[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient attended A&E on account of unsteadiness.  Please examine their cerebellum and discuss your findings with the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191743″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has a cerebellar defect that lateralises to the right.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Lateralising Cerebellar Signs

Cerebellar disease is a common condition in the neurological station due to the unfortunate high rates of alcohol related disease and strokes. However, you might also be given a patient with materialising cerebellar signs and it is important that you can idtenify and understand the pathology of these lesions.

Unilateral disease will cause unilateral signs on the ipsilateral side. Vermis lesions (the midline of the cerebellum) will cause ataxia that is either midline or truncal while lesions of the cerebellar hemisphere will cause ataxia of the limb.

Therefore, depending upon the above, the lesion may be unilateral, bilateral, midline, specific to a hemisphere or global (aka pan-cerebellar).

Causes of cerebellar lesions

Infectious
  • Creutzfeldt-Jakob disease (global);
  • Syphilis (global);
  • Encephalitis (global).
Cerebrovascular accident
  • associated with vertigo and vomiting (unilateral, midline or hemispheric).
Metabolic
  • alcohol induced Wernicke’s encephalopathy with chronic degeneration (global);
  • anti-convulsant medications such as sodium valproate and phenytoin (global);
  • vitamin B12 deficiency (global);
  • hypothyroidism (global).
Neoplastic
  • primary tumour (unilateral, bilateral (unlikely) midline or hemispheric);
  • secondary (unilateral, bilateral, midline or hemispheric).
Neurodegenerative
  • multisystem atrophy (global).
Auto-immune
  • multiple sclerosis (unilateral, bilateral, midline or hemispheric or even global);
  • Miller-Fisher syndrome (global);
  • parneoplastic (global).
Genetic
  • Friedreich’s ataxia (global);
  • mitochondrial disease (global).

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has a right sided cerebellar defect.  I would like to investigate this patient further with neuroimaging to determine the underlying cause.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]