ABSTRACT
CEREBELLAR FUNCTION Mrs Barker, a 67-year-old lady, is complaining of being unsteady whilst walking. Please carry out a neurological examination to assess her balance and cerebellar function.
Introduces self and seeks permission to examine Confirms patient’s name and age Enquires about relevant symptoms Asks if patient is currently in any pain
Stands at the end of the bed and observes for presence of wheelchair, urinary catheter, titubation Examines for nystagmus Assesses for dysarthric speech (asks patient to say ‘British constitution’ or ‘baby hippopotamus’) Assesses tone in upper limbs Asks patient to perform finger-nose test, looking for upper limb ataxia Assesses for dysdiadochokinesis (by observing rapid alternating hand movements) Examines fine finger movements (asks patient to oppose each finger in turn against her thumb) Assesses for cerebellar drift Asks patient to perform heel-shin test, looking for lower limb ataxia Assesses gait Assesses tandem gait (asks patient to walk heel to toe) Performs Romberg’s test
Cleans hands by washing or using alcohol gel
Fluency of examination Competence in presenting findings, summarizing and forming differential diagnoses
KEY An easy way to remember the features of cerebellar disease is to remember the following:
D: dysmetria (past pointing in finger-nose test and dysdiadochokinesis), A: ataxia (finger-nose ataxia, heel-shin ataxia, ataxic gait – broad based and patient
falls to side of lesion), N: nystagmus (lesion is ipsilateral to the fast phase), I: intention tremor elicited in finger-nose test, S: slurring/staccato speech, H: hypotonia, hyporeflexia.
