Chapter 33: Cerebellar Lesions Flashcards
The flocculonodular lobe is also called the vestibulocerebellum. This implies that the flocculonodular lobe receives input from the _____ nuclei.
- Vestibular
The flocculonodular lobe is the _____: it receives input from the vestibular nuclei and projects back to the _____ nuclei.
- Vestibulo-cerebellum
The vestibular nuclei receive input from the vestibular apparatus: saccule, utricle, and _____.
- Semicircular canals
Damage to the flocculonodular lobe affects a patient ‘s sense of _____.
- Balance
Poor _____ will cause the patient to have difficulty in walking.
- Balance
Because a lesion in the flocculonodular lobe impairs _____ rather than motor control, the patient’s legs will function _____ when the patient is lying down.
- Balance
- Normally
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.
- Flocculonodular
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.
- Flocculonodular
A medulloblastoma in the roof of the 4th ventricle will wreck the patient’s sense of _____.
- Balance
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 _____.
- Roof
- 4th ventricle
The roof of the 4th ventricle is the most common location for a _____.
- Medullablastoma
A neuroma in the vestibulocochlear nerve is called an acoustic _____ after the old name for the vestibulocochlear nerve.
- Neuroma
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.
- Vestibulocochlear
- Flocculus
The pressure of an acoustic neuroma on a vestibulocochlear nerve will impair _____ and _____.
- Hearing
- Balance
The pressure of an acoustic neuroma on a flocculus will have even more effect on _____ than the pressure on the vestibulocochlear nerve does.
- Balance
If a gait problem is due to damage to the _____ on only one side, the patient is likely to fall toward the affected side.
- Flocculus
Many patients will try to compensate for damage to the flocculus by keeping the feet far _____ in a wide stance.
- Apart
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.
- Side
- Wide
- Affected (lesioned)
The usual blood supply of the flocculi are the _____ arteries which are the most inferior branches of the _____.
- Anterior inferior cerebellar
- Basilar artery
The posterior inferior cerebellar arteries branch off the _____ arteries just before the _____ arteries join to form the basilar artery.
- Vertebral
- Vertebral
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.
- Flocculonodular lobe
The inferior cerebellar peduncle brings muscle stretch information to the _____ to facilitate cerebellar regulation of muscle tone.
- Cerebellum
Occlusion of the posterior inferior cerebellar artery will destroy the _____ peduncle, and the several nuclei in the dorsolateral third of the _____.
- Inferior cerebellar
- Medulla
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
- Same (ipsilateral)
- Flocculus
- Inferior cerebellar
Occlusion of the posterior inferior cerebellar artery will cause additional symptoms due to destruction of the dorsolateral third of the _____.
- Medulla
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.
- Posterior inferior cerebellar artery
- Balance
- Ipsilateral to
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 _____.
- Tumor (medulloblastoma)
- Flocculonodular
- Posterior inferior cerebellar artery
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.
- Vermis
- Fastigial nuclei (cerebellar roof)
Damage to one fastigial nucleus causes few symptoms because the output of the fastigial nuclei is _____.
- Bilateral (partially crossed)
Swaying of the trunk severe enough to interfere with walking suggests damage to the _____ or to both _____.
- Vermis
- Fastigial nuclei
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 _____.
- Inferior cerebellar
- Inferior cerebellar peduncle
The anterior lobe uses the information supplied by the _____ and the _____ to adjust muscle tone in the _____ and _____ respectively.
- Posterior spinocerebellar tract
- Cuneocerebellar tract
- Legs
- Arms
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.
- Inferior cerebellar
- Same (ipsilateral)
Damage to one side of the anterior lobe makes it very difficult to place the _____ foot where one wishes to.
- Ipsilateral
Damage to both sides of the anterior lobe makes it very difficult, if not impossible, to place the feet _____. This condition is called ataxia.
- Where one wishes
Damage to the anterior lobe of the cerebellum when its supply of ATP is cut off by thiamine deficiency causes _____.
- Ataxia
Bilateral damage to the anterior lobe also makes it difficult to direct one’s gaze in the _____.
- Desired direction
Wernicke’s ataxia is damage to the _____ lobe of the cerebellum due to _____
deficiency.
- Anterior
- Thiamine
Wernicke’s ataxia usually includes both _____ and difficulty in directing one’s _____.
- Ataxia
- Gaze
Alcoholics often have Wernicke’s ataxia because alcoholic beverages contain no _____.
- Thiamine
Failure to absorb thiamine due to gastric bypass surgery or antacid therapy can also cause _____.
- Wernicke’s ataxia
Due to its constant high expenditure of _____ the heart needs almost as much thiamine as the spinocerebellum.
- Energy (ATP)
Wernicke’s ataxia may involve life-threatening effects on the _____.
- Heart
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.
- Globose
- Emboliform
The globose and emboliform nuclei project to the ventrolateral nucleus of the _____ via the superior cerebellar peduncles.
- Thalamus
Through its projections in the _____ peduncle, the anterior lobe of the cerebellum instructs the ventrolateral nucleus of the _____ in the adjustment of muscle tone.
- Superior cerebellar
- Thalamus
Without the assistance of the spinocerebellum, the basal nuclei and thalamus create too little or too much _____.
- Muscle tone
“Dys” is Greek for bad. Dystonia is too little or too much _____.
- Muscle tone
Dystonia is a typical result of damage to the _____ of the _____.
- Anterior lobe
- Cerebellar
If you press down on the outstretched arm of a patient with dystonia, there will be little or no _____.
- Resistance (muscle tone)
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.
- Muscle tone
The anterior lobe of the cerebellum and its output nuclei, the _____ and _____ nuclei, receive their blood supply from the superior cerebellar artery.
