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Dear students, today we will learn diagnostic aprroach of Cerebellar syndromes. Objectives of our class:

To review the structure and functions of the cerebellum;

To review some of the common clinical problems involving the cerebellum.

Please analyse case study, answer to questions here and watch video of Cerebellar examination.

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1) control of posture and voluntary movements
2) influences the smooth contraction of voluntary muscles and carefully coordinates their actions, together with the relaxation of their antagonists
3) each cerebellar hemisphere controls muscular movements on the same side of the body and that the cerebellum has no direct pathway to the lower motor neurons but exerts its control via the cerebral cortex and the brainstem

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A 14‐year‐old boy with a lesion in the cerebellum developed gradually worsening headaches, nausea, vomiting, and unsteadiness over the course of 2 months. His headaches were worse at night and were mainly in the left occipital area. A neurologic examination revealed bilateral papilledema, nystagmus, mildly slurred speech, and irregular, ataxic movements that were worse on the left side than the right.

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What caused this patient’s problems?

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The patient was well until 2 months previously, when he began having headaches, which were initially attributed to a sinus infection. The headaches gradually worsened, with headache mainly in the left occipital area, and sometimes accompanied by nausea and vomiting, but no visual changes. The headaches were worse at night and in the early morning hours. His teachers noticed that over the past few months he had had some difficulty concentrating and learning new material at school. During the week prior to presentation his mother noted increasing gait instability and mildly slurred speech and decided to bring him to the pediatrician.

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COORDINATION: Marked dysmetria on finger‐to‐nose testing, worse on the left, with approximately 2 inches of error. There was also dysdiadochokinesia, with inaccurate rapid alternating movements, worse on the left side. Heel‐ to‐shin movements were ataxic on the left but normal on the right.
GAIT. Wide‐based, with feet approximately 2 feet apart, and unsteady, staggering to the left. Unable to perform tandem gait. On the Romberg test with feet 4 inches apart there was no worsening of unsteadiness (unable to stand with feet together even with eyes open).
SENSORY: Intact light touch, pinprick, vibrati

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Neurology  - Topic 4 - Cerebellar Syndrome Examination

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On the basis of the symptoms and signs mentioned above, where is the lesion?

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1) What is the most likely diagnosis, and what are some other possibilities?
2) What is the next step in therapy?