Review Questions

Directions: Each of the numbered items ln this section ls followed by answers. Select the ONE lettered answer that
is CORRECT.

1. The following statements concern the gross appear- ance of the cerebellum:
(a) It is separated from the occipital lobes of the

5.

with Involvement of the vermls of the cerebellum. The child died 9 months later after extensive deep x-ray therapy.
The sudden onset of vomitlng, the Increased size of the head beyond normal llmlts, the sutural separation, and the
severe bilateral pap- llledema could all be accounted for by the rapid rise In intracranlal pressure owing to the rapid
increase in size of the tumor. The broad-based, unsteady gait and the tendency to fall backward (or forward). and
not to one side, indicate a tumor involving the ver- mis. The presence of bilateral hypotonia, especially during the
later stages, was due to involvement of both cerebellar hemispheres. At autopsy, the tumor was found to have
invaded the fourth ventricle extensively, and there was evidence of internal hydrocephalus because the
cerebrospinal fluid had been wiable to escape through the foramina in the roof of the fourth ventricle.

Nystagmus, an involuntary oscillation of the eye- ball, may occur physiologically, as when a person watches rapidly
moving objects, or by rapid rota- tion of the body. It commonly occurs in diseases of the nervous system, eye, and
Inner ear. In cerebellar disease, nystagmus is due to ataxia of the muscles moving the eyeball. There is lack of
coordination between the agonists and antagonists involved in the eyeball movement. For full understanding of the
different forms of nystagmus, a textbook of neurolo- gy should be consulted. Also see page 242.

cerebral hemispheres by the tentorlum cerebelll.

lum.

6. Acute lesions, such as those resultlng from a throm- bosis of a cerebellar artery or a rapidly growing tumor,
produce sudden severe symptoms and signs because of the sudden withdrawal of the Influence of the cerebellum on
muscular activity. Patients can recover quickly from large cerebellar injuries, and this can be explained by the fact
that the cerebel- lum influences muscular activity not directly, but indirectly, through the vestibular nuclei, reticular
formation, red nucleus, tectum, and corpus striatum and the cerebral cortex; it may be that these other areas of the
central nervous system (CNS) take over this function. Jn chronlc lesions, the symptoms and signs are much less
severe, and there ts enough time to allow other CNS areas to compensate for loss of cerebellar function.

(b) It lies anterior to the medulla oblongata and the pons.

(c) The anterior lobe is separated from the middle (posterior) lobe by the uvulonodular fissure.

(d) The flocculonodular lobe is separated from the middle {posterior) lobe by the horizontal fissure. (e) The third
ventricle lies anterior to the cerebel-

Review Ouestions 245

246 CHAPTER 6 Cerebellum and Its Connections
 2. The following general statements concern the cere- bellum:

(a) The cerebellum greatly influences the activity of smooth muscle.

(b) The cerebellum has no influence on the skeletal muscles supplied by the cranial nerves.

(c) Each cerebellar hemisphere controls the tone of skeletal muscles supplied by spinal nerves on the same
side of the body.

(d) The important Purkinje cells are Golgi type II neurons.

(e) The Purklnje cells exert a stimulatory influence on the intracerebellar nuclei.

3. The following statements concern the structure of

(c) The inferior cerebellar peduncle is made up exclusively of fibers that pass from the inferior olivary nuclei to the
middle lobe of the cerebel- lar hemisphere.

(d) The middle cerebellar peduncle is formed of fibers that arise from the dentate nuclei.

(e) The cerebellar peduncles are surface structures that are difficult to see even by brain dissection. 7. The following
statements concern the afferent

fibers entering the cerebellum:

(a) The mossy fibers end by making synaptic con-

tacts with the dendrites of the Purkinje cells. (b) The fibers enter the cerebellum mainly through

the internal and external arcuate fibers.

