paces 11 _cns- cerebellar
Post on 13-Dec-2015
16 Views
Preview:
DESCRIPTION
TRANSCRIPT
Pearls in PACES (CNS- Cerebellar)
Adel Hasanin
1
CNS – CEREBELLAR
STEPS OF EXAMINATION
Step 1: Approach the patient
• Read the instructions carefully for clues (almost always there is problem with coordination or
equilibrium)
• Approach the right hand side of the patient, shake hands, introduce yourself
• Ask permission to examine him
• Expose the upper and lower limbs completely and keep the patient descent (genital area is covered)
Step 2: General inspection:
•••• Bedside: walking stick, shoes-callipers, built-up heels
•••• General appearance: scan the patient quickly looking for:
���� Nutritional status (under/average built or overweight)
���� Cachexia (paraneoplastic cerebellar syndrome, alcoholic cerebellar syndrome), unkempt
appearance and stigmata of liver disease (alcoholic cerebellar syndrome)
���� Kyphoscoliosis (Friedreich’s ataxia)
���� Intention tremors
���� Pyramidal posture (MS, Friedreich’s ataxia)
���� Myxoedematous facies
���� Abnormal facial movements (hemifacial spasm, facial myokymia, blepharospasm, oro-facial
dyskinesia)
���� Facial asymmetry (hemiplegia)
���� Nystagmus (towards the side of the lesion)
���� Skew deviation of the eyes
���� Radiotherapy burn (paraneoplastic cerebellar syndrome)
���� Pacemaker scar (Friedreich’s ataxia)
���� Pes cavus (Friedreich’s ataxia)
•••• Face (mouth): look for gingival hypertrophy (phenytoin), high arched palate (Friedreich’s ataxia)
•••• Hands: tell the patient and demonstrate “outstretch your hands like this (palms facing downwards)”…
then “like this (palms facing upwards)”
���� Check for clubbing and tar-stained fingers (paraneoplastic cerebellar syndrome)
���� Feel the radial pulse (hypothyroidism)
•••• Legs: pes cavus (Friedreich’s ataxia)
Step 3: Cerebellar dysarthria: Ask the patient some general questions to get him talking: “Please could
you tell me your name? Your age? Are you right handed or left handed? Where do you live?” In cerebellar
dysarthria, speech is slurred, slow, jerky and explosive (lalling, staccato, scanning), with irregular breaks in
articulation and equal emphasis on each syllable. There may be inspiratory whoops indicating the lack of
coordination between respiration and phonation.
Step 4: Nystagmus: see “Ch 18. Eye – General”
Step 5: Pronator drift test: see “Ch 7. CNS – Upper Limb”
Step 6: Coordination in UL: see “Ch 7. CNS – Upper Limb”
Step 7: Coordination in LL: see “Ch 6. CNS – Lower Limb”
Step 8: Gait and Romberg’s test: ask the examiner’s permission to examine the patient’s gait and
perform Romberg’s test (see Ch 9. CNS - Gait)
Pearls in PACES (CNS- Cerebellar)
Adel Hasanin
2
Step 9: Examination of lower limbs: see “Ch 6. CNS – Lower Limb”
•••• Inspection
•••• Tone
•••• Power
•••• Reflexes
•••• Sensory
Step 10: Examination of upper limbs: see “Ch 7. CNS – Upper Limb”
• Inspection
• Tone
• Power
• Reflexes
• Sensory
Step 11: Cranial nerves: see “Ch 8. CNS – Cranial Nerves”
Step 12: Additional signs:
•••• Ipsilateral deafness and cranial nerves V and VII affection (cerebellopontine angle lesion, usually
acoustic neuroma)
•••• Fundal examination: optic atrophy (MS, Friedreich’s ataxia), papilloedema (posterior fossa space
occupying lesion)
Step 13: Thank the patient and cover him (her)
top related