Chapter 33: Cerebellar Lesions

Question 1

The flocculonodular lobe is also called the vestibulocerebellum. This implies that the flocculonodular lobe receives input from the _____ nuclei.

Answer 1

• Vestibular

Question 2

The flocculonodular lobe is the _____: it receives input from the vestibular nuclei and projects back to the _____ nuclei.

Answer 2

• Vestibulo-cerebellum

Question 3

The vestibular nuclei receive input from the vestibular apparatus: saccule, utricle, and _____.

Answer 3

• Semicircular canals

Question 4

Damage to the flocculonodular lobe affects a patient ‘s sense of _____.

Answer 4

• Balance

Question 5

Poor _____ will cause the patient to have difficulty in walking.

Answer 5

• Balance

Question 6

Because a lesion in the flocculonodular lobe impairs _____ rather than motor control, the patient’s legs will function _____ when the patient is lying down.

Answer 6

• Balance

- Normally

Question 7

Since the nodulus and the connections of the flocculi are in the roof the 4th ventricle, lesions anywhere in the surroundings of the 4th ventricle will affect the _____ lobe.

Answer 7

• Flocculonodular

Question 8

The roof of the 4th ventricle is the most common site for medulloblastomas. A medulloblastoma in the roof of the 4th ventricle will impair the function of the _____ lobe.

Answer 8

• Flocculonodular

Question 9

A medulloblastoma in the roof of the 4th ventricle will wreck the patient’s sense of _____.

Answer 9

• Balance

Question 10

Difficulty in walking not accompanied by poor control or poor tone of the legs when the patient is lying down is often due to a medulloblastoma in the _____ of the _____.

Answer 10

• Roof

- 4th ventricle

Question 11

The roof of the 4th ventricle is the most common location for a _____.

Answer 11

• Medullablastoma

Question 12

A neuroma in the vestibulocochlear nerve is called an acoustic _____ after the old name for the vestibulocochlear nerve.

Answer 12

• Neuroma

Question 13

The vestibulocochlear nerve enters the brainstem next to the flocculus. Thus an acoustic neuroma will press on the _____ nerve and on the _____ on the same side.

Answer 13

• Vestibulocochlear

- Flocculus

Question 14

The pressure of an acoustic neuroma on a vestibulocochlear nerve will impair _____ and _____.

Answer 14

• Hearing

- Balance

Question 15

The pressure of an acoustic neuroma on a flocculus will have even more effect on _____ than the pressure on the vestibulocochlear nerve does.

Answer 15

• Balance

Question 16

If a gait problem is due to damage to the _____ on only one side, the patient is likely to fall toward the affected side.

Answer 16

• Flocculus

Question 17

Many patients will try to compensate for damage to the flocculus by keeping the feet far _____ in a wide stance.

Answer 17

• Apart

Question 18

Occlusion of an anterior inferior cerebellar artery will also damage the flocculus on only one _____. This will cause the patient to have a _____ stance and to fall toward the _____
side when walking.

Answer 18

• Side
• Wide
• Affected (lesioned)

Question 19

The usual blood supply of the flocculi are the _____ arteries which are the most inferior branches of the _____.

Answer 19

• Anterior inferior cerebellar

- Basilar artery

Question 20

The posterior inferior cerebellar arteries branch off the _____ arteries just before the _____ arteries join to form the basilar artery.

Answer 20

• Vertebral

- Vertebral

Question 21

The posterior inferior cerebellar artery supplies blood to the nodulus of the cerebellum and to the dorsolateral 1/3 of the _____, which includes the _____ peduncle.

Answer 21

• Flocculonodular lobe

Question 22

The inferior cerebellar peduncle brings muscle stretch information to the _____ to facilitate cerebellar regulation of muscle tone.

Answer 22

• Cerebellum

Question 23

Occlusion of the posterior inferior cerebellar artery will destroy the _____ peduncle, and the several nuclei in the dorsolateral third of the _____.

Answer 23

• Inferior cerebellar

- Medulla

Question 24

Occlusion of the posterior inferior cerebellar artery will cause dysfunction of the _____ side of the cerebellum due to damage to the _____ of the cerebellum and lack of tone in the ipsilateral limbs due to destruction of the _____ peduncle

Answer 24

• Same (ipsilateral)
• Flocculus
• Inferior cerebellar

Question 25

Occlusion of the posterior inferior cerebellar artery will cause additional symptoms due to destruction of the dorsolateral third of the _____.

