Tuesday, February 8, 2011

CEREBELLAR DISORDER

COMMON CAUSES OF CEREBELLAR SYNDROMES

Acute (hours to days)
Cerebellar infarcts (Wallenberg / PICA syndrome)
Cerebellar hemorrhage
Encephalitis
Phenytoin toxicity

Subacute (weeks to month)
Alcohol abuse
Metastases
Paraneoplastic syndromes
Multiple sclerosis

Chronic (months to years)
Hereditary cerebellar degenaration (spinocerebellar ataxia)

=================
SHORTCASE
=================

UPPER LIMB (4)
1. arms outstretched and eyes closed --> limb of affected side DRIFT AWAY
2. arms outstretched, same level, quick push downward --> affected side REBOUND
3. finger-nose test --> INTENTIONAL TREMOR + DYSMETRIA
4. rapid alternating movement --> DYSDIADOCHOKINESIA

HEAD (3)
1. Eye --> HORIZONTAL NYSTAGMUS (> when look toward affected side)
2. Speech --> SCANNING/STACCATO
3. Head --> TITUBATION

TRUNK (1)
1. Sit patient up without support --> TRUNCAL ATAXIA

LOWER LIMBS
(2)
1. Heel-shin test --> DYSMETRIA + INTENTIONAL TREMOR
2. Knee reflex --> PENDULAR KNEE JERK

GAIT
(2)
1. Walk --> BROAD BASE + REEL TOWARD AFFECTED SIDE
2. Rombergs test --> NEGATIVE (in cerebellar disorders)

--------
Notes
--------

Unsteadiness + broadbase gait
= ?cerebellar OR ?vestibular OR ?proprioceptive

Vestibular
nystagmus; no other definite cerebellar signs; romberg negative

Proprioceptive
cerebellar sign may present; typically worse when eyes closed; romberg positive

Cerebellar
cerebellar signs; romberg negative

8 comments:

izianmunirah said...

Pneumonic : DASHING PR -dysdiadokinesia -ataxia (central) -scanning speech ( ask pt to pronounce:Persatuan peladang2 Pulau Pinang) -hypotonia -intentional tremor -nystagmus -gait (broad base) P-pendular jerk . R-Rebound phenomenon

Aizzat said...

Make sure korang tau how to examine parkison k ;)

Anonymous said...

mnemonic,bukan pneumonic (as in pneumonic changes in xray),any way thanks for the refreshment guys..it helps a lot..^^

IM said...

typing errorlah..

FaDhLi said...

haa..sape bleh tlg post untuk parkinson plak ? :D

Anonymous said...

nystagmus pon cerebellar kn?
so dashing prn la..huhu

FaDhLi said...

hehe.. takpe..add je mana yang kurang..

tapi bahaya jugak mnemonic sebab tak ikut susunan untuk examine.. lainla kalau boleh susun huruf mnemonic tu btol2 ikut susunan macam nak examine real patient..

lain org lain cara :)

Anonymous said...

Heel-shin test --> Dyssynergia
toe to finger test --> Dysmetria and intention tremor

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