Cerebellar Dysfunction

Question 1

What could be the cause if cerebellar dysfunction is acute/abrupt?

Answer 1

CVA or brain lesion

Question 2

What could be the cause if cerebellar dysfunction has rapid progression (hours to days)?

Answer 2

• infarction
• immune-mediated disorders

Question 3

What could be the cause if cerebellar dysfunction has slower progression (weeks to months)?

Answer 3

• paraneoplastic disorders
• encephalopathy
• vitamin deficiency states
• general medical conditions

Question 4

What could be the cause if cerebellar dysfunction is chronic (months to years)?

Answer 4

• general ataxias
• toxins (alcohol)

Question 5

Primary method of diagnosis of cerebellar issues

Answer 5

brain and brainstem MRI

Question 6

What happens to the cerebrum and cerebellum with alcoholic ataxia?

Answer 6

starts to shrivel up

Question 7

What is the most noticeable symptom of cerebellar dysfunction?

Answer 7

ataxia - poor muscle control that causes clumsy voluntary movements

Question 8

S&S of alcoholic ataxia

Answer 8

• wide-footed, unsteady gait
• dysarthria
• clumsiness of their hands
• diplopia, saccades
• peripheral neuropathy

Question 9

characteristics of Korsakoff’s psychosis

Answer 9

• severe impairments in immediate recall
• anterograde or retrograde amnesia
• disorientation
• emotional changes
• confabulation - honest lying

Question 10

characteristics of Wernicke’s Encephalitis

Answer 10

• confusion
• ataxia
• ophthalmoplegia - weakness of optic muscles
• anisocoria - unequal pupil sizes
• nystagmust

Question 11

What causes Wernicke-Korsakoff syndrome?

Answer 11

chronic alcohol use that leads to thiamine (vitamin B1) deficiency

Question 12

What is chiari malformation?

Answer 12

congenital condition in which structural abnormalities lead to herniation of cerebellum through foramen magnum, compression involved structures

Question 13

Type 1,2,3 of chiari malformation

Answer 13

Type 1 - symptoms appear in adolescence or adulthood

Type 2 - symptoms appear in childhood

Type 3 - symptoms appear in babies - rare but most severe

Question 14

symptoms of chiari malformation

Answer 14

Can be asymptomatic

• neck pain
• occipital headache
• hearing or balance problems
• dizziness
• vomiting
• tinnitus
• incoordination

Question 15

What is Friedreich’s ataxia? When do symptoms onset?

Answer 15

• degeneration of spinal and peripheral nerves, cerebellum
• symptom onset in childhood, latest mid-20s

Question 16

S&S of cerebellar Friedreich’s ataxia

Answer 16

• imbalance
• incoordination
• dysarthria
• dysphagia
• weakness

Question 17

S&S of non-cerebellar Friedreich’s ataxia

Answer 17

• scoliosis
• visual or hearing loss
• hypertrophic cardiomyopathy
• peripheral neuropathy

Question 18

prognosis of Friedreich’s ataxia. What is the most common cause of death?

Answer 18

• mortality between 40s-60s
• most common cause of death is heart disease
• average time from someone going from walking to needing a wheelchair is ~ 10 years

treatment - symptom management and functional training

Question 19

What is spinocerebellar ataxia? What type of symptoms will be seen?

Answer 19

• degenerative process involving the cerebellum and its efferent and afferent connections
• See UMN and LMN signs due to spinal cord and alpha motor neuron involvement

Question 20

What is unique about spinocerebellar ataxia?

Answer 20

Significant degree of variations of presentation, prognosis, and progression because there are over 50 types

Question 21

When does onset occur with spinocerebellar ataxia?

Answer 21

anywhere between childhood and adulthood

Question 22

What will be seen with type 1 spinocerebellar ataxia?

Answer 22

most common
- optic atrophy
- ophthalmoplegia
- dementia/cog deficits
- amyotrophy - asymmetric lower limb motor neuropathy
- extrapyramidal signs

Question 23

What are extrapyramidal signs?

Answer 23

basal ganglia impairments
- involuntary muscle contractions
- tremors
- stiff muscles
- bradykinesia
- involuntary movements

Question 24

What will be seen with type 2 spinocerebellar ataxia?

Answer 24

dominated by visual loss
- retinal degeneration which may be associated with ophthalmoplegia and extrapyramidal signs

Question 25

What will be seen with type 3 spinocerebellar ataxia?

Answer 25

pure cerebellar ataxia

Question 26

What will be seen with type 4 spinocerebellar ataxia?

Answer 26

hearing loss - deafness and the presence of myoclonus - brief, involuntary, or jerking of muscles

Question 27

What is the SARA? What is the scale?

Answer 27

scale for assessment and rating of ataxia 8-items - 0 = no ataxia - 40 = most severe ataxia

Question 28

What does the SARA evaluate? What does it not evaluate

Answer 28

Evaluates - gait - standing - sitting - speech - finger to finger and finger to nose - RAMs and heel to shin Does not evaluates - does not consider oculomotor function

Question 29

What medications may help cerebellar symptoms?

Answer 29

- vitamin E - coenzyme Q10

Question 30

______________ involvement poorer prognosis for recovery compared to cerebellar cortex

Answer 30

deep nuclear involvement

Question 31

T/F: If nearby brainstem involved in injury, patients will likely have more significant and lingering deficits

Answer 31

true

Question 32

What diagnosis tends to have excellent prognosis?

Answer 32

cerebellar CVAs