Cerebellar examination is a part of a complete neurological examination concerned with the evaluation of all the functions of the cerebellum.
Classification of cerebellum
1. Archicerebellum: Concerned with truncal movement, balance, posture
2. Paleocerebellum: Concerned mainly with tone
3. Neocerebellar(major portion): Concerned with crude movements
The nucleus of the cerebellum
DEFG
- Dentate
- Embolism
- Fastigii
- Globus
Functions of the cerebellum and cerebellar examinations
SIDDHART N DP
Pneumonics
| S | I | D | D | H | A | R | T | N | D | P |
| Scanning Speech | Intention Tremor | Dysdiadokinesia | Dysmetria | Hypotonia | Ataxic Gait | Rebound Phenomena | Truncal Ataxia | Nystagmus | Dyssynergia | Pendular Jerk |
Nystagmus
The involuntary rhythmic movement of the eye
| Types of Nystagmus | Affected lesion in | Anatomical features |
|---|---|---|
| Horizontal | Vestibular nucleus, Cerebellum | |
| Rotatory | Labyrinth | Circular (@) |
| Vertical | the brain stem | Straight (¥) |
Examination: Check for nystagmus in the eye
Scanning Speech
Examinations:
Prerequisites:- There should be no weakness in the limbs
Ask to speak : PA_TA_KA
Hot potato speech will be heard i.e. there will be long pauses between syllables and words with a loss of melody in speech production
Tremor
Intentional tremor (Target approach tremor) is seen
A tremor is a coarse rapid side-to-side oscillation that increases as the person approaches the target.
Examinations:
Ask the patient to approach a target with the tip of the finger
Tremor will be seen and unable to approach the target
Rest tremor is present during rest. Eg. Parkinsonism
Dysdiadokinesia
Inability to defined as the inability to perform rapid alternating muscle movements
Examination:
Ask the patient to do quick, synchronous, and can include pronation/supination, fast finger tapping, opening and closing of the fists, and foot tapping
Unable to do so
Dysmetria
Dysmetria is the inability to control the distance, speed, and range of motion necessary to perform smoothly coordinated movements and activities.
Examination:
Pre-pointing
Could not approach the target by pointing the finger
Rebound Phenomena
Rebound phenomena is elicited by having the patient attempt to move a limb against resistance. When the resistance is suddenly removed, the limb normally moves a short distance in the desired direction and then rebounds (jerks back in the opposite direction)
Examination:
Pre-requisites: Eye close
Unable to control hand movement, the hand will hit the face
Dyssynergia
Dyssynergia is any disturbance of muscular coordination, resulting in uncoordinated and abrupt movements.
Examination:
Ask the patient to perform step-by-step work
Unable to perform in a sequence suggest dyssynergia
Step-by-step work
Truncal Ataxia (Head nodding)
Examination:
Ask patient to squat and stand up
Involuntary tremor that occurs in the head, neck, and trunk area or called Titubation
Pendular Jerk
Examination:
Pre-requisites: Sitting position knee jerk in performed
(>3 times) signifies increase jerk
Hypotonia
Look for the tone of muscle
See also: Motor Examination
Gait
Wide-based Ataxic gait (gait while drunk)
