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Quick tips for localizing lesions

File:1613 Major Regions of the Cerebellum-02.svg - Wikimedia Commons

Cerebellar lesions

  • Role of cerebellum is to coordinate movements and balance. Suspect cerebellar lesions when patient is ataxic
  • Lesions in the vermis of the cerebellum cause
    • Dysarthria
    • Gait abnormalities
    • Wide based gait
  • Lesions within the hemispheres of the cerebellum cause
    • Ipsilateral limb abnormalities
      • Hypotonia
      • Hyporeflexia
    • Nystagmus
    • Tremor
    • Speech sparing
    • Falls are toward the side of the lesion
    • Nystagmus is worse when looking towards the same side as the lesion
  • Lesions within the deep cerebellar nuclei cause
    • Resting tremor
    • Myoclonus
    • Opsoclonus

Brainstem lesions

Associated with cranial nerve palsies

Supratentorial lesions

Unlike with cerebellar lesions, supratentorial lesions result in contralateral focal motor or sensory abnormalities