Answer 25

- Medulla

Question 26

Damage to the lateral medulla due to occlusion of the _____ will impair the sense of _____ and may cause the patient to fall toward the side _____ the lesion when walking.

Answer 26

- Posterior inferior cerebellar artery - Balance - Ipsilateral to

Question 27

Balance problems alone suggest the likelihood of a _____ in the vicinity of the _____ lobe. Balance problems combined with unilateral lack of muscle tone and loss of lower cranial nerve function suggest the likelihood of occlusion of the _____.

Answer 27

- Tumor (medulloblastoma) - Flocculonodular - Posterior inferior cerebellar artery

Question 28

The vermis and fastigial nuclei are responsible for tone in the axial musculature. Damage to either the _____ or the _____ will cause instability of the trunk.

Answer 28

- Vermis | - Fastigial nuclei (cerebellar roof)

Question 29

Damage to one fastigial nucleus causes few symptoms because the output of the fastigial nuclei is _____.

Answer 29

- Bilateral (partially crossed)

Question 30

Swaying of the trunk severe enough to interfere with walking suggests damage to the _____ or to both _____.

Answer 30

- Vermis | - Fastigial nuclei

Question 31

The anterior lobe of the cerebellum is called the spinocerebellum because it gets most of its input from the spinal cord via the _____ peduncle. The posterior spinocerebellar tract and the cuneocerebellar tract enter the cerebellum in the _____.

Answer 31

- Inferior cerebellar | - Inferior cerebellar peduncle

Question 32

The anterior lobe uses the information supplied by the _____ and the _____ to adjust muscle tone in the _____ and _____ respectively.

Answer 32

- Posterior spinocerebellar tract - Cuneocerebellar tract - Legs - Arms

Question 33

Damage to the anterior lobe or the _____ peduncle causes loss of tone on the affected side because cerebellum works with the _____ side of the body.

Answer 33

- Inferior cerebellar | - Same (ipsilateral)

Question 34

Damage to one side of the anterior lobe makes it very difficult to place the _____ foot where one wishes to.

Answer 34

- Ipsilateral

Question 35

Damage to both sides of the anterior lobe makes it very difficult, if not impossible, to place the feet _____. This condition is called ataxia.

Answer 35

- Where one wishes

Question 36

Damage to the anterior lobe of the cerebellum when its supply of ATP is cut off by thiamine deficiency causes _____.

Answer 36

- Ataxia

Question 37

Bilateral damage to the anterior lobe also makes it difficult to direct one’s gaze in the _____.

Answer 37

- Desired direction

Question 38

Wernicke’s ataxia is damage to the _____ lobe of the cerebellum due to _____ deficiency.

Answer 38

- Anterior | - Thiamine

Question 39

Wernicke’s ataxia usually includes both _____ and difficulty in directing one’s _____.

Answer 39

- Ataxia | - Gaze

Question 40

Alcoholics often have Wernicke’s ataxia because alcoholic beverages contain no _____.

Answer 40

- Thiamine

Question 41

Failure to absorb thiamine due to gastric bypass surgery or antacid therapy can also cause _____.

Answer 41

- Wernicke's ataxia

Question 42

Due to its constant high expenditure of _____ the heart needs almost as much thiamine as the spinocerebellum.

Answer 42

- Energy (ATP)

Question 43

Wernicke’s ataxia may involve life-threatening effects on the _____.

Answer 43

- Heart

Question 44

The anterior lobe of the cerebellum projects to the ventrolateral nucleus of the thalamus via the globose and emboliform nuclei. Damage to the _____ and _____ nuclei will have the same effect as damage to the anterior lobe of the cerebellum.

Answer 44

- Globose | - Emboliform

Question 45

The globose and emboliform nuclei project to the ventrolateral nucleus of the _____ via the superior cerebellar peduncles.

Answer 45

- Thalamus

Question 46

Through its projections in the _____ peduncle, the anterior lobe of the cerebellum instructs the ventrolateral nucleus of the _____ in the adjustment of muscle tone.

Answer 46

- Superior cerebellar | - Thalamus

Question 47

Without the assistance of the spinocerebellum, the basal nuclei and thalamus create too little or too much _____.

Answer 47

- Muscle tone

Question 48

“Dys” is Greek for bad. Dystonia is too little or too much _____.

Answer 48

- Muscle tone

Question 49

Dystonia is a typical result of damage to the _____ of the _____.

Answer 49

- Anterior lobe | - Cerebellar

Question 50

If you press down on the outstretched arm of a patient with dystonia, there will be little or no _____.

