Symptomatology of Cerebellar Tumours; A Study of Forty Cases

Stewart, Tammy; Holmes, Gordon

doi:10.1093/brain/27.4.522

Cited by 83 publications

(25 citation statements)

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“…The so-called cerebellar fits are spasms that have been observed in posterior fossa tumors, Chiari malformations and stroke involving the cerebellar cortex but sparing the nuclei [61, 62]. The mechanism of this rare phenomenon is presumably an extensor tone disinhibition.…”

Section: Cerebellar Tone (Mark Hallett)mentioning

confidence: 99%

Consensus Paper: Revisiting the Symptoms and Signs of Cerebellar Syndrome

Bodranghien¹,

et al. 2015

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The cerebellum is involved in sensorimotor operations, cognitive tasks and affective processes. Here, we revisit the concept of the cerebellar syndrome in the light of recent advances in our understanding of cerebellar operations. The key symptoms and signs of cerebellar dysfunction, often grouped under the generic term of ataxia, are discussed. Vertigo, dizziness, and imbalance are associated with lesions of the vestibulo-cerebellar, vestibulo-spinal, or cerebellar ocular motor systems. The cerebellum plays a major role in the online to long-term control of eye movements (control of calibration, reduction of eye instability, maintenance of ocular alignment). Ocular instability, nystagmus, saccadic intrusions, impaired smooth pursuit, impaired vestibulo-ocular reflex (VOR), and ocular misalignment are at the core of oculomotor cerebellar deficits. As a motor speech disorder, ataxic dysarthria is highly suggestive of cerebellar pathology. Regarding motor control of limbs, hypotonia, a- or dysdiadochokinesia, dysmetria, grasping deficits and various tremor phenomenologies are observed in cerebellar disorders to varying degrees. There is clear evidence that the cerebellum participates in force perception and proprioceptive sense during active movements. Gait is staggering with a wide base, and tandem gait is very often impaired in cerebellar disorders. In terms of cognitive and affective operations, impairments are found in executive functions, visual-spatial processing, linguistic function, and affective regulation (Schmahmann’s syndrome). Nonmotor linguistic deficits including disruption of articulatory and graphomotor planning, language dynamics, verbal fluency, phonological, and semantic word retrieval, expressive and receptive syntax, and various aspects of reading and writing may be impaired after cerebellar damage. The cerebellum is organized into (a) a primary sensorimotor region in the anterior lobe and adjacent part of lobule VI, (b) a second sensorimotor region in lobule VIII, and (c) cognitive and limbic regions located in the posterior lobe (lobule VI, lobule VIIA which includes crus I and crus II, and lobule VIIB). The limbic cerebellum is mainly represented in the posterior vermis. The cortico-ponto-cerebellar and cerebello-thalamocortical loops establish close functional connections between the cerebellum and the supratentorial motor, paralimbic and association cortices, and cerebellar symptoms are associated with a disruption of these loops.

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Section: Cerebellar Tone (Mark Hallett)mentioning

confidence: 99%

Consensus Paper: Revisiting the Symptoms and Signs of Cerebellar Syndrome

Bodranghien¹,

et al. 2015

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“…Others 5-7 have attributed skew deviation to cerebellar damage from surgery 5,13 or cerebellar diseases on the basis of clinical findings. 6,7,13 In most cases, [5][6][7]13,14,18,37 however, brainstem involvement had not been excluded by either neuroimaging or pathological correlation. To document that a discrete lesion in the cerebellum alone can cause skew deviation, we described in detail the clinical course of 5 patients with skew deviation caused by focal cerebellar lesions.…”

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confidence: 99%

Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy

Wong¹

2010

Journal of American Association for Pediatric Ophthalmology and

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SUMMARYSkew deviation is a vertical strabismus caused by a supranuclear lesion in the posterior fossa. Because skew deviation may clinically mimic trochlear nerve palsy, it is sometimes difficult to differentiate the 2 conditions. In this review we compare the clinical presentations of skew deviation and trochlear nerve palsy and examine the pathophysiology that underlies skew deviation. We then describe a novel clinical test-the upright-supine test-to differentiate skew deviation from trochlear nerve palsy: a vertical deviation that decreases by ≥50% from the upright to supine position suggests skew deviation and warrants investigation for a lesion in the posterior fossa as the cause of vertical diplopia.Skew deviation is a vertical strabismus caused by supranuclear lesions. It is often associated with ocular torsion and head tilt, which together constitute the ocular tilt reaction. [1][2][3][4] Skew deviation is often the initial manifestation of diseases that affect the brainstem, cerebellum, or peripheral vestibular system. [4][5][6][7][8][9][10] Because both skew deviation and trochlear nerve palsy may result from intracranial lesions or trauma, and because some skew deviations may clinically mimic trochlear nerve palsy, differentiating these 2 conditions can be challenging. Understanding skew deviation remains difficult, partly because it requires knowledge of the underlying anatomy and pathophysiology. In this review, we first compare the clinical presentation of skew deviation versus trochlear nerve palsy. We then focus on the pathophysiologic mechanism of skew deviation and examine some current evidence that shows that skew deviation results from an imbalance of the utriculo-ocular pathway. We then present a novel upright-supine test that can be used clinically to differentiate skew deviation from trochlear nerve palsy at the bedside. Clinical PresentationSkew deviation was first induced experimentally in animals by Magendie 11 and later Hertwig, 12 who produced skew deviation in cats by sectioning the middle cerebellar peduncle. It was first observed in humans with cerebellar tumors by Stewart and Holmes in 1904. 13 Skew deviation is a vertical misalignment of the visual axes caused by a disturbance of supranuclear inputs as a result of lesions in the brainstem, cerebellum, or peripheral CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript vestibular system (ie, the inner ear and its afferent projections). The vertical misalignment may be comitant or incomitant. Rarely, it alternates with eye position (eg, right hypertropia on right gaze and left hypertropia on left gaze). 14,15 Skew deviation often is associated with other neurologic signs and may be part of the ocular tilt reaction, which consists of a triad of skew deviation, ocular torsion, and head tilt. [1][2][3]10 In ocular tilt reaction, the pathologic head tilt is ipsilateral to the hypotropic eye, and the ocular torsion is such that the upper poles of both eyes rotate in the same direction as that of the head tilt (ie, the h...

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“…It may be explained by a defect in synergy among the different elementary movements of the upper extremity and more particularly in a disharmony in the function of antagonistic muscles." Stewart and Holmes [9], in a discussion of the symptomatology of cerebellar tumours, record the interesting fact in their remarks upon cerebellar ataxia that " in cases of chronic course, or when the lesion has became latent, the ataxia is as a rule less definite. Then it may be less typical and approximate to the intention type, characteristic of disseminated sclerosis.…”

Section: Case 3-onset Of the Disease In A Man Aged 28 With Intentimentioning

confidence: 99%

Dyssynergia Cerebellaris Progressiva—a Chronic Progressive Form of Cerebellar Tremor

Hunt¹

1914

Brain

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Symptomatology of Cerebellar Tumours; A Study of Forty Cases

Cited by 83 publications

References 0 publications

Consensus Paper: Revisiting the Symptoms and Signs of Cerebellar Syndrome

Consensus Paper: Revisiting the Symptoms and Signs of Cerebellar Syndrome

Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy

Dyssynergia Cerebellaris Progressiva—a Chronic Progressive Form of Cerebellar Tremor

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