- 1. General
- a. Disequilibrium - Falling: forward, backward, laterally when
standing; unsteady, staggering gait; sensations of spinning and
- b. Muscle tone disturbance - Softness of muscle bellies on palpation;
decreased tendon reflexes; asthenia (muscles tire easily).
Pendular swinging of dependent limb segment after displacement.
- c. Movement disorders
- 1) Incoordination of movements - Ataxia, asynergia -
decreased capability for smooth, cooperative, segmental
action between a series of muscle groups.
- 2) Decomposition of movements - Complex movement
performed as a sequence of irregular disjointed episodes.
- 3) Adiadochokinesis - Inability to rapidly pronate and
- 4) Dysmetria - Inability to correctly judge distances. Tested
by reaching out and touching an object ("prepointing;
- 5) Inability to trace a specific course with finger or heel
(e.g., right heel to left knee).
- 6) Staggering gait - Tendency to fall, particularly with closed
- 7) Intention tremor - Tremor when voluntary movement is
- d. Speech deficits - Slow onset, slurring, jerky, intermittent sound
productions with explosive nature: "scanning speech".
- e. Cerebellar nystagmus - Inability to fixate on object. Conjugate
drift of eyes away from it, with rapid return. May be positional
(more pronounced when body adopts a particular posture), or
directional (increasing when subject attempts to gaze in particular
- 2. Specific Syndromes
- a. Flocculonodular syndrome: Loss of whole body equilibrium.
Swaying when standing, staggering when walking, tendency to
fall (usually backwards), positional nystagmus.
- b. Neocerebellar syndrome: Cerebellar hemisphere (lateral zone) or
efferent pathways. In unilateral disease, manifestations occur on
same side as lesion. Gross intention tremor and staggering gait
only supervene if dentate nucleus or brachium conjunctivum are
involved. This syndrome may include dysmetria, unilateral limb
weakness, adiadochokinesis, intention tremor and speech defects.