Cerebellar disorders

Some activities require MORE COORDINATION

Relevant Points in the HISTORY:

- Frequent falls- Clumsiness & difficulty with fine

coordinated movements- Tremors- Waxing & Waning of symptoms—MS- Stroke-- Drug toxicity: Phenytoin, alcohol

abuse, lead poisoning & solvent abuse- History of HYPOTHYROIDISM- F.H--------FA & other hereditary ataxias

SIGNS

HYPOTONIA

Cerebellar Ataxia

a b c

d

Causes: 1-Inhereted

• Autosomal recessive • Progressive degeneration of dorsal root ganglia,

spinocerebellar tracts, corticospinal tracts and cerebellar Purkinje cells.

• Chromosome 9q13• Fraxatin • Progressive difficulty in walking occurs around

the age of 12. Death is usual before 40.

• ataxia of gait and trunk• nystagmus (25%)• dysarthria• absent lower limb joint position and vibration

sense• absent lower limb reflexes• optic atrophy (30%)• pes cavus• cardiomyopathy.

ATAXIA TELANGIECTASIA

2.DEVELOPMENTAL

• ARNOLD-CHIARI MALFORMATION

• BASILAR INVAGINATION

• CEREBRAL PALSY

• BLOOD SUPPLY• Superior surface-SUPERIOR

CEREBELLAR Branch of BASILAR Artery

• Inferior surface– Anterior part: ANTERIOR INFERIOR CEREBELLAR

Branch of BASILAR Artery

• Inferior surface—Posterior part: POSTERIOR INFERIOR CEREBELLAR Branch of VERTEBRAL Artery

• VEINS: Straight sinus, Occipital sinus, Transverse sinus

3-VASCULAR

The Cerebellum is supplied by 3 major arteries on each side:

1. PICA…..The MOST common syndrome: Lateral Medullary syndrome….Wallenberg's

2. AICA, the second most common syndrome

3. SCA; the least frequent syndrome

Wallenberg's Syndrome is typified by:• Vertigo • Ipsilateral hemiataxia • Dysarthria• Ipsilateral Horner's Syndrome (Central)• Most patients with this stroke recover very well and often resume their

previous activities• Diagnosis is generally via MRI

Infectious:- Abscess- Acute cerebellitis---VIRAL- Creutzfeldt-Jacob disease

Metabolic:- Antiepileptic drugs- CO poisoning- Alcohol……vitamin B1

deficiency - Lead poisoning

4.Tumours

If you are allowed to perform ONE investigation, which one you choose in a Pt with a suspected cerebellar lesion?

…… MRI…………...