Clinical features of cerebellar disease

The clinical features of cerebellar disease are:

• from unilateral hemisphere damage - ipsilateral signs:
  • intention tremor - increases as limb reaches target
  • dysdiadochokinesis - alternating hand, heel-knee-shin
  • dysmetria - overshooting in finger-nose test
  • ataxia of extremities - unsteadiness of gait towards side of lesion
  • pendular reflexes - legs swing back and forth when knee jerk elicited
  • rebound phenomena - outstretched arm swings excessively when displaced
    
    
• from damage to midline structures:
  • disturbance of equilibrium - manifest as unsteadiness in walking: a drunken gait which is wide based or reeling on a narrow base; sitting - truncal ataxia
    
    
• eye movements:
  • nystagmus - in unilateral diseases, amplitude and rate increase when looking towards the diseased side; this is an inconsistent finding
  • ocular dysmetria - overshoot when eyes voluntarily fixate
    
    
• speech:
  • scanning dysarthria - especially with explosive speech - an inconsistent finding
    
    
• involuntary movements:
  • myoclonic jerks and choreiform motions if deep nuclei involved
    
    
• abnormal head tilt - also in trochlear palsy, tonsillar herniation
  
  
• rhythmic nodding tremor of head - side to side or 'to and fro' - titubation