The cerebellar syndrome is a disease that affects the cerebellum, producing a series of signs and symptoms that interfere with its activity: hypotonia, ataxia, impaired balance and gait, intentional tremor, reflex disorders, nystagmus and dysarthria.
The cerebellum is one of the parts that make up the central nervous system. This organ is the largest part of the hindbrain and is located in the posterior cranial fossa, behind the fourth ventricle, the medulla oblongata, and the pons..
The main function of the cerebellum is to ensure that movements are uniform and coordinated. To achieve this task, it receives orders and information from other organs such as the brain, spinal cord and sensory receptors..
The cerebellum has always been attributed functions related to motor skills and, thanks to new studies, new ones have been attributed to it. Among them is the regulation of muscle tone, maintaining posture, measurement of the force and energy necessary for motor acts, activation of learning processes related to the motor apparatus, intervention in cognitive processes and in the fluency of language or regulation of executive function and emotional processes.
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That is, low muscle tone. This symptom is characterized by decreased resistance to palpation or passive manipulation of the muscles. Normally, hypotonia is accompanied by decreased tendon and tendon reflexes..
One way to determine these effects is with the Stewart Holmes test, in which the patient is asked to flex his arm and resist. Meanwhile, the person conducting the test will try to bring it to him.
The effect is that, when released, the patient will hit his face with his own arm. In the case of a person who lacks a disease that affects the cerebellum, the triceps would stop and, in this way, the flexion of the arm would be stopped.
Ataxia consists of the alteration of the coordination of voluntary movements. This symptom leads to the appearance of the following signs:
This alteration produces instability in an upright position (also known as orthostatism). For this reason, patients with cerebellar syndrome tend to spread their feet to widen their base of support..
During gait, they present frequent oscillations and these do not vary if the eyes are closed, as occurs in vestibular disorders.
The gait of these patients resembles that of a person who has consumed a large amount of alcohol and, in fact, is clinically designated as drunken march. This gait is characterized by being hesitant, walking with feet apart, and drifting to the side of the injury..
They present tremors that can be easily appreciated when performing movements involving the fine muscles. That is, they are imprecise movements, for example: buttoning, writing, etc..
They show reflections for a longer time. In the case of osteotendinous reflex, a pendulum movement of the knee occurs after having struck the patellar tendon.
Eye movement disorder, similar to an ataxia of these muscles. This symptom is a rhythmic oscillation of the eyes that is more easily demonstrated by deviating the eyes in a horizontal direction..
It may happen that the oscillation has the same speed in both directions (pedicle nystagmus) or, that it is faster in one direction than in the other (jerk nystagmus).
The disastria is produced by ataxia in the muscles of the larynx. The articulation of the words occurs in jerks and the syllables are emitted, normally, separated from each other.
They are not directly related to the cerebellum, but they are because they are located in structures near it. They are as follows:
There are two types of cerebellar syndrome, divided according to the area they affect.
The most frequent cause is the existence of a medulloblastoma of the vermis in children. This type of malignant tumor causes muscle incoordination of the head and trunk, not the extremities.
In addition, it causes the head to fall forward or backward, as well as the inability to keep it still and in an upright position. The inability to stay in a firm position also affects the trunk.
It is usually caused by the existence of a tumor or ischemia (arrest or decrease in blood circulation) in one hemisphere of the cerebellum. Symptoms usually occur unilaterally and affect the affected cerebellar hemisphere ipsilaterally..
That is, they affect the same side of the body as the diseased hemisphere. In this case, limb movements are affected. Hypermetria (excessive and excessive movements) and decomposition of movements are common and easily observable.
There are multiple reasons why a person can have a cerebellar syndrome. Among them, we find the following:
The detection of cerebellar syndrome can be carried out through simple tests that can provide information to the specialist about the difficulty of the patient to execute certain movements. It is also important that the patient's medical history and some tests, such as blood tests, be taken into account. The following tests can be performed:
The person is asked to touch their nose with their finger. Through this test it can be found if the movements are shaky and / or if there is dyssynergia (muscle coordination disorder).
The patient will take the supine position and, subsequently, will have to slide the heel of one of his legs over the opposite leg, starting from the knee. If the heel oscillates, it indicates the presence of cerebellar syndrome.
In this test, you are asked to perform the following movements: hit your thigh, raise your hand and rotate it, then hit your thigh again. If you are not able to perform, you are likely to have adiadochokinesia.
Looking at who is administering the test, the person should be still, with their feet together and touching their heels. Afterwards, you should raise your arms with the palms of your hands facing up and close your eyes. If during the execution of the movements, it oscillates and / or moves, it will be the cerebellar syndrome.
It will be observed if during the march, the patient oscillates and / or staggers. Also, if you walk spreading your legs to get a bigger base.
In addition to these techniques, some radiology tests such as functional magnetic resonance imaging or computerized axial tomography must be performed to check if there is any type of organic involvement.
In the case of this syndrome, the most widespread and probably best-successful treatment is physical therapy. To carry out this dynamic well, an evaluation must first be carried out and see which aspects have to work to a greater extent..
In this way, you will be able to carry out a work plan adapted to the needs of the patient. Normally, physiotherapy is aimed at improving movement coordination, reinserting functional automatisms, as well as re-educating balance and gait.
The need for other treatment and / or medical prescription will be determined by the healthcare professional and is probably determined by the etiology of the cerebellar syndrome depending on the patient, as well as their needs and the manifestations of the disease..
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