426 resultados para Cerebellar vermis
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The present study investigated the effect of thioperamide (THIO), an H3 histaminergic receptor antagonist, microinjected into the cerebellar vermis on emotional memory consolidation in male Swiss albino mice re-exposed to the elevated plus-maze (EPM). We implanted a guide cannula into the cerebellar vermis using stereotactic surgery. On the third day after surgery, we performed behavioral tests for two consecutive days. On the first day (exposure), the mice (n=10/group) were exposed to the EPM and received THIO (0.06, 0.3, or 1.5 ng/0.1 µL) immediately after the end of the session. Twenty-four hours later, the mice were re-exposed to the EPM under the same experimental conditions, but without drug injection. A reduction in the exploration of the open arms upon re-exposure to the EPM (percentage of number of entries and time spent in open arms) compared with the initial exposure was used as an indicator of learning and memory. One-way analysis of variance (ANOVA) followed by the Duncan post hoc test was used to analyze the data. Upon re-exposure, exploratory activity in the open arms was reduced in the control group, and with the two highest THIO doses: 0.3 and 1.5 ng/0.1 µL. No reduction was seen with the lowest THIO dose (0.06 ng/0.1 µL), indicating inhibition of the consolidation of emotional memory. None of the doses interfered with the animals' locomotor activity. We conclude that THIO at the lowest dose (0.06 ng/0.1 µL) microinjected into the cerebellum impaired emotional memory consolidation in mice.
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This study investigated the effects of histamine H1 or H2 receptor antagonists on emotional memory consolidation in mice submitted to the elevated plus maze (EPM). The cerebellar vermis of male mice (Swiss albino) was implanted using a cannula guide. Three days after recovery, behavioral tests were performed in the EPM on 2 consecutive days (T1 and T2). Immediately after exposure to the EPM (T1), animals received a microinjection of saline (SAL) or the H1 antagonist chlorpheniramine (CPA; 0.016, 0.052, or 0.16 nmol/0.1 µL) in Experiment 1, and SAL or the H2 antagonist ranitidine (RA; 0.57, 2.85, or 5.7 nmol/0.1 µL) in Experiment 2. Twenty-four hours later, mice were reexposed to the EPM (T2) under the same experimental conditions but they did not receive any injection. Data were analyzed using one-way ANOVA and the Duncan test. In Experiment 1, mice microinjected with SAL and with CPA entered the open arms less often (%OAE) and spent less time in the open arms (%OAT) in T2, and there was no difference among groups. The results of Experiment 2 demonstrated that the values of %OAE and %OAT in T2 were lower compared to T1 for the groups that were microinjected with SAL and 2.85 nmol/0.1 µL RA. However, when animals were microinjected with 5.7 nmol/0.1 µL RA, they did not show a reduction in %OAE and %OAT. These results demonstrate that CPA did not affect behavior at the doses used in this study, while 5.7 nmol/0.1 µL RA induced impairment of memory consolidation in the EPM.
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Aim: Complete or subtotal absence of one cerebellar hemisphere is exceptional; only single cases have been described. We aimed to assess the long-term outcome in children with severe unilateral cerebellar hypoplasia (UCH). Method: As part of a retrospective study we describe neuroimaging features, clinical findings, and cognitive outcomes of seven children with UCH (five males, two females; age at first magnetic resonance imaging [MRI]: median 1y 3mo, range 9d-8y 10mo; age at latest follow-up: median 6y 6mo, range 2y 3mo-14y 11mo). Results: One child had abnormalities on prenatal MRI at 21 weeks' gestation. The left cerebellar hemisphere was affected in five children, and the right hemisphere in two children. The vermis was involved in five children. The volume of the posterior fossa was variable. At the latest follow-up, neurological findings included truncal ataxia and muscular hypotonia in five children, limb ataxia in three patients, and head nodding in two patients. Three children had learning disability*, five had speech and language disorders, and one had a severe behavioural disorder. Interpretation: Severe UCH is a residual change after a disruptive prenatal cerebellar insult, most likely haemorrhagic. The outcome is variable, ranging from almost normal development to marked developmental impairment. Ataxia is a frequent but not a leading sign. It seems that involvement of the cerebellar vermis is often, but not consistently, associated with a poorer cognitive outcome, whereas an intact vermis is associated with normal outcome and no truncal ataxia.
