Definition/Introduction
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.
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 that 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 and a good history assist 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).[2]
Common 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 mnemonic to remember some of the cerebellar signs is DANISH.
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