Cerebellar lesions:-examination, signs, lesions and ataxic gait ,heel knee shin test

Описание: Cerebellum receives afferents from the vestibular nuclei to flocculonodular lobe- lesions here cause disequilibrium.
From the spinal cord to the vermis- Lesions here cause truncal and gait ataxia.
Each cerebellar hemisphere receives afferents from the contralateral cerebral cortex.
Cerebellar lesions cause incoordination, ataxia and tremor.
Assessing cerebellar signs starts as patient walks into the room. See if they use walking aids to steady themselves. See if they have abnormal posture.
Patients with cerebellar lesions have ataxic gait.
Midline cerebellar lesions cause wide-based, unsteady gait, with irregular sized paces and can topple in any direction.
Cerebellar hemisphere lesion cause ipsilateral limb incoordination and patient topples towards the side of the lesion.
Patients with cerebellar lesions find it difficult to turn.
Ask patient to walk keeping their heel to their toes.
This is particularly difficult for patients with lesions of the vermis. Seen in alcohol induced cerebellar degeneration.
. Ask the patient to place their left heel on their right knee and then run it down their shin in a straight line. Now ask them to repeat this sequence of movements in a smooth motion until you tell them to stop.
Then ask them to return their left heel to the starting position over the right knee Repeat the assessment with the right heel on the left leg. In cerebellar dysfunction there will be a tremor when patient places his heel on top of his shin and they cannot run the heel down the shin either- incoordination of this movement is called dysmetria.
Hypotonia in cerebellar lesions causes a pendular knee jerk where the knee swings back and forth more than 4 times.
Briefly assess tone in the muscle groups of the hip, knee and ankle on each leg, comparing each side as you go:

With the patient lying on the examination couch, roll each leg to assess tone in the muscles responsible for the rotation of the hip.

Lift each knee briskly off the bed (warning the patient first) and observe the movement of the leg. In patients with normal tone, the knee should rise whilst the heel remains in contact with the bed (the heel will typically lift off the bed if there is increased tone).
Hypotonia can be caused by an ipsilateral cerebellar lesion. However, the ability to detect reduced muscle tone is highly subjective and in many cases, tone can feel ‘normal’ in cerebellar disease. As a result, it is advisable not to put too much weight on this sign or the lack of it..
Make allowance for weakness, especially spastic weakness as it can cause incoordination.
Test proprioception as proprioceptive loss can give rise to incoordination (sensory ataxia tested by the Romberg test).
#Cerebellar lesions #examination #signs #lesions and ataxic gait #heel knee shin test
previous video links ;-
   • Hemorrhoids:-pathology, Types, Causes, Sig...   (Hemorrhoids)