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The direction of synaptic plasticity at the connection between parallel fibres (PFs) and Purkinje cells can be modified by PF stimulation alone. Strong activation (Hartell, 1996) or high frequency stimulation (Schreurs and Alkon, 1993) of PFs induced a long-term depression (LTD) of PF-mediated excitatory postsynaptic currents. Brief raised frequency molecular layer stimulation produced a cAMP-dependent long-temi potentiation (LTP) of field potential (FP) responses (Salin et al., 1998). Thin slices of cerebellar vermis were prepared from 14-21 day old male Wistar rats decapitated under Halothane anaesthesia. FP's were recorded from the Purkinje cell layer in response to alternate 0.2Hz activation of stimulating electrodes placed in the molecular layer. In the presence of picrotoxin, FPs displayed two tetrodotoxin-sensitive, negative-going components termed N1 and N2. EPs were graded responses with paired pulse facilitation and were selectively blocked by 101AM 6-cyano-7-nitroquinoxaline-2,3-dicne (CNQX) an antagonist at iy,-amino-3-hydroxy-5-methyl-4-isoxazolepropionate-type ionotropic glutamate receptors (AMPAR) suggesting that they were primarily PE-mediated. The effects of raised stimulus intensity (RS) and/or increased frequency (IF) activation of the molecular layer on FP responses were examined. In sagittai and transverse slices combined RS and IF molecular layer activation induced a LTD of the N2 component of FP responses. RSIF stimulation produced fewer incidences of LTD in sagittal slices when an inhibitor of nitric oxide synthase (NOS), guanylate cyclase (GC), protein kinase G (PKG) or the GABAB receptor antagonist CGP62349 was included into the perfusion medium. Application of a nitric oxide (NO) donor, a cyclic guanosine monophosphate (cGMP) analogue or a phosphodiesterase (PDE) type V inhibitor to prevent cGMP breakdown paired with IF stimulation produced an acute depression, Raised frequency (RF) molecular layer stimulation produced a slowly emerging LTD of N2 in sagittal slices that was largely blocked in the presence of NOS, cGMP or PKG inhibitors. In transverse slices RE stimulation produced a LTP of the N2 component that was prevented by an inhibitor of protein kinase A or NOS. Inhibition of cGMP-signalling frequently revealed an underlying potentiation suggesting that cGMP activity might mask the effects of cAMP. In sagittal slices RE stimulation resulted in a potentiation of FPs when the cAMP-specific PDE type IV inhibitor rolipram was incorporated into the perfusion medium. In summary, raised levels of PE stimulation can alter the synaptic efficacy at PF-Purkinje cell synapses. The results provide support for a role of NO/cGMP/PKG signalling in the induction of LTD in the cerebellar cortex and suggest that activation of GABAa receptors might also be important. The level of cyclic nucleotide-specific PDE activities may be crucial in determining the level of cGMP and CAMP activity and hence the direction of synaptic plasticity.
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Focal symmetrical encephalomalacia (FSE) is the most prominent lesion seen in the chronic form of enterotoxemia by Clostridium perfringens type D. This paper reports FSE in sheep in Brazil. Six deaths occurred within a seven days period in a flock of 70, four to 30-month-old Santa Inês sheep in the state of Paraíba in the Brazilian semiarid. The flock was grazing a paddock of irrigated sprouting Cynodon dactylon (Tifton grass), and supplemented, ad libitum, with a concentrate of soybean, corn and wheat. Nervous signs included blindness and recumbence. A 19 month-old sheep was examined clinically and necropsied after a clinical course of three days. Gross lesions were herniation of the cerebellar vermis and multifocal, bilateral, symmetric brownish areas in the internal capsule, thalamus and cerebellar peduncles. Histologic lesions were multifocal, bilateral malacia with some neutrophils, swelling of blood vessels endothelium, perivascular edema, and hemorrhages. The flock was vaccinated, before the outbreak, with only one dose of Clostridium perfringens type D vaccine. Two factors are suggested to be important for the occurrence of the disease: insufficient immunity due to the incorrect vaccination; and high nutritional levels by the supplementation with highly fermentable carbohydrates.
