Examinations
CPSA · Clinical examination · Neurological
Cerebellar examination
Screen for cerebellar dysfunction — the mnemonic **DANISH**: Dysdiadochokinesia, Ataxia, Nystagmus, Intention tremor, Slurred (staccato) speech, Hypotonia/Heel-shin.
Practise it out loudPosition: Patient seated, with room to test gait.
The routine
Speech & eyes
- 1Ask a phrase to elicit staccato/scanning dysarthria
- 2Look for nystagmus (fast phase towards the lesion) on lateral gaze
Upper limb
- 1Dysdiadochokinesia (rapid alternating hands)
- 2Finger-to-nose: intention tremor and past-pointing
- 3Rebound phenomenon; tone (hypotonia)
Lower limb & gait
- 1Heel-to-shin ataxia
- 2Gait: broad-based, unsteady, veering to the side of the lesion
- 3Romberg negative (distinguishes from sensory ataxia)
Signs & what they mean
Ipsilateral limb signs (falls/points towards the lesion)Cerebellar hemisphere lesion
Truncal ataxia, wide-based gait, minimal limb signsMidline (vermis) lesion
Bilateral cerebellar signsAlcohol, drugs (phenytoin), MS, paraneoplastic
To complete, I would…
- Full neurological examination
- Check for causes: alcohol history, drug levels, consider MRI brain
OSCE tips
- Cerebellar signs are ipsilateral to the lesion.
- Romberg is negative in cerebellar ataxia (positive = sensory).
- Use DANISH so you don’t miss a component.