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Neurology - cerebellar

Neurology - cerebellar. PULSE: Preparation for Finals Tutor name. TuBS attendance. https://tutorialbooking.com/. Session overview. Common cerebellar pathologies How to present your findings Demonstration of clinical signs Case presentations and OSCE questions.

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Neurology - cerebellar

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  1. Neurology - cerebellar PULSE: Preparation for Finals Tutor name

  2. TuBS attendance • https://tutorialbooking.com/

  3. Session overview • Common cerebellar pathologies • How to present your findings • Demonstration of clinical signs • Case presentations and OSCE questions

  4. What is the purpose of an OSCE? “This station tests a student’s ability to perform an appropriate focussed physical examination, demonstrating consideration for the patient, and to report back succinctly describing the relevant findings. It also tests a student’s clinical judgement i.e. the ability to decide the differential diagnosis, choose investigations and formulate a management plan.”

  5. Presenting your findings • What were you asked to do? • What were your key positive findings? • What were the important negative findings? • What does this mean? • How would you complete your examination, and what investigations would you do?

  6. Common cerebellar conditions in the OSCE • Tremor • Speech difficulties - dysarthria • Balance problems - ataxia

  7. Cerebellum • What it does: motor control and co-ordination • Findings in cerebellar disorder: DANISH • Common conditions linked with cerebellar disorder

  8. What are the signs of cerebellar dysfunction? • DANISH! • Dysdiadochokinesis • Ataxia • Nystagmus • Intention tremor • Slurred/stacatto/slow speech • Hypotonia

  9. How would you tell a central from a peripheral cerebellar lesion? • Hemisphere - ipsilateral deficits such as dysmetria, disdiadochokinesis, intention tremor • Vermis - generalised or truncal deficits such as ataxic gait, dysarthria, nystagmus, vertigo

  10. What are the causes of cerebellar dysfunction? • POCS/ Tumour/Para-neoplastic syndromes • MS • Arnold-Chiari malformation • Friedrichs ataxia • Alcohol/ Thiamine deficiency • Anti-epileptic medications

  11. Example case presentation • 60 year old man, looks unkempt. Asked to examine his cerebellar system.

  12. Cerebellar examination • WINDEC • STAND BACK INSPECT (comment on any obvious findings)

  13. What are the different patterns of speech disturbance? • Dysphasia; Brocas (expressive/non-fluent), Wernickes (receptive/fluent), conduction, mixed • Dysarthria; cerebellar, extrapyramidal, bulbar/pseudobulbar palsy • Dysphonia; extrapyramidal, myaesthenia, GuillaineBarre

  14. Hands – both hands shaky at rest, evidence of past pointing and dysdiadochokinesis. Upper limb tone slightly reduced. • Face and speech – eye movements appear normal but patient has difficulty following demands. Speech is slurred. Skin has a yellow tinge. • Gait – broad based ataxic gait, furniture walking to door. Please present your findings.

  15. Completing your examination • Full neurological examination of the limbs and cranial nerves • You will still elicit cerebellar signs if you perform neuro limb examination • Early identification of clear cerebellar signs may allow you to perform focused cerebellar examination • Focused history • Speech

  16. Gait disturbance • How would you classify disturbances in gait?

  17. Gait disturbance • Asymmetrical • Hemiplegic (unilateral pyramidal) • Foot drop • Antalgic • Functional • Symmetrical • Normal pace • Cerebellar ataxia (BROAD-based) • Spastic paraparesis (scissoring) • Sensory ataxia (HIGH-stepping) • Proximal myopathy (waddling) • Frontal (apraxic) • Small pace • Parkinsonian (festinent)

  18. Session overview • Common cerebellar pathologies • How to present your findings • Demonstration of clinical signs • Case presentations and viva questions

  19. Please complete TuBS feedback • Tutor details: ______ • For more information on Examining for Finals sessions: • examiningforfinals@gmail.com • www.sefce.net/pulse • Resource updated 2017: Dr A Swan • With thanks to previous contributors: • Dr Emma Claire Phillips • Dr Kristina Lee • Dr Russell Hewett (Neurology Consultant)

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