The 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.
Lesions of the cerebellum produce neurological signs which are easy to recognize and have been shown to have excellent inter-rater reliability. 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.
Early 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).
Common cerebellar neurological signs are as follows:
Scanning speech: Cerebellar disorders can cause ataxic speech, also known as scanning speech, where the patient usually breaks words into respective syllables.
Adiadochokinesia (dysdiadochokinesia) :
Rebound phenomenon :
Intention tremor :
Cerebellar mutism :
A pneumonic to remember some of the cerebellar signs is DANISH
|||Thaller M,Hughes T, Inter-rater agreement of observable and elicitable neurological signs. Clinical medicine (London, England). 2014 Jun; [PubMed PMID: 24889570]|
|||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. Journal of otolaryngology - head [PubMed PMID: 30201056]|
|||Muncie HL,Sirmans SM,James E, Dizziness: Approach to Evaluation and Management. American family physician. 2017 Feb 1; [PubMed PMID: 28145669]|
|||Jeffcoat B,Shelukhin A,Fong A,Mustain W,Zhou W, Alexander's Law revisited. Journal of neurophysiology. 2008 Jul; [PubMed PMID: 18450584]|
|||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 (London, England). 2016 Jun; [PubMed PMID: 26105056]|
|||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; [PubMed PMID: 19762709]|
|||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. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2013 Oct; [PubMed PMID: 24127701]|
|||Manto M, Cerebellar motor syndrome from children to the elderly. Handbook of clinical neurology. 2018; [PubMed PMID: 29903437]|
|||Manto M, Mechanisms of human cerebellar dysmetria: experimental evidence and current conceptual bases. Journal of neuroengineering and rehabilitation. 2009 Apr 13; [PubMed PMID: 19364396]|
|||Crawford P,Zimmerman EE, Tremor: Sorting Through the Differential Diagnosis. American family physician. 2018 Feb 1; [PubMed PMID: 29431985]|
|||Baker JM, Gait Disorders. The American journal of medicine. 2018 Jun; [PubMed PMID: 29288631]|
|||Walker HK, The Cerebellum 1990; [PubMed PMID: 21250233]|
|||Khasnis A,Gokula RM, Romberg's test. Journal of postgraduate medicine. 2003 Apr-Jun; [PubMed PMID: 12867698]|
|||Neuroanatomy of pediatric postoperative cerebellar cognitive affective syndrome and mutism. Neurology. 2020 Mar 3 [PubMed PMID: 32033987]|