we are now going to demonstrate the
cerebellar exam the cerebellum can be
affected in many of your patients and
you might not recognize that it's
effective unless you test the cerebellum
the signs of cerebellar dysfunction from
head to foot our scanning speech so if
you ask the patient to say something
with many consonants in it such as the
British constitution they might say the
burger Tisha Constitution scanning
speech breaking it out into individual
syllables they might have nystagmus so
if I ask the patient to follow my finger
they would have a nystagmus with the
fast phase pointing to the site of
disease I should also say that if they
have disease in the vermis and
flocculonodular lobe the patient
wouldn't even be able to sit up they
would have truncal ataxia and you would
not even be able to get this far in the
testing continuing after doing scanning
speech nystagmus we would now look for
desmet jia with the finger to nose test
the whole idea here is to try and put as
many joints in play as we can just count
them 1 2 3 4 5 6 as many joints as we
can we're agonist antagonist muscles are
working together and the great beauty of
the cerebellum is that it's able to
coordinate all of this in one smooth
motion and I'm going to now ask the
patient to touch his nose as quickly as
you can
back and forth if you don't mind
excellent and now touch my finger in
your nose this task which is not easy
comes about because of an intact
cerebellum another test that you can do
is called the rebound tests it's called
the rebound phenomenon or tests of
Stuart and Holmes when I ask the patient
to pull on my hand pull on my hand if
you would when I let go if I were to let
go suddenly the hand doesn't go and hit
him in the face because the antagonist
muscle quickly stops the movement but in
cerebellar disease that
may not happen so protect the patient by
putting a hand across the chest pull on
my hand please one more time and again
if the patient had cerebellar disease
the hand might go flying up there and
that is why you need to protect them I'm
now going to test for rapid alternating
movements so if you can put one hand out
like so
and with your other hand do this as
quickly as you can do it on the other
side and this phenomenon if it's
abnormal is called
dis diet ou doko kinesia the next thing
we look for is pendular knee jerks
patients with cerebellar disease might
have hypotonia but it may not be very
evident because we're much more tuned to
looking for hypertonia than hypotonia
and one manifestation is that when you
do the knee reflex in a patient with
cerebellar disease in hypotonia the leg
will keep swinging three or four or five
times after you've done the reflex as an
indication of their hypertonia we're now
going to step into the hall and do the
gait the cerebellar gait is
characterized by a broad stand and by a
wide staggering quality to it people
will tend to fall towards the side of
their illness so if the illness is in
the cerebellar hemisphere on the left
they might fall in that direction when
asked to stand still their trunk may
sway like this and that is called tissue
bation and obviously they would have
problems with all the other cerebellar
tests one caveat many people think of
the Romberg test as being a test of
cerebellar disease the Romberg test has
nothing to do with the cerebellum the
cerebellum is already swing and it gets
a lot worse when you have them close
their eyes but the Romberg test is
really a test of proprioception when you
and I are standing like this with our
eyes open we are getting signals from
our joints to tell us where we are in
space if however you have a problem with
proprioception because of your
peripheral nerves or posterior columns
then you're relying on your eyes to tell
you where you are in space and therefore
the moment you ask the patient to stand
still and close their eyes
the patient begins to sway and that is a
positive Romberg test it has very little
to do with the cell button
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