- Globose
- Emboliform
Occlusion of one _____ will cause ataxia and loss of muscle tone in the _____ extremities.
- Superior cerebellar artery
- Ipsilateral
The posterior lobe of the cerebellum is called the pontocerebellum because the _____ that project to it are in the pons.
- Neurons (nuclei)
Axons of some neurons in the motor and associative areas of the _____ synapse on neurons in the pontine nuclei.
- Cerebral cortex
The contralateral _____ nuclei relay information from the cerebral cortex to the cortex of the pontocerebellum.
- Pontine
The axons of neurons in the _____ pontine nuclei reach the cortex of the _____ lobe of the cerebellum via the middle cerebellar peduncle.
- Contralateral
- Posterior
The enormous number of axons in the _____ suggests the magnitude of the influence of the pontine nuclei on the _____
of the cerebellum.
- Middle cerebellar peduncle
- Posterior lobe
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.
- Contralateral (opposite)
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).
- Contralateral (opposite)
- Contralateral (opposite)
- Contralateral
Like the anterior lobe of the cerebellum, the posterior lobe of the cerebellum projects to the _____ ventrolateral nucleus of the _____.
- Contralateral
- Ventrolateral
Like most thalamic nuclei, the ventrolateral nucleus of the thalamus projects to the _____ side of the _____ cortex.
- Ipsilateral (same)
- Cerebral
Because the pontocerebellum influences the contralateral primary motor cortex, the signs of pontocerebellar damage appear in the _____ limbs.
- Ipsilateral
The posterior lobe of the cerebellum coordinates and smooths out premeditated actions initiated by the contralateral _____.
- Primary motor cortex (cerebral motor cortex)
Premeditated actions resolve (or decompose) into a series of small steps if the _____ of the cerebellum is damaged.
- Posterior lobe
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.
- Resolution (decomposition)
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.
- Too far
Reaching _____ is called “past pointing.”
- Too far
Resolution of _____ and _____ are signs of damage to the posterior lobe of the cerebellum.
- Movement
- Past pointing
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.
- Cerebral (motor)
The wobbling of the arm or leg around the _____ line of action is often called “intention tremor.”
- Intended (desired)
While “intention tremor” starts with the _____ to act, it becomes worse during actual movement.
- Intention
Since “kinetic” is Greek for “moving,” intention tremor is also called _____.
- Kinetic tremor
Kinetic tremor, or _____ is a typical sign of damage to the _____ of the _____.
- Intention tremor
- Posterior lobe
- Cerebellum
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.
- Kinetic (intention)
Rarely, resting tremor is a sign of an _____ of caffeine.
- Overdose
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.
- Movement
- Past
“Dys” is Greek for _____, and Kinesis is Greek for _____. “Diadocho” is Greek for reversal. Thus “dysdiadochokinesis” is _____ of _____.
- Bad
- Movement
- Bad reversal
- Movement
Whereas anterior lobe cerebellar lesions cause dystonia, posterior lobe lesions cause _____.
- Dysdiadochokinesis
_____ is usually due to a lesion in the posterior lobe of the cerebellum.
- Dysdiadochokinesis
The cortex of the posterior lobe of the cerebellum projects to the _____ nucleus.
- Dentate
The dentate nucleus projects to the ventrolateral nucleus of the thalamus via the _____ peduncle.
- Superior cerebellar
A lesion in the dentate nucleus has the same effect as a lesion in the _____ lobe of the _____.
- Posterior
- Cerebellum
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 _____.
- Kinetic (intention)
- Pointing
- Resolution
- Dysdiadochokinesis
The posterior lobe of the cerebellum, its input tract and output nucleus are completely dependent on the _____ artery.
- Anterior inferior cerebellar
The word “usually” frequently appears in discussions of the _____ artery.
- Anterior inferior cerebellar
The course and size of the _____ cerebellar artery are extremely variable.
- Anterior inferior
The posterior lobe of the cerebellum suppresses unwanted _____ and unwanted thoughts.
- Movement
Dysdiadochokinesis and kinetic tremor are often accompanied by depression because the damaged _____ fails to _____ negative thoughts.
- Posterior lobe
- Suppress
Difficulty in walking due to poor balance alone suggests damage to the _____ on the side to which the patient falls.
- Flocculus
The most common cause of damage to the flocculus or its connections is _____ in the _____ of the 4th ventricle.
- Medulloblastoma
- Roof
The flocculus may also be damaged by an _____ neuroma or by occlusion of a branch of the _____.
- Acoustic
- Anterior inferior cerebellar artery
An acoustic neuroma will also damage _____ and cause _____ paralysis of the _____ muscles on the side of the neuroma.
- Hearing
- Flaccid
- Facial
Difficulty in walking due to poor muscle tone in the trunk suggests damage to the _____ due to occlusion of a branch of the _____.
- Nodulus
- Posterior inferior cerebellar artery
Unilateral dystonia of the extremities accompanied by vertigo and loss of protopathic sensation suggests damage to the _____ due to occlusion of the _____.
- Inferior cerebellar peduncle
- Posterior inferior cerebellar artery
Global dystonia is usually due to damage to the _____ of the cerebellum due to _____ deficiency.
- Anterior lobe
- Thiamine
Global dystonia due to _____ deficiency is often treated by intravenous drip of _____ to prevent damage to the _____.
- Thiamine
- Thiamine
- Heart
The posterior lobe of the cerebellum may be damaged by occlusion of the _____.
- Anterior
- Inferior cerebellar artery
Lesions of the posterior lobe of the cerebellum usually cause _____ tremor, _____ of movement, and _____.
- Kinetic (intention)
- Resolution (decomposition)
- Dysdiadochokinesis
In addition to disorders of _____, lesions of the posterior lobe of the cerebellum often cause _____.
- Movement
- Depression
