The fastigial nucleus of the cerebellum projects primarily to which brainstem structures, and dysfunction is characterised by which clinical syndrome?
- A Red nucleus and VL thalamus; intention tremor of the contralateral limb
- B Inferior olivary nucleus; palatal tremor
- C Pontine nuclei; cerebellar atrophy
- D Vestibular nuclei and reticular formation; ipsilateral truncal ataxia and gaze disturbance ✓
Explanation
The fastigial nucleus is the most medial deep cerebellar nucleus and receives input from the vermis (midline cerebellar cortex), which processes trunk and axial motor functions as well as vestibular input. Fastigial efferents project bilaterally to the vestibular nuclei and reticular formation via the uncinate fasciculus (hook bundle), controlling axial and proximal muscle tone and gaze. Vermis/fastigial lesions produce truncal ataxia, wide-based gait, and oculomotor disturbances (gaze-evoked nystagmus). Intention tremor and limb dysmetria arise from interpositus/dentate nucleus lesions projecting to the red nucleus and VL thalamus.
Reference: BD Chaurasia's Human Anatomy, 8th ed.
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