The most midline part of the cerebellum is the cerebellar vermis which is flanked on either side by the cerebellar hemispheres. Lesions to the cerebellar vermis cause truncal ataxia (wide-based, "drunken sailor" gait), and nystagmus. The vermis is centrally located and can be thought of as affecting the center of the body or the trunk of the body. Degeneration of the vermis is associated with chronic alcohol use, as seen with the patient in this vignette.
Lesions to the cerebellar hemisphere cause intention tremors, limb ataxia, and loss of balance. These lesions cause ipsilateral deficits and patients tend to fall toward the side of the lesion. The cerebellar hemispheres are laterally located and can be thought of as affecting the lateral parts of the body, such as the limbs. Cerebellar hemisphere damage can also cause dysdiadochokinesia and dysmetria.
Positive Romberg sign is ONLY (as far as I know) seen in only one clinical presentation which is with tertiary syphilis caused by spirochete Treponema pallidum. It presents with gummas (chronic granulomas, aortitis (vasa vasorum destruction), and most importantly neurosyphilis or tabes doraslis. Tabes dorsalis is demyelination of the dorsal columns and roots (DCML), causing progressive sensory ataxia, impaired proprioception and poor coordination.
submitted by โshak360(19)
The most midline part of the cerebellum is the cerebellar vermis which is flanked on either side by the cerebellar hemispheres. Lesions to the cerebellar vermis cause truncal ataxia (wide-based, "drunken sailor" gait), and nystagmus. The vermis is centrally located and can be thought of as affecting the center of the body or the trunk of the body. Degeneration of the vermis is associated with chronic alcohol use, as seen with the patient in this vignette.
Lesions to the cerebellar hemisphere cause intention tremors, limb ataxia, and loss of balance. These lesions cause ipsilateral deficits and patients tend to fall toward the side of the lesion. The cerebellar hemispheres are laterally located and can be thought of as affecting the lateral parts of the body, such as the limbs. Cerebellar hemisphere damage can also cause dysdiadochokinesia and dysmetria.
Positive Romberg sign is ONLY (as far as I know) seen in only one clinical presentation which is with tertiary syphilis caused by spirochete Treponema pallidum. It presents with gummas (chronic granulomas, aortitis (vasa vasorum destruction), and most importantly neurosyphilis or tabes doraslis. Tabes dorsalis is demyelination of the dorsal columns and roots (DCML), causing progressive sensory ataxia, impaired proprioception and poor coordination.