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La schizophrénie est une psychopathologie largement hétérogène caractérisée entre autres par d’importantes défaillances dans le fonctionnement cognitif et émotionnel. En effet, par rapport à la population générale, forte proportion de ces individus présentent une mémoire déficitaire pour les événements émotionnels. À ce jour, le peu d’études qui se sont penchées sur la mémoire émotionnelle épisodique dans la schizophrénie, ont uniquement mis l’emphase sur l'effet de la valence des stimuli (c’est-à-dire le caractère agréable ou désagréable du stimulus). Toutefois, aucune n’a investigué spécifiquement l’intensité de la réaction aux stimuli (c’est-à-dire une faible par rapport à une forte réaction) malgré quantité de preuves faisant montre, dans la population générale, de différents processus de mémoire émotionnelle pour des stimuli suscitant une forte réaction par rapport à ceux évoquant une faible réponse. Ce manque est d’autant plus flagrant étant donné le nombre d’études ayant rapporté un traitement et un encodage atypiques des émotions spécifiquement au niveau de l’intensité de la réponse subjective chez des patients atteints de schizophrénie. Autre fait important, il est étonnant de constater l’absence de recherches sur les différences de sexe dans la mémoire émotionnelle étant donné l’ensemble des divergences entre hommes et femmes atteints de schizophrénie au niveau de la prévalence, de l’âge de diagnostic, de la manifestation clinique, de l’évolution de la maladie, de la réponse au traitement et des structures cérébrales. Pour pallier à ces lacunes, ce mémoire a évalué : (1) l’effet de la valence des stimuli et de l'intensité de la réaction émotionnelle au niveau des fonctions cérébrales correspondant à la mémoire émotionnelle chez des patients atteints de schizophrénie comparativement à des participants sains; et (2) les possibles différences de sexe dans les processus cérébraux impliqués dans la mémoire émotionnelle chez des patients atteints de schizophrénie par rapport à des volontaires sains. Ainsi, la première étude a comparé les activations cérébrales de patients atteints de schizophrénie par rapport à des participants sains au cours d’une tâche de mémoire émotionnelle dont les stimuli variaient à la fois au niveau de la valence et de l'intensité de la réaction subjective. 37 patients atteints de schizophrénie ainsi que 37 participants en bonne santé ont effectué cette tâche de mémoire émotionnelle lors d’une session d’imagerie par résonance magnétique fonctionnelle (IRMf). Pour toutes les conditions étudiées (images négatives, positives, de faible et de forte intensité), le groupe atteint de schizophrénie a performé significativement moins bien que les volontaires sains. Comparativement aux sujets sains, ils ont montré moins d’activations cérébrales dans les régions limbiques et préfrontales lors de la reconnaissance des images négatives, mais ont présenté un patron d'activations similaire à celui des participants sains lors de la reconnaissance des images chargées positivement (activations observées dans le cervelet, le cortex temporal et préfrontal). Enfin, indépendamment de la valence des stimuli, les deux groupes ont démontré une augmentation des activations cérébrales pour les images de forte intensité par rapport à celles de plus faible intensité. La seconde étude a quant à elle exploré les différences de sexe potentielles au niveau des activations cérébrales associées à la mémoire émotionnelle dans la schizophrénie et dans la population en général. Nous avons comparé 41 patients atteints de schizophrénie (20 femmes) à 41 participants en bonne santé (19 femmes) alors qu’ils effectuaient la même tâche de mémoire émotionnelle mentionnée plus haut. Or, pour cette étude, nous nous sommes concentrés sur les conditions suivantes : la reconnaissance d’images positives, négatives et neutres. Nous n'avons