Cristian Stefan, MD Department of Cellular Biology and Anatomy Georgia Health Sciences University April 13, 2011

CEREBELLUM Part II
Clinical examination and functional and clinical applications Based on the anatomy and physiology of the cerebellum discussed yesterday. Vestibulocerebellum Spinocerebellum Cerebrocerebellum Please think about the cerebellar circuits (parts of cerebellum involved, input, output) and how they work separately and together. In real life, pathological processes in the cerebellum could affect more than one circuit. Main cerebellar syndromes. Lesions of the spinal cord or brainstem could result in cerebellar dysfunctions.

Cristian Stefan, MD - April 2011

Important questions Ipsilateral or contralateral clinical manifestations? Location of lesions and severity of manifestations. Examples: cerebellar cortex, nuclei, peduncles Acute vs. chronic lesions Etiology vs. localization Age of patient Plasticity phenomenon Clinical manifestations Ataxia = lack of order (incoordination) Truncal ataxia Limb ataxia

Postural instability (imbalance) When and how? Static - Precautions Romberg test What does it test? (meaning, practical significance)

Dynamic Impaired gait Wide base gait vs. ataxia in one lower limb How does it manifest Where is the lesion? Falling down

Titubation

Cristian Stefan, MD - April 2011

Muscle tone (hypotonia)

Rebound phenomenon

Dysmetria Finger-to-nose Heel-to-shin

Kinetic (intentional) tremor it intensifies with the movement

Dysdiadochokinesis (difficulty to perform rapidly alternating movements)

Decomposition of movements

Dysarthria (scanning, slurred speech, irregular emphasis on syllables, usually with preservation of grammar and vocabulary)

Difficulties in learning / remembering motor tasks, especially complex ones.

Deficit in voluntary eye movements

Nystagmus (could have many origins, not only cerebellar!)

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During the second hour (9-10 am) on April 13, we will continue with the discussion of cases that exemplify motor system disorders.

Cristian Stefan, MD - April 2011