Cerebellar Examination

Introduction0/5

• Greetings
• Hand wash
• Verify the patient's identity using at least two or three details
• Explanation
• Consent

Inspection0/3

• Posture / symmetry / tremorInspect for any walking aids, obvious limb weakness, facial asymmetry
• GaitLook for wide based gait (ataxia from midline vermal lesion), staggering to one side (unilateral cerebellar hemisphere lesion causes staggering to side of lesion)
• Romberg's testDifferentiates between cerebellar vs proprioceptive cause

Eyes0/1

• NystagmusTest in both horizontal and vertical planes. Note: nystagmus will be elicited in everyone at extremes of lateral gaze.

Speech0/1

• Ask the patient to say 'West register street', 'baby hippopotamus', 'British Constitution'Assess for dysarthria

Arms0/4

• Drift / pronator driftCan occur in acute cerebellar lesions due to hypotonia. Note: Also present in lesions affecting proprioception.
• Intention tremor and past pointingPatient should move index finger to touch their nose to your finger as quickly and accurately as possible. Assess both sides.
• DysdiadochokinesisPatient should turn hand over on opposite palm as quickly as possible. Assess both sides.
• ReboundInability to stop may indicate cerebellar lesion. Note: Also present in lesions affecting proprioception.

Trunk0/2

• Knee reflexesCheck while patient is sitting up
• Assess if patient is able to sit unsupported / note any imbalances

Legs (lower limbs)0/3

• Tone
• Heel to shin testAssesses coordination
• Toe tappingAssesses coordination

• Wash hands