List 4 clinical signs which may be noticeable on examination of the head in a patient with cerebellar disease.

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College Answer

  • Nystagmus
  • Titubation
  • Staccato speech
  • Skew deviation of the eyes
  • Impairment of finger-nose test

Discussion

This question interrogates one's knowledge of the highly regarded Talley and O'Connor manual of physical examination.

Talley and O'Connor visits the cerebellum twice, once in the chapter on the neurological examination of the head, and once in the discussion of "Correlation of physical signs and neurological disease". Neither time is there discussion of what specifically to look for in the patient's head. Its just not that specific.

Similarly, L.I.G Wortheley in the 3rd edition of CECIP (Clinical Examination of the Critically Ill Patient) makes mention of the cerebellum, but does not actually go through it in quite such a fashion.

So, where does one go for a thorough summary of what one can expect from a cerebellum-damaged head?

It seems, nowhere.*

Thankfully, from our medical school days, it seems about 84% of us can remember at least a few of the cerebellar signs. But, in searching for the specific signs mentioned by the college, I came across something. A website by the Coopers. ** These seem to be a couple who have moved from Australia to Ohio. This, in a deliciously unexplained twist, is completely irrelevant to the extravagant and all-encompassing mass of neurological examination material which abounds on their site. I have taken the liberty of linking to some of the documents they host.

Bob and Christina Cooper, I salute you.

* Several years after writing this rant, I have discovered a venerable document from 1990, available for free for all to read, which conveniently divides the cerebellar examination into body regions. This resource has subsequently given rise to a locally available summary of cerebellar physical signs and examination technique. The obsolete rant still remains in situ for structural reasons. - AY.(2015)

** That Coopers website is now down. http://www.hy-q.com/ now sends you to something completely unlike the cranial nerves. I believe it now belong to the manufacturer of industrial sensors. At this  stage, the whereabouts of the Coopers are unknown. Their site can still be seen by accessing the archived copy on the Wayback Machine Internet Archive, where some of the PDF documents are still preserved. - AY.(2018)

 

References

References

Schmahmann JD (2004). "Disorders of the cerebellum: ataxia, dysmetria of thought, and the cerebellar cognitive affective syndrome"J Neuropsychiatry Clin Neurosci 16 (3): 367–78

Clinical Examination of the Critically Ill Patient, 3rd edition by L.I.G. Worthley - which can be ordered from our college here.

Clinical Examination: whatever edition, by Talley and O'Connor. Can be acquired any damn where.

My own gibberish notes from medical school.

Walker, H. Kenneth, W. Dallas Hall, and J. Willis Hurst. "The Neurologic System." (1990). Specifically: Chapter 69, "The Cerebellum"