pas observé de différences entre les hommes et les femmes au niveau des performances à la tâche de mémoire pour aucune des conditions. En ce qui a trait aux données de neuroimagerie, comparativement aux femmes en bonne santé, celles atteintes de schizophrénie ont montré une diminution des activations cérébrales dans les régions corticales du système limbique (p. ex. cortex cingulaire moyen) et dans les régions sous-corticales (p. ex. amygdale) lors de la reconnaissance d'images négatives. Pour ce qui est de la condition positive, elles ont présenté, comparativement au groupe de femmes saines, des diminutions d’activations spécifiquement dans le cervelet ainsi que dans le gyrus frontal inférieur et moyen. Les hommes atteints de schizophrénie, eux, ont montré une augmentation d’activations par rapport aux hommes sains dans le gyrus préfrontal médian lors de la reconnaissance des stimuli négatifs ; ainsi que dans les régions pariétales, temporales et limbiques lors de la reconnaissance des stimuli positifs. Dans un autre ordre d’idées, notre analyse corrélationnelle a mis en évidence, chez les femmes, un lien significatif entre l’activité cérébrale et les symptômes au cours de la mémoire des stimuli positifs, alors que chez les hommes atteints schizophrénie, ce lien a été observé au cours de la mémoire des stimuli négatifs. Bref, l’ensemble de nos résultats suggère, chez les patients atteints de schizophrénie, un fonctionnement cérébral atypique spécifiquement lors de la reconnaissance d’images négatives, mais un fonctionnement intact lors de la reconnaissance de stimuli positifs. De plus, nous avons mis en évidence la présence de différences de sexe dans les activations cérébrales associées à la mémoire épisodique émotionnelle soulignant ainsi l'importance d’étudier séparément les hommes et les femmes atteints de schizophrénie dans le cadre de recherches sur les plans cognitif et émotionnel.
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Obiettivo: Valutare il ruolo brainstem-vermis angle (BV angle) a 16-18 settimane per la diagnosi precoce delle anomalie cistiche della fossa cranica posteriore. Metodi: Uno studio prospettico, multicentrico, osservazionale. Volumi ecografici tridimensionali della testa fetale sono stati acquisiti in feti a 16-18 settimane. Tre operatori di simile esperienza hanno misurato il BV angle nel piano sagittale come precedentemente descritto1,2 e hanno annotato se il quarto ventricolo era aperto sul piano assiale. Un follow-up dettagliato è stato ottenuto in tutti i casi. Risultati: Tra novembre 2009 e marzo 2011, 150 volumi sono stati acquisiti ad un’epoca gestazionale media di 16 settimane. A causa di una scarsa qualità delle immaginai, 49 volumi sono stati esclusi, con una popolazione finale di 101 casi. Di questi, 6 hanno ricevuto successivamente una diagnosi di malformazione di Dandy-Walker (DWM) e 2 di cisti della tasca di Blake (BPC), gli altri erano normali. In tutti i feti con anomalie cistiche della fossa cranica posteriore, il BV angle è risultato significativamente più ampio rispetto ai controlli (57.3+23.0° vs 9.4+7.7°, U-Mann Whitney test p<0.000005). Nel 90.3% dei feti normali, il BV angle era <20° e il quarto ventricolo era chiuso sul piano assiale. In 9 feti normali e nei casi con BPC, l’angolo era >20° ma <45° (25.8+5.6°) e il quarto ventricolo era aperto posteriormente sul piano assiale, ma solo utilizzando una scansione non convenzionale. In tutti i feti con DWM, il BV angle era >45° (67.9+13.9°) e il quarto ventricolo era aperto anche sul piano assiale standard. Conclusioni: Fino ad ora la diagnosi di anomalie cistiche della fossa cranica posteriore è stata consideratea difficile o impossibile prima di 20 settimane, a causa del presunto sviluppo tardivo del verme cerebellare. La nostra esperienza suggerisce che la misurazione del BV angle consente un’identificazione precisa di queste condizioni già a 16 settimane.