(c) The climbing and mossy fibers constitute the two main lines of input to the cerebellar cortex. (d) The afferent
fibers are Inhibitory to the Purklnje

cells.
(e) The afferent fibers to the cerebellum are non-

myelinated.
8. The following statements concern the functions of

the cerebellum:
(a) The cerebellum influences the actions of mus-

cle tendons.
(b) The cerebellum controls voluntary movement

by coordinating the force and extent of contrac-

tion of different muscles.

(c) The cerebellum stimulates the contraction of
antagonistic muscles.
(d) The cerebellum directly influences skeletal

muscle activity without the assistance of the

cerebral cortex.
(e) The cerebellum coordinates the peristaltic

waves seen in intestinal muscle.

9. The following statements concern the cerebellum:

(a) The afferent climbing fibers make single synap- tic contacts with individual Purkinje cells.

(b) The afferent mossy fibers may stimulate many Purkinje cells by first stimulating the stellate cells. (c) The
neurons of the intracerebellar nuclei send axons without interruption to the opposite cere-

bral hemisphere.
(d) The output of the cerebellar nuclei influences

muscle activity so that movements can progress in an orderly sequence from one movement to t h e next.

(e) Past-pointing Is caused by the failure of the cere- bral cortex to inhibit the cerebellum after the movement has
begun.

10. The following statements concern the cerebellum: (a) The cerebellar cortex has a different microscopic

structure in different individuals.

(b) The axons of the Purkinje cells exert an inhibi-

tory influence on the neurons of the deep cere-

bellar nuclei.
(c) Each cerebellar hemisphere principally influ-

ences movement on the opposite hand.

(d) The part of the cerebellum that lies in the mid-

line is called the flocculus.

(e) Intention tremor is a sign of cerebellar disease.

the (a)

(b)

(c) (d) (e)

cerebellum:
The cerebellum consists of two cerebellar hemi- spheres joined by a narrow median vermis. The inferior surface of
the cerebellum shows a deep groove formed by the superior surface of thevermis.
The inferior cerebellar peduncles join the cere- bellum to the pons.
The gray matter is confined to the cerebellar cortex.
The gray matter of folia of the dentate nucleus has a branched appearance on the cut surface, called the arbor vitae.

4. The following statements concern the structure of the cerebellar cortex:

1. (a)  The cortex is folded by many vertical fissures

into folia.

2. (b)  The structure of the cortex differs widely in

different parts of the cerebellum.

3. (c)  The Purkinje cells are found in the most super-

flclal layer of the cortex.

4. (d)  The Golgi cells are found in the most superficial

layer of the cerebellar cortex.

5. (e)  The axons of the Purkinje cells form the efferent

fibers from the cerebellar cortex.

5. The following statements concern the intracerebel-

lar nuclei:

1. (a)  The nuclei are found within the superficial lay-

ers of the white matter.

2. (b)  The nuclei are located in the walls of the fourth

ventricle.

3. (c)  The nuclei are composed of many small unipo-

lar neurons.

4. (d)  The axons of the nuclei form the main cerebel-

lar outflow.

5. (e)  From medial to lateral, the nuclei are named

as follows: dentate, emboliform, globose, and

 fastigial.

6. The following statements concern the cerebellar

peduncles:
(a) In the superior cerebellar peduncle, most of the

fibers are afferent and arise from the neurons of

the spinal cord.

(b) The anterior spinocerebellar tract enters the

cerebellum through the superior cerebellar peduncle.

Directions: Matching Questions. Following thrombosis of the posterior inferior cerebellar artery, a patient
presents the numbered signs and symptoms listed below; match the signs and symptoms with the appro-
priate lettered structures involved. Each lettered option may be selected once, more than once, or not at
all.

11. Loss of pain and temperature on the left side of the body

12. Nystagmus
13. Hypotonicity of the muscles on the right with a ten-

dency to fall to the right

(a) Right reticulospinal tract
(b) Right inferior cerebellar peduncle (c) Noneoftheabove

Directions: Match the numbered nerve tracts llsted below with the lettered pathways by which they leave
the cerebellum. Each lettered option may be selected once, more than once, or not at all.

