Neurology - The Cerebellar Exam

LSU Physician Champion - Dr. Jesus Lovera

Truncal Ataxia

During walking observe for gait ataxia. Have the patient stand with their feet together and eyes open. Observe for swaying.

Finger to nose

Place your finger a full arm’s length from the patient and then ask the patient to touch their nose and then touch your finger. Make sure your finger is far enough to have the patient fully extend their arm. Move your finger to several different target positions on both sides. Observe for action tremor or tremor at the end of movement.

Rapid alternating movements

Have the patient tap alternatingly on the palm of one hand alternating the dorsum and the palm of the hand.

Heel to shin

Have the patient touch their heel and slide it up and down their shin.

Examine for hypotonia

Observe reflexes for pendular reflexes: Under normal situation, after eliciting triceps and patellar reflexes, the antagonist muscle will stop further oscillation after eliciting the deep tendon reflex and the arm or leg will not move back and forth. With decreased tone from cerebellar lesions, the foot or forearm will continue to oscillate.
Have the patient stand and shake their trunk from side to side: The affected side will move excessively with a flapping motion.