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BACKGROUND: Nephronophthisis (NPHP) is an autosomal recessive cystic kidney disease that constitutes the most common genetic cause of renal failure in the first three decades of life. Using positional cloning, six genes (NPHP1-6) have been identified as mutated in NPHP. In Joubert syndrome (JBTS), NPHP may be associated with cerebellar vermis aplasia/hypoplasia, retinal degeneration and mental retardation. In Senior-Løken syndrome (SLSN), NPHP is associated with retinal degeneration. Recently, mutations in NPHP6/CEP290 were identified as a new cause of JBTS. METHODS: Mutational analysis was performed on a worldwide cohort of 75 families with SLSN, 99 families with JBTS and 21 families with isolated nephronophthisis. RESULTS: Six novel and six known truncating mutations, one known missense mutation and one novel 3 bp pair in-frame deletion were identified in a total of seven families with JBTS, two families with SLSN and one family with isolated NPHP.
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Effective adaptive behavior rests on an appropriate understanding of how much responsibility we have over outcomes in the environment. This attribution of agency to ourselves or to an external event influences our behavioral and affective response to the outcomes. Despite its special importance to understanding human motivation and affect, the neural mechanisms involved in self-attributed rewards and punishments remain unclear. Previous evidence implicates the anterior insula (AI) in evaluating the consequences of our own actions. However, it is unclear if the AI has a general role in feedback evaluation (positive and negative) or plays a specific role during error processing. Using functional magnetic resonance imaging and a motion prediction task, we investigate neural responses to self- and externally attributed monetary gains and losses. We found that attribution effects vary according to the valence of feedback: significant valence × attribution interactions in the right AI, the anterior cingulate cortex (ACC), the midbrain, and the right ventral putamen. Self-attributed losses were associated with increased activity in the midbrain, the ACC and the right AI, and negative BOLD response in the ventral putamen. However, higher BOLD activity to self-attributed feedback (losses and gains) was observed in the left AI, the thalamus, and the cerebellar vermis. These results suggest a functional lateralization of the AI. The right AI, together with the midbrain and the ACC, is mainly involved in processing the salience of the outcome, whereas the left is part of a cerebello-thalamic-cortical pathway involved in cognitive control processes important for subsequent behavioral adaptations.
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Elimination of excess climbing fiber (CF)–Purkinje cell synapses during cerebellar development involves a signaling pathway that includes type 1 metabotropic glutamate receptor, Gαq, and the γ isoform of protein kinase C. To identify phospholipase C (PLC) isoforms involved in this process, we generated mice deficient in PLCβ4, one of two major isoforms expressed in Purkinje cells. PLCβ4 mutant mice are viable but exhibit locomotor ataxia. Their cerebellar histology, parallel fiber synapse formation, and basic electrophysiology appear normal. However, developmental elimination of multiple CF innervation clearly is impaired in the rostral portion of the cerebellar vermis, in which PLCβ4 mRNA is predominantly expressed. By contrast, CF synapse elimination is normal in the caudal cerebellum, in which low levels of PLCβ4 mRNA but reciprocally high levels of PLCβ3 mRNA are found. These results indicate that PLCβ4 transduces signals that are required for CF synapse elimination in the rostral cerebellum.
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Pain is a unified experience composed of interacting discriminative, affective-motivational, and cognitive components, each of which is mediated and modulated through forebrain mechanisms acting at spinal, brainstem, and cerebral levels. The size of the human forebrain in relation to the spinal cord gives anatomical emphasis to forebrain control over nociceptive processing. Human forebrain pathology can cause pain without the activation of nociceptors. Functional imaging of the normal human brain with positron emission tomography (PET) shows synaptically induced increases in regional cerebral blood flow (rCBF) in several regions specifically during pain. We have examined the variables of gender, type of noxious stimulus, and the origin of nociceptive input as potential determinants of the pattern and intensity of rCBF responses. The structures most consistently activated across genders and during contact heat pain, cold pain, cutaneous laser pain or intramuscular pain were the contralateral insula and anterior cingulate cortex, the bilateral thalamus and premotor cortex, and the cerebellar vermis. These regions are commonly activated in PET studies of pain conducted by other investigators, and the intensity of the brain rCBF response correlates parametrically with perceived pain intensity. To complement the human studies, we developed an animal model for investigating stimulus-induced rCBF responses in the rat. In accord with behavioral measures and the results of human PET, there is a progressive and selective activation of somatosensory and limbic system structures in the brain and brainstem following the subcutaneous injection of formalin. The animal model and human PET studies should be mutually reinforcing and thus facilitate progress in understanding forebrain mechanisms of normal and pathological pain.
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Relative cerebral glucose metabolism was examined with positron-emission tomography (PET) as a measure of neuronal activation during performance of the classically conditioned eyeblink response in 12 young adult subjects. Each subject received three sessions: (i) a control session with PET scan in which unpaired presentations of the tone conditioned stimulus and corneal airpuff unconditioned stimulus were administered, (ii) a paired training session to allow associative learning to occur, and (iii) a paired test session with PET scan. Brain regions exhibiting learning-related activation were identified as those areas that showed significant differences in glucose metabolism between the unpaired control condition and well-trained state in the 9 subjects who met the learning criterion. Areas showing significant activation included bilateral sites in the inferior cerebellar cortex/deep nuclei, anterior cerebellar vermis, contralateral cerebellar cortex and pontine tegmentum, ipsilateral inferior thalamus/red nucleus, ipsilateral hippocampal formation, ipsilateral lateral temporal cortex, and bilateral ventral striatum. Among all subjects, including those who did not meet the learning criterion, metabolic changes in ipsilateral cerebellar nuclei, bilateral cerebellar cortex, anterior vermis, contralateral pontine tegmentum, ipsilateral hippocampal formation, and bilateral striatum correlated with degree of learning. The localization to cerebellum and its associated brainstem circuitry is consistent with neurobiological studies in the rabbit model of eyeblink classical conditioning and neuropsychological studies in brain-damaged humans. In addition, these data support a role for the hippocampus in conditioning and suggest that the ventral striatum may also be involved.
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BACKGROUND This study was realized thanks to the collaboration of children and adolescents who had been resected from cerebellar tumors. The medulloblastoma group (CE+, n = 7) in addition to surgery received radiation and chemotherapy. The astrocytoma group (CE, n = 13) did not receive additional treatments. Each clinical group was compared in their executive functioning with a paired control group (n = 12). The performances of the clinical groups with respect to controls were compared considering the tumor's localization (vermis or hemisphere) and the affectation (or not) of the dentate nucleus. Executive variables were correlated with the age at surgery, the time between surgery-evaluation and the resected volume. METHODS The executive functioning was assessed by means of WCST, Complex Rey Figure, Controlled Oral Word Association Test (letter and animal categories), Digits span (WISC-R verbal scale) and Stroop test. These tests are very sensitive to dorsolateral PFC and/or to medial frontal cortex functions. The scores for the non-verbal Raven IQ were also obtained. Direct scores were corrected by age and transformed in standard scores using normative data. The neuropsychological evaluation was made at 3.25 (SD = 2.74) years from surgery in CE group and at 6.47 (SD = 2.77) in CE+ group. RESULTS The Medulloblastoma group showed severe executive deficit (= 1.5 SD below normal mean) in all assessed tests, the most severe occurring in vermal patients. The Astrocytoma group also showed executive deficits in digits span, semantic fluency (animal category) and moderate to slight deficit in Stroop (word and colour) tests. In the astrocytoma group, the tumor's localization and dentate affectation showed different profile and level of impairment: moderate to slