What Is Cerebellar Atrophy?

Cerebellar atrophy is not exactly a disease, but a neuroimaging manifestation. It can be seen not only in some hereditary and degenerative diseases, but also in some acute diseases such as the late stage of acute cerebellitis and certain drug poisoning, and even in some clinically asymptomatic people, imaging examination can also show cerebellar atrophy. More common among the elderly. Its common feature is that the volume of the cerebellum is reduced and the sulcus is widened by neuroimaging. Can be divided into localized and extensive cerebellar atrophy. Because the cerebellum is mainly involved in the regulation of body balance and muscle tension, patients with cerebellar atrophy often experience symptoms such as gait instability, ataxia, and slurred speech.

Basic Information

English name

cerebellar atrophy

Visiting department

Neurology

Multiple groups

Seniors

Common causes

Heredity, ischemia and hypoxia, drug poisoning, inflammation, alcoholism, etc.

Common symptoms

Generally manifested as unstable gait, ataxia, and slurred speech

Causes of cerebellar atrophy

Heredity

Such as spinal cerebellar degeneration (SCA), Friedreich type ataxia, dentate nucleus, red nucleus, pale bulb Lewy body atrophy, etc.

2. Transsexuality

Multiple system atrophy brain type (MSA-C).

3. Ischemic hypoxia

poisoned by carbon monoxide.

4. Drug poisoning

Phenytoin sodium.

5. Inflammatory

Sequelae of acute cerebellitis.

6. Alcoholism

Alcoholic cerebellar degeneration.

7. Other

Paraneoplastic tumor syndrome.

Clinical manifestations of cerebellar atrophy

Ataxia

Ataxia is the main clinical manifestation of cerebellar atrophy. The patient is unstable, swaying, and has difficulty standing on one foot. Generally, he cannot stand on one leg. He staggers, walks with his legs apart, swings left and right, and his upper limbs flex and stretch forward like a fall. Poor discernment and movement easily exceed The closer the target is to the target, the more obvious the tremor, the tremor when writing, the irregular writing, and the writing becomes larger and larger.

2. Cerebellar dysarthria

Bard-like language, which is characterized by slow speech, crashing, monotonous, and nasal sounds. It is caused by ataxia of muscles such as lips, tongue, throat and so on.

3. Eye movement disorders

Patients with early cerebellar atrophy may present with radial disturbance and extraocular muscle movement disorder. There may be coarse tremor in both eyes, and a few patients can see nystagmus and rebound nystagmus.

4. Decreased muscle tone

It is mainly seen in acute cerebellar hemisphere lesions, and rare in chronic lesions. However, in some cases of cerebellar atrophy, a gradual increase in systemic muscle strength can be seen, which may appear similar to tremor paralysis.

5. Non-exercise performance

Including cognitive and language dysfunction, some evidence suggests that the cerebellum is associated with mental illness, including schizophrenia, bipolar disorder, and addictive behavior.

Cerebellar atrophy test

Neurological examination

(1) Finger-nose test instructs the patient to straighten the upper limbs and abduct, then touch the tip of the nose with the fingertips of the fingers, repeat the open and closed eyes with different directions and speeds, and compare them on both sides. Actions vary in speed, speed, and misalignment, or adjustments can be made to target. Cerebellar hemisphere lesions appear more ataxia as the ipsilateral side approaches the target. Poor discrimination can often exceed the target.

(2) The patient with the knee and tibia test shall perform the following three actions in sequence on one's back: raise one side of the lower extremity and straighten the knee, place the heel of the raised side on the knee of the opposite lower extremity, and then place the heel along The anterior edge of the tibia slides downwards, striving for accurate and consistent movement. When the cerebellum is damaged, the leg is lifted and the knee is often unstable due to poor discrimination and intentional tremor.

(3) Rapid rotation test Tap the back of the opposite hand in rapid succession with one hand, or make a pronation and swerve motion with the forearm or touch the desktop with the palm and back of the hand alternately. When the cerebellum is damaged, the above actions are awkward and the rhythm is uneven.

(4) In the rebound test, the upper limbs of the patients with closed eyes flexed hard with the fist, and the doctor suddenly released them during the process of pulling them open. Normal protective actions will not touch themselves. When the cerebellar lesions are controlled, the active and antagonist muscles are controlled. Poor coordination often results in excessive movements and knocks on yourself. Or maintain the two arms straight forward, the examiner suddenly or downwardly push their arms down, and then release, normal people can accurately return to the original position, patients with cerebellar ataxia can not control the active muscles normally Coordination with antagonist muscles, often excessive movements and excessive swing time. When examining the lower extremity, the patient can push the calf to check while maintaining the posture of the flexor and flexion of the knees at 90 °, the same meaning as above.

(5) In the finger test, the upper limbs of the patient are stretched forward, and the index finger is placed on the fixed finger of the examiner. Then the patient is instructed to raise the hand to the vertical position and then lower it to the examiner's finger. Keep your upper limbs straight and open your eyes before closing your eyes. When the cerebellum is damaged, the patient's finger cannot correctly point to the examiner's finger, but is excessively moved.

(6) Patients in the sit -up test are lying on their backs with their hands placed on their chests without support. Normal people only have torso flexion, and both lower limbs can be pressed down without leaving the bed. Patients with cerebellar damage have hip and trunk flexion at the same time, and both lower limbs Lifting is called joint flexion sign.

2. Neuroimaging

Neuroimaging examinations such as CT and magnetic resonance imaging can show that cerebellar atrophy shows increased, widened, and reduced volume of cerebellar sulcus, branch-like leaves, increased space around the cerebellum, and enlarged fourth ventricle.

Cerebellar atrophy diagnosis

It is not difficult to diagnose cerebellar atrophy based on medical history, symptoms, clinical examination and imaging examination.

Cerebellar atrophy treatment

The current medical level lacks effective treatments for the formed cerebellar atrophy. Therefore, the intervention is mainly aimed at some controllable pathogenic factors. Based on this, some drugs that can improve the ataxia of patients can be selected to partially improve the clinical symptoms of patients. Neural stem cell transplantation is one of the research directions for the treatment of cerebellar atrophy in the future, but it is currently limited by ethics. At the same time, the technical level is immature and it is rarely used in clinical practice.

Cerebellar atrophy rehabilitation training

Language rehabilitation training

Language rehabilitation should start within 6 months after language dysfunction occurs. It is necessary to develop a moderate and easy treatment plan, which must be highly targeted; strengthening tongue movement can improve tongue movements; vocal cord vibration can be used to exercise Adjust the airflow through breathing exercises; insist on "seeing, listening, speaking, and writing"; if possible, arrange group training, which can promote mutual encouragement, encourage each other, and eliminate fear and fear of speaking Psychological.

2. Motor function rehabilitation training

Including balance training and gait training.

Cerebellar atrophy prevention

1. Actively prevent and treat the risk factors of cerebrovascular diseases, such as hypertension, diabetes, hyperlipidemia, etc .; quit drinking and smoking, develop good eating habits; avoid using drugs that damage the brain tissue; avoid excessive thinking, and keep quiet and peaceful Mentality, especially middle-aged and elderly, should be more so; work and rest combined, moderate exercise.

2. Adjust your diet. The diet should be light and nutritious, eat less fatty and nourishing products, and focus on high-protein and high-vitamin diets. Eat more vegetables and fruits and iodine-containing foods. Pay attention to balanced nutrition.

3. For elderly people over 50 years old, especially those with a family history of hereditary brain atrophy, it is more necessary to choose Chinese medicine to delay aging around 50 years old to improve the condition of brain cell aging.