Summary of Common Conditions Seen in OSCEs
| Causes of cerebellar symptoms |
| Multiple sclerosis |
| Stroke |
| Posterior fossa tumour |
| Degenerative: alcohol, Friedreich’s ataxia |
| Iatrogenic (anticonvulsants: carbamazepine, phenytoin) |
| Hypothyroidism |
| Paraneoplastic syndrome (lung cancer) |
Figure 7.1 Scar from resection of a cerebellar tumour. This patient presented with classical cerebellar symptoms. He was found to have a cerebellar haemangioblastoma that was successfully resected surgically
Hints and Tips for the Exam
The mnemonics in the table below will make it easier to remember the signs and causes of cerebellar disease.
| D | Dysmetria & dysdiadochokinesis |
| A | Ataxia |
| N | Nystagmus |
| I | Intention tremor |
| S | Slurred/staccato speech |
| H | Hypotonia |
| P | Posterior fossa tumour |
| A | Alcohol |
| S | Multiple sclerosis |
| T | Trauma |
| R | Rare |
| I | Inherited (e.g. Friedreich’s ataxia) |
| E | Epilepsy medication (carbamazepine, phenytoin toxicity) |
| S | Stroke |
Describing Gait
In the cerebellar examination, the gait can point to a set of diagnoses, so it is important to get this right. It may be valuable to start with the gait assessment to localise the side of the cerebellar damage, which you can confirm with the rest of your examination. In cerebellar disease, the patient will deviate (or fall!) to the side of the lesion.
A wide-based gait is classic in cerebellar disease, with patients choosing to place their feet wide apart to improve their stability. This may not be very obvious and is the reason for subsequently performing a tandem (heel–toe or tightrope) gait assessment.
| Things to note when assessing gait |
| Use of walking aids |
| Stance-phase symmetry (how long the patient spends on each foot) |
| Heel strike |
| Toe-off |
| Stride length |
| Arm swing (symmetrical, reduced, absent) |
| Time to turn and smoothness of turn (turn slowly, en bloc – Parkinson’s disease) |
Figure 7.2 Scar after posterior craniotomy and resection of an infarcted cerebellar mass
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
