Figure 569

Anatomical relations of the basal ganglia to the cerebral cortex and thalamus, shown in three-dimensional view. (Redrawn from Guyton AC: Basic Neuroscience: Anatomy and Physiology. Philadelphia: WB Saunders Co, 1992.)

Therefore, past pointing is actually a manifestation of dysmetria.

Failure of Progression

Dysdiadochokinesia. When the motor control system fails to predict where the different parts of the body will be at a given time, it "loses" perception of the parts during rapid motor movements. As a result, the succeeding movement may begin much too early or much too late, so that no orderly "progression of movement" can occur. One can demonstrate this readily by having a patient with cerebellar damage turn one hand upward and downward at a rapid rate. The patient rapidly "loses" all perception of the instantaneous position of the hand during any portion of the movement. As a result, a series of stalled attempted but jumbled movements occurs instead of the normal coordinate upward and downward motions. This is called dysdiadochokinesia.

Dysarthria. Another example in which failure of progression occurs is in talking because the formation of words depends on rapid and orderly succession of individual muscle movements in the larynx, mouth, and respiratory system. Lack of coordination among these and inability to adjust in advance either the intensity of sound or duration of each successive sound causes jumbled vocalization, with some syllables loud, some weak, some held for long intervals, some held for short intervals, and resultant speech that is often unintelligible. This is called dysarthria.

Intention Tremor. When a person who has lost the cerebellum performs a voluntary act, the movements tend to oscillate, especially when they approach the intended mark, first overshooting the mark and then vibrating back and forth several times before settling on the mark. This reaction is called an intention tremor or an action tremor, and it results from cerebellar overshooting and failure of the cerebellar system to "damp" the motor movements.

Cerebellar Nystagmus. Cerebellar nystagmus is tremor of the eyeballs that occurs usually when one attempts to fixate the eyes on a scene to one side of the head. This off-center type of fixation results in rapid, tremulous movements of the eyes rather than steady fixation, and it is another manifestation of failure of damping by the cerebellum. It occurs especially when the flocculonodu-lar lobes of the cerebellum are damaged; in this instance it is also associated with loss of equilibrium because of dysfunction of the pathways through the flocculonodu-lar cerebellum from the semicircular ducts.

Hypotonia. Loss of the deep cerebellar nuclei, particularly of the dentate and interposed nuclei, causes decreased tone of the peripheral body musculature on the side of the cerebellar lesion. The hypotonia results from loss of cerebellar facilitation of the motor cortex and brain stem motor nuclei by tonic signals from the deep cerebellar nuclei.

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