Feature Vacca, Vincent M. Jr. MSN, RN, CCRN Vincent M. Vacca, Jr., is a clinical nurse educator at
Brigham & Women's Hospital in Boston, Mass. Nursing 40(6):p 58-59, June 2010. | DOI: 10.1097/01.NURSE.0000376301.06218.6f Full Text Access for Subscribers:
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Institutional UsersAccess through Ovid® Not a Subscriber?Buy Subscribe Request Permissions You can read the full text of this article if you: Log In Access through Ovid NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Definition/IntroductionThe cerebellum is a complex structure located in the posterior cranial fossa. It has connections to the brainstem, basal ganglia, and cerebral cortex and plays a vital role in the coordination of movements. Issues of ConcernLesions of the cerebellum produce neurological signs which are easy to recognize and have been shown to have excellent inter-rater reliability.[1] These signs evolve secondary to lesions in the vestibulocerebellar, vestibulospinal, and cerebellar ocular motor tracts. However, many signs such as gait ataxia and nystagmus may present in non-cerebellar lesions. A detailed neurological exam, combined with a good history, assists in accurate localization. Clinical SignificanceEarly and accurate identification of these signs helps facilitate appropriate diagnostic testing and management, especially in time-sensitive emergency situations such as an acute cerebellar infarction. Utilizing a combination of signs at the bedside, such as HINTS testing, is useful in broadly differentiating neurological signs of peripheral nervous system etiology from central etiologies (such as cerebellar lesions).[2] Nursing, Allied Health, and Interprofessional Team InterventionsCommon cerebellar neurological signs are as follows: Extraocular Movements
Scanning speech: Cerebellar disorders can cause ataxic speech, also known as scanning speech, where the patient usually breaks words into respective syllables.[8] Dysmetria [9]
Adiadochokinesia (dysdiadochokinesia) [5]
Rebound Phenomenon [5]
Intention Tremor [10]
Ambulation
Hypotonia
Cerebellar Mutism [14]
A pneumonic to remember some of the cerebellar signs is DANISH.
Review QuestionsReferences1.Thaller M, Hughes T. Inter-rater agreement of observable and elicitable neurological signs. Clin Med (Lond). 2014 Jun;14(3):264-7. [PMC free article: PMC4952538] [PubMed: 24889570] 2.Quimby AE, Kwok ESH, Lelli D, Johns P, Tse D. Usage of the HINTS exam and neuroimaging in the assessment of peripheral vertigo in the emergency department. J Otolaryngol Head Neck Surg. 2018 Sep 10;47(1):54. [PMC free article: PMC6131950] [PubMed: 30201056] 3.Muncie HL, Sirmans SM, James E. Dizziness: Approach to Evaluation and Management. Am Fam Physician. 2017 Feb 01;95(3):154-162. [PubMed: 28145669] Jeffcoat B, Shelukhin A, Fong A, Mustain W, Zhou W. Alexander's Law revisited. J Neurophysiol. 2008 Jul;100(1):154-9. [PubMed: 18450584] 5.Bodranghien F, Bastian A, Casali C, Hallett M, Louis ED, Manto M, Mariën P, Nowak DA, Schmahmann JD, Serrao M, Steiner KM, Strupp M, Tilikete C, Timmann D, van Dun K. Consensus Paper: Revisiting the Symptoms and Signs of Cerebellar Syndrome. Cerebellum. 2016 Jun;15(3):369-91. [PMC free article: PMC5565264] [PubMed: 26105056] 6.Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009 Nov;40(11):3504-10. [PMC free article: PMC4593511] [PubMed: 19762709] 7.Newman-Toker DE, Kerber KA, Hsieh YH, Pula JH, Omron R, Saber Tehrani AS, Mantokoudis G, Hanley DF, Zee DS, Kattah JC. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med. 2013 Oct;20(10):986-96. [PubMed: 24127701] 8.Manto M. Cerebellar motor syndrome from children to the elderly. Handb Clin Neurol. 2018;154:151-166. [PubMed: 29903437] 9.Manto M. Mechanisms of human cerebellar dysmetria: experimental evidence and current conceptual bases. J Neuroeng Rehabil. 2009 Apr 13;6:10. [PMC free article: PMC2679756] [PubMed: 19364396] 10.Crawford P, Zimmerman EE. Tremor: Sorting Through the Differential Diagnosis. Am Fam Physician. 2018 Feb 01;97(3):180-186. [PubMed: 29431985] 11.Baker JM. Gait Disorders. Am J Med. 2018 Jun;131(6):602-607. [PubMed: 29288631] 12.Walker HK. The Cerebellum. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Butterworths; Boston: 1990. [PubMed: 21250233] 13.Khasnis A, Gokula RM. Romberg's test. J Postgrad Med. 2003 Apr-Jun;49(2):169-72. [PubMed: 12867698] 14.Neuroanatomy of pediatric postoperative cerebellar cognitive affective syndrome and mutism. Neurology. 2020 Mar 03;94(9):414. [PubMed: 32033987] Copyright © 2022, StatPearls Publishing LLC. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. Bookshelf ID: NBK556080PMID: 32310540 ViewsIn this PageBulk DownloadRelated information
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Which of the following is used to test for cerebellar dysfunction quizlet?Cerebellar function is tested by balance tests (e.g., gait, Romberg test) and coordination and skilled movements (e.g., rapid alternating movements, finger-to-finger test, finger-to-nose test, heel-to-shin test).
Which technique is used to assess the cerebellum quizlet?Which technique is used to assess the cerebellum? -Having the patient walk on the heels and then on the toes to test for balance.
Which assessment would the nurse perform during the neurologic examination of a patient?A thorough neurologic assessment will include assessing mental status, cranial nerves, motor and sensory function, pupillary response, reflexes, the cerebellum, and vital signs. However, unless you work in a neuro unit, you won't typically need to perform a sensory and cerebellar assessment.
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