cerebellum disorders

vertigo, n/v, horizontal nystagmus, appendicular ataxia, unsteady gait, HA

s/s of cerebellar infarcts

AICA

infarct causes unilat hearing loss (supplies internal auditory A)

SCA and PICA

most common As that are infarcted

SCA

infarct mostly involves cerebellum (ipsilat ataxia) w/ little/no brainstem s/s

PICA

infarct causes ipsilat ataxia and has brainstem s/s

PICA or SCA

large infarcts of ___ can cause swelling in cerebellum (post fossa)

down/lat, 4th, hydrocephalus and increased intracranial pressure

swelling can cause cerebellum to push ___ compressing the ___ ventricle, which leads to ___

foramen magnum

if cerebellum swells too much, can herniate thru ___

HA, n/v, ataxia, nystagmus

s/s of cerebellar hemorrhage

hemorrhage, hydrocephalus, abducens 6 palsy, LOC

large cerebellum ___ can cause 4th ventricle involvement causing ___, ___, ___, and eventually cause brainstem compression which leads to death

fatal gastroenteritis

GI sxs seen initially w/ cerebellar hemorrhage

ataxia

disordered contraction of agonist/antagonist ms that result in lack of norm coordination btwn movements at different jts

ataxia

movements have an irregular, wavering course that consists of continuous overshooting and over-correcting

dysrhythmia

abnorm timing of movement

dysdiadockokinesia

abnorm rapid alternating movements (RAM) (1 hand face up, other down, alternate quickly)

dysmetria

abnorm trajectories (ex: drunk putting key in lock)

truncal ataxia

lesion of vermis (medial part of cerebellum)

truncal ataxia

very wide base, unsteady gait (looks like a drunk walking)

appendicular ataxia

lesion of lat and intermediate cerebellum

appendicular ataxia

lesion of lat motor systems (lat corticospinal tract, rubrospinal tract)

appendicular ataxia

discoordination of extremities; causes intention tremors

intention tremors

irregular oscillating movements in multi planes thru/o trajectory while pt attempts to move limb towards a target

intention tremor

measured as 2 or 4 hertz

ipsilat appendicular ataxia

lesion of cerebellar hemispheres or cerebellar peduncles cause ___

truncal ataxia

tends to be bilat, pts often fall or sway towards side of lesion

false localization of ataxia

ataxia can be caused by lesions outside the cerebellum that involve cerebellar input/output pathways

sensory ataxia

DCML pathway disrupted (associated w/ cuneocerebellar and dorsal spincocerebellar tracts)

sensory ataxia

jt position should be better w/ eyes open and worse w/ eyes closed

UMN

non cerebellum lesion that can also cause slow, clumsy movements of extremities

LMN

non cerebellum lesion that can cause weakness

dysmetria, dysrhythmia

when testing for appendicular ataxia, watch out for ___

finger nose finger, heel shin, heel knee shin, rapid hand movements, rapid foot taps, precision finger tap, RAM, overshoot

tests for appendicular ataxia

wide-base, unsteady gait

when testing for truncal ataxia, watch out for ___

tandem gait (heel-to-toe gait), rhomberg

tests for truncal ataxia

spinocerebellar ataxia

hereditary ataxia that can occur in children and adults