Directions: Each case history ls followed by questions. Read the case history, then select the ONE BEST
lettered answer.

A 45-year-old man, who was an alcoholic, started to develop a lurching, staggering gait even when he
was not intoxicated. The condition became slowly worse over a period of several weeks and then
appeared to stabilize. Friends noticed that he had difficulty In walking in tandem with another person and
tended to become unsteady on turning quickly.

14. 15. 16. 17.

1.

2.

3.

Corticopontocerebellar Cuneocerebellar Cerebellar reticular Cerebellar rubral

1. (a)  Superior cerebellar peduncle

2. (b)  Corpus callosum
3. (c)  Striae medullarls
4. (d)  Inferior cerebellar

peduncle

5. (e)  Middle cerebellar

peduncle

6. (f)  None of the above

18.

19.

A thorough physical examination of this patient revealed the following findings except:

1. (a)  The patient exhibited Instability of trunk move-

ments and lncoordinatlon of leg movements.

2. (b)  While standing still, the patient stood with his

feet together.

3. (c)  He had no evidence of polyneuropathy.

4. (d)  The ataxia of the legs was confirmed by per-

forming the heel-to-shin test.

5. (e)  Magnetic resonance Imaging showed evidence

of atrophy of the cerebellar vennis.

The following additional abnormal signs might have been observed In this patient except:
(a) Nystagmus In both eyes
(b) Dysarthrla
(c) Tremor of the left hand when reaching for a cup (d) Paralysis of the right upper arm muscles
(e) Dysdiadochokinesia

Answers and Explanations to Review Questions

A is correct. The cerebellum is separated from the occipital lobes of the cerebral hemisphere by the ten-
torium cerebelll. 8. The cerebellum lies posterior to the medulla oblongata (see Fig. 6-1). C. The anterior
lobe ls separated from the middle (posterior) lobe by the primary fissure (see Fig. 6-3). D. The flocculonod-
ular lobe ls separated from the middle (posterior) lobe bythe uvulonodular fissure (see Fig. 6-3). E. The
fourth ventricle lies anterior to the cerebellum (see Fig. 6-1).

C is correct. Each cerebellar hemisphere controls the tone of skeletal muscles supplied by spinal nerves
on the same side of the body. A. The cer- ebellum has no effect on the activity of smooth muscle. B. The
cerebellum has the same influence on the skeletal muscle supplied by cranial nerves as on that supplied
by spinal nerves. D. The Import- ant Purkinje cells are Golgl type I neurons. E. The Purk:inje cells exert an
Inhibitory Influence on the intracerebellar nuclei.

A is correct. The cerebellum consists of two cer- ebellar hemispheres joined by a narrow median vermis
(see Fig. 6-2). B. The inferior surface of the cerebellum shows a deep groove fonned by the inferior
surface of the vermis (see Fig. 6-2). C. The inferior cerebellar peduncle joins the cerebellum
to the medulla oblongata (see Fig. 6-9). D. The gray matter of the cerebellum is found In the cortex and in
the three masses forming the lntracerebellar nuclei. E. The white matter and folla of the cortex. have a
branched appearance on the cut surface, called the arbor vitae (see Fig. 6-1).

4. E is correct. The axons of the Purkinje cells form the efferent fibers from the cerebellar cortex. A. The
cer- ebellar cortex is folded by many transverse fissures into folia (see Fig. 6-1). B. The structure of the
cor- tex is identical in different parts of the cerebellum. C. The Purkinje cells are found in the middle layer
of the cerebellar cortex (see Fig. 6-4). D. The Golgi cells are found in the deepest (granular) layer of the
cerebellar cortex (see Fig. 6-4).

