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 ____________- cerebellum: it receives input from the ________________ nuclei and projects back to the vestibular nuclei

Answer 2

vestibulo-

vestibular

Question 3

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

Answer 3

semicircular

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

medulloblastoma

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

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 of (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 (or 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 | cerebellum

Question 50

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

Answer 50

resistance (or 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 (in either order)

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 (or 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 (or 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 (or opposite) contralateral (or opposite side of the) contralateral

Question 61

Like the anterior lobe of the cerebellum, the posterior lobe of the cerebellum projects to the __________-lateral ventrolateral nucleus of the ______________.

Answer 61

contra- ventrolateral

Question 62

Like most thalamic nuclei, the ventrolateral nucleus of the thalamus projects to the ________________ side of the _______________ cortex

Answer 62

ipsilateral (or 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 (or 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 (or 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 (or motor)

Question 71

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

Answer 71

intended (or 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 (or 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 (or 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 (or intention) | resolution (or decomposition) dysdiadochokinesis

Question 100

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

Answer 100

movement | depression