬ ‭to‬ ‭the‬ ‭limbs‬ ‭by‬ ‭the‬ ‭examiner‬ ‭is‬ ‭increased:‬ ‭at‬ ‭the‬ ‭level‬ ‭of‬ ‭the‬ ‭hands,‬ ‭when‬ ‭alternating‬ ‭rotational‬ ‭movements‬ ‭are‬ ‭applied‬ ‭to‬ ‭the‬‭patient's‬‭trunk,‬‭at‬‭the‬‭level‬‭of‬‭the‬‭feet,‬‭on‬‭the‬‭patient‬‭lying‬ ‭down (flail, doll of her).‬ ‭-‬ ‭The‬ ‭patellar‬ ‭reflexes‬ ‭can‬ ‭be‬ ‭a‬ ‭pendulum‬ ‭(on‬ ‭the‬ ‭patient‬ ‭seated,‬ ‭legs‬ ‭dangling,‬‭after‬‭percussion‬‭of‬‭the‬‭patellar‬‭tendon,‬‭the‬‭leg‬‭oscillates‬‭like‬‭a‬ ‭pendulum).‬ ‭-‬‭Stewart-Holmes maneuver.‬ ‭-‬ ‭Speech and writing disorders‬ ‭-‬‭Result from hypermetria and hypotonia.‬ ‭-‬ ‭Cerebellar dysarthria: typically scanned and explosive. In fact it is more‬ ‭often just “pasty”.‬ ‭-‬‭When writing, the letters are disproportionately uneven and spaced apart. o‬ ‭Ladder rung test: we draw the two uprights and we ask him to draw the‬ ‭rungs precisely, he will have difficulty stopping his action.‬ ‭Additional tests‬ ‭-‬ T ‭ here is no additional electrophysiological examination to confirm‬ ‭the existence of cerebellar syndrome.‬ ‭-‬ ‭On the other hand, brain imaging (CT or MRI) can reveal a lesion of the‬ ‭cerebellum or its peduncles. This imaging therefore aims as much at positive‬ ‭diagnosis as at etiological diagnosis.‬ ‭Differential diagnosis‬ ‭-‬ ‭Cerebellar syndrome is quite rarely isolated. It is often associated with a‬ ‭pyramidal syndrome, and when the voluntary command deficit is significant‬ ‭enough, false hypermetria may appear during finger/nose or heel/knee‬ ‭maneuvers. In other words, cerebellar maneuvers are quite often‬ ‭uninterpretable when there is a motor deficit.‬ ‭-‬ P ‭ roprioceptive ataxia (heel gait), vestibular ataxia and frontal ataxia can‬ ‭mimic cerebellar ataxia. The signs of a deep, vestibular or frontal sensory‬ ‭syndrome usually make it possible to decide.‬ ‭-‬ ‭In many cases, a pyramidal syndrome, a cerebellar syndrome and a‬ ‭proprioceptive syndrome coexist in the same patient, causing complex‬ ‭ataxias (for example, cerebellospastic ataxia).‬ ‭Topographic shapes‬ ‭-‬ ‭Static cerebellar syndrome, resulting in cerebellar ataxia. It is‬ ‭ ue to predominant damage to the cerebellar vermis.‬ d ‭-‬ ‭Kinetic cerebellar syndrome, dominated by hypermetria: it is mainly due to‬ ‭damage to the cerebellar hemispheres and/or the superior cerebellar‬ ‭peduncle.‬ ‭-‬‭NB: In fact, cerebellar syndrome is quite often stato-kinetic.‬ ‭-‬ ‭Damage to the superior cerebellar peduncle above the corner of Wernekinck‬ ‭can give rise to a cerebellar syndrome contralateral to the lesion, with typically‬ ‭a large intentional tremor. Impairment of the thalamus can also involve a‬ ‭cerebellar syndrome because it is in the thalamus that the superior cerebellar‬ ‭peduncle ends, which is the main cerebellar efference.‬