5. D ls correct. The axons from the neurons of the intracerebellar nuclei form the main cerebellar out-
flow. A. The lntracerebellar nuclei are deeply embed- ded In the white matter (see Fig. 6-7). B. The nuclei
are located posterior to the roof of the fourth ven- tricle (see Fig. 6-7). C. The nuclei are composed of large
multipolar neurons. E. From medial to lateral, the nuclei are named as follows: fastigial, globose,
emboliform, and dentate (see Fig. 6-7).

6. B is correcL The anterior spinocerebellar tract enters the cerebellum through the superior cerebellar

Answers and Explanations to Review Questions 247

248
CHAPTER 6 Cerebellum and Its Connections

7.

8.

peduncle (see Fig. 6-11). A. In the superior cere- bellar peduncle, most of the fibers are efferent and arise from the
neurons of the intracerebellar nuclei (see Fig. 6-12). C. The inferior cerebellar peduncle contains afferent fibers of
the posterior spinocere- bellar tract, the cuneocerebellar tract, the vestibular nucleus, and the olivocerebellar tract
(see Figs. 6-10 and 6-11). In addition, efferent fibers come from the cerebellum, including the fastigial vestibular
path- wayand the fastigial reticular pathway (see Fig. 6-12). D. The middle cerebellar peduncle is formed of fibers
that arise from the pontine nuclei (see Fig. 6-10); other fibers connect the cerebellar hemispheres of the two sides
together (see Fig. 6-12). E. The cerebel- lar peduncles are surface structures and are easily seen on dissection.

C is correct. The climbing and mossy fibers of the cerebellum constitute the two main lines of input to the
cerebellar cortex. A. The mossy fibers end by malting synaptic contacts with the dendrites of the granular cells and
the Golgi cells (see Fig. 6-8). B. The afferent fibers enter the cerebellum through the superior, inferior, and middle
cerebellar pedun- cles. D. The afferent fibers are excitatory to the Pur- kinje cells. E. The afferent fibers to the
cerebellum are myelinated.

B is correct. The cerebellum controls voluntary movement by coordinating the force and extent of contraction of
different muscles. A. The cerebellum influences the actions of muscles not tendons. C. The cerebellum inhibits the
contraction of antag- onistic muscles. D. The cerebellum indirectly influ- ences skeletal muscle activity with the
assistance of the cerebral cortex. E. The cerebellum has no effect on the control of smooth muscle in the wall of the
intestine.

9. D is correct. The output of the cerebellar nuclei influences muscle activity so that movements can progress in an
orderly sequence from one move- ment to the next. A. The afferent climbing fibers make multiple synaptic contacts
with 1 to 10 Purkin- je cells. B. The afferent mossy fibers may stimulate many Purkinje cells by first stimulating the
granular cells. C. The neurons of the intracerebellar nuclei send axons to the ventrolateral nucleus of the thal- amus,
where they are relayed to the cerebral cortex (see Fig. 6-12). E. Past-pointing is caused by the fail- ure of the
cerebellum to inhibit the cerebral cortex after the movement has begun.

10. E is correct. Intention tremor is a sign of cerebellar disease. A. The cerebellar cortex has the same uni- form
microscopic structure in different individuals. B. The axons of the Purkinje cells exert a stimulato- ry influence on
the neurons of the deep cerebellar nuclei. C. Each cerebellar hemisphere principally influences movement on the
same side of the body. D. The part of the cerebellum that lies in the midline is called the vermis.

11. C is correct.
12. B Is correct:
13. B is correct:
14. Eis correct:
15. D is correct:
16. D is correct:
17. A is correct:
18. B is correct. Patients with cerebellar disease fre-

right inferior cerebellar peduncle. right inferior cerebellar peduncle. middle cerebellar peduncle. inferior cerebellar
peduncle. inferior cerebellar peduncle. superior cerebellar peduncle.

quently exhibit poor muscle tone, and to compen- sate for this, they stand stiff legged with their feet wide apart.
19. D is correct. Although patients with cerebellar dis- ease display disturbances of voluntary movement, none of the
muscles are paralyzed or show atrophy.