Answer 50

- Resistance (muscle tone)

Question 51

When you release the dystonic arm, it will rise too high because, in the absence of cerebellar instruction, the basal nuclei and thalamus have created too much _____ in the outstretched arm.

Answer 51

- Muscle tone

Question 52

The anterior lobe of the cerebellum and its output nuclei, the _____ and _____ nuclei, receive their blood supply from the superior cerebellar artery.

Answer 52

- Globose | - Emboliform

Question 53

Occlusion of one _____ will cause ataxia and loss of muscle tone in the _____ extremities.

Answer 53

- Superior cerebellar artery | - Ipsilateral

Question 54

The posterior lobe of the cerebellum is called the pontocerebellum because the _____ that project to it are in the pons.

Answer 54

- Neurons (nuclei)

Question 55

Axons of some neurons in the motor and associative areas of the _____ synapse on neurons in the pontine nuclei.

Answer 55

- Cerebral cortex

Question 56

The contralateral _____ nuclei relay information from the cerebral cortex to the cortex of the pontocerebellum.

Answer 56

- Pontine

Question 57

The axons of neurons in the _____ pontine nuclei reach the cortex of the _____ lobe of the cerebellum via the middle cerebellar peduncle.

Answer 57

- Contralateral | - Posterior

Question 58

The enormous number of axons in the _____ suggests the magnitude of the influence of the pontine nuclei on the _____ of the cerebellum.

Answer 58

- Middle cerebellar peduncle | - Posterior lobe

Question 59

Because the axons in the middle cerebellar peduncle cross higher than the axons in the corticospinal tract do, the pontine nuclei and the cerebral cortex both control movement on the _____ side of the body.

Answer 59

- Contralateral (opposite)

Question 60

Because the input to the pontocerebellum comes from the _____ side of the pons, the pontocerebellum should project back to the _____ cerebral cortex (via the _____ ventrolateral nucleus of the thalamus).

Answer 60

- Contralateral (opposite) - Contralateral (opposite) - Contralateral

Question 61

Like the anterior lobe of the cerebellum, the posterior lobe of the cerebellum projects to the _____ ventrolateral nucleus of the _____.

Answer 61

- Contralateral | - Ventrolateral

Question 62

Like most thalamic nuclei, the ventrolateral nucleus of the thalamus projects to the _____ side of the _____ cortex.

Answer 62

- Ipsilateral (same) | - Cerebral

Question 63

Because the pontocerebellum influences the contralateral primary motor cortex, the signs of pontocerebellar damage appear in the _____ limbs.

Answer 63

- Ipsilateral

Question 64

The posterior lobe of the cerebellum coordinates and smooths out premeditated actions initiated by the contralateral _____.

Answer 64

- Primary motor cortex (cerebral motor cortex)

Question 65

Premeditated actions resolve (or decompose) into a series of small steps if the _____ of the cerebellum is damaged.

Answer 65

- Posterior lobe

Question 66

One of the typical signs of damage to the posterior lobe of the cerebellum, the pontine nuclei, or the middle cerebellar peduncle is _____ of movement.

Answer 66

- Resolution (decomposition)

Question 67

Damage to the posterior lobe of the cerebellum leaves the cerebral cortex uncertian of how much effort is required to reach an object. This results in the patient reaching _____ or not far enough to grasp or touch an object.

Answer 67

- Too far

Question 68

Reaching _____ is called “past pointing.”

Answer 68

- Too far

Question 69

Resolution of _____ and _____ are signs of damage to the posterior lobe of the cerebellum.

Answer 69

- Movement | - Past pointing

Question 70

Lack of feedback from the posterior lobe of the cerebellum causes the _____ cortex to seek the correct line of action by moving the arm or leg from one side to the other of the intended line of action.

Answer 70

- Cerebral (motor)

Question 71

The wobbling of the arm or leg around the _____ line of action is often called “intention tremor.”

Answer 71

- Intended (desired)

Question 72

While “intention tremor” starts with the _____ to act, it becomes worse during actual movement.

Answer 72

- Intention

Question 73

Since “kinetic” is Greek for “moving,” intention tremor is also called _____.

Answer 73

- Kinetic tremor

Question 74

Kinetic tremor, or _____ is a typical sign of damage to the _____ of the _____.

Answer 74

- Intention tremor - Posterior lobe - Cerebellum

Question 75

Resting tremor is a typical sign of Parkinson’s disease but _____ tremor is a sign of a lesion in the posterior lobe of the cerebellum.

Answer 75

- Kinetic (intention)

Question 76

Rarely, resting tremor is a sign of an _____ of caffeine.

Answer 76

- Overdose

Question 77

The combination of resolution of _____ and “_____ pointing” makes it impossible for a patient with damage to the posterior lobe of the cerebellum to reverse a movement quickly.

Answer 77

- Movement | - Past

Question 78

“Dys” is Greek for _____, and Kinesis is Greek for _____. “Diadocho” is Greek for reversal. Thus “dysdiadochokinesis” is _____ of _____.

Answer 78

- Bad - Movement - Bad reversal - Movement

Question 79

Whereas anterior lobe cerebellar lesions cause dystonia, posterior lobe lesions cause _____.

Answer 79

- Dysdiadochokinesis

Question 80

_____ is usually due to a lesion in the posterior lobe of the cerebellum.

Answer 80

- Dysdiadochokinesis

Question 81

The cortex of the posterior lobe of the cerebellum projects to the _____ nucleus.

Answer 81

- Dentate

Question 82

The dentate nucleus projects to the ventrolateral nucleus of the thalamus via the _____ peduncle.

Answer 82

- Superior cerebellar

Question 83

A lesion in the dentate nucleus has the same effect as a lesion in the _____ lobe of the _____.

Answer 83

- Posterior | - Cerebellum

Question 84

The anterior inferior cerebellar artery supplies blood to the middle cerebellar peduncle, the posterior lobe of the cerebellum, and, usually, the dentate nucleus. Thus occlusion of the anterior inferior cerebellar artery causes _____ tremor, “past-_____”, _____ of movement, and _____.

Answer 84

- Kinetic (intention) - Pointing - Resolution - Dysdiadochokinesis

Question 85

The posterior lobe of the cerebellum, its input tract and output nucleus are completely dependent on the _____ artery.

Answer 85

- Anterior inferior cerebellar

Question 86

The word “usually” frequently appears in discussions of the _____ artery.

Answer 86

- Anterior inferior cerebellar

Question 87

The course and size of the _____ cerebellar artery are extremely variable.

Answer 87

- Anterior inferior

Question 88

The posterior lobe of the cerebellum suppresses unwanted _____ and unwanted thoughts.

Answer 88

- Movement

Question 89

Dysdiadochokinesis and kinetic tremor are often accompanied by depression because the damaged _____ fails to _____ negative thoughts.

Answer 89

- Posterior lobe | - Suppress

Question 90

Difficulty in walking due to poor balance alone suggests damage to the _____ on the side to which the patient falls.

Answer 90

- Flocculus

Question 91

The most common cause of damage to the flocculus or its connections is _____ in the _____ of the 4th ventricle.

Answer 91

- Medulloblastoma | - Roof

Question 92

The flocculus may also be damaged by an _____ neuroma or by occlusion of a branch of the _____.

Answer 92

- Acoustic | - Anterior inferior cerebellar artery

Question 93

An acoustic neuroma will also damage _____ and cause _____ paralysis of the _____ muscles on the side of the neuroma.

Answer 93

- Hearing - Flaccid - Facial

Question 94

Difficulty in walking due to poor muscle tone in the trunk suggests damage to the _____ due to occlusion of a branch of the _____.

Answer 94

- Nodulus | - Posterior inferior cerebellar artery

Question 95

Unilateral dystonia of the extremities accompanied by vertigo and loss of protopathic sensation suggests damage to the _____ due to occlusion of the _____.

Answer 95

- Inferior cerebellar peduncle | - Posterior inferior cerebellar artery

Question 96

Global dystonia is usually due to damage to the _____ of the cerebellum due to _____ deficiency.

Answer 96

- Anterior lobe | - Thiamine

Question 97

Global dystonia due to _____ deficiency is often treated by intravenous drip of _____ to prevent damage to the _____.

Answer 97

- Thiamine - Thiamine - Heart

Question 98

The posterior lobe of the cerebellum may be damaged by occlusion of the _____.

Answer 98

- Anterior | - Inferior cerebellar artery

Question 99

Lesions of the posterior lobe of the cerebellum usually cause _____ tremor, _____ of movement, and _____.

Answer 99

- Kinetic (intention) - Resolution (decomposition) - Dysdiadochokinesis

Question 100

In addition to disorders of _____, lesions of the posterior lobe of the cerebellum often cause _____.

Answer 100

- Movement | - Depression