🧼 Hand Hygiene: Wash your hands thoroughly.
🙂 Introduce Yourself: Confirm patient’s name & DOB, explain the exam.
✅ Consent & Comfort: Gain consent, ensure a quiet, well-lit room with privacy.

🛠️ Equipment Needed

Gloves (optional)
Pen & paper 📝 (for drawing tasks, documentation)
No specialist equipment required

📊 Background: Key Cerebellar Signs

🧠 Cerebellar Sign	🔍 Description	⚠️ Causes
🚶 Ataxia	Unsteady, wide-based gait	Degeneration, stroke, alcohol, tumour
🎯 Dysmetria	Overshoot/undershoot in finger–nose or heel–shin	MS, stroke, metabolic causes
🔄 Dysdiadochokinesia	Impaired rapid alternating movements	Degeneration, alcohol damage
✋ Intention Tremor	Worsens as target is approached	MS, infarct, inherited ataxias
🗣️ Scanning Speech	Irregular, broken syllables	Cerebellar ataxia, paraneoplastic
👀 Nystagmus	Involuntary rhythmic eye oscillations	MS, alcohol, cerebellar lesions
🛌 Hypotonia	Reduced tone on passive movement	Cerebellar lesions, metabolic
↩️ Rebound Phenomenon	Overshoot when resistance released	Focal cerebellar lesions

1️⃣ General Observation

Posture & stance 🚶: look for ataxia, wide-based gait.
Visible tremors, head titubation (nodding), irregular limb movements.

2️⃣ Cranial & Ocular Exam 👀

Eye movements: Ask patient to follow finger in “H” → look for nystagmus (gaze-evoked vs primary position).
Scanning speech: Ask patient to say “British Constitution” → listen for irregular syllabic rhythm.

3️⃣ Upper Limb Tests 💪

Finger–nose: Dysmetria or intention tremor?
Rapid alternating movements: Dysdiadochokinesia?
Rebound phenomenon: Push down arms then release → overshoot?
Pronator drift: Palms up, eyes closed → watch for drift.

4️⃣ Lower Limb Tests 🦵

Heel–shin: Run heel down shin → smooth vs irregular zigzag.
Gait: Wide-based, staggering?
Tandem gait: Heel-to-toe walk → unsteadiness suggests cerebellar disease.
Romberg: Eyes closed → if sway worsens = sensory ataxia (NOT cerebellar).

5️⃣ Additional Signs 🌟

🎯 Intention tremor → worsens near target.
🛌 Hypotonia → soft “floppy” resistance on passive limb movement.

6️⃣ Closure 🙏

Thank patient, redress, wash hands 🧼.
Present findings: “This patient has ipsilateral cerebellar signs (dysmetria, nystagmus, scanning speech) consistent with …”
Suggest further: cranial nerves, full neuro exam, MRI brain, bloods (B12, autoimmune screen), genetic tests if inherited.

💡 OSCE Pearls

• Always differentiate sensory vs cerebellar ataxia with Romberg. • Test scanning speech explicitly (examiners love this!). • Nystagmus → note direction & type (gaze-evoked vs primary). • Compare sides carefully. • Kneel at eye level for heel–shin test.

⚠️ Common Pitfalls

Confusing Romberg (sensory) with cerebellar ataxia.
Rushing → missing subtle nystagmus or speech abnormalities.
Not explaining manoeuvres → poor patient cooperation.

📚 References

Stanford Medicine 25 – Cerebellar Examination
Geeky Medics: Cerebellar Exam
StatPearls – Cerebellar Signs

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Cerebellar Examination (OSCE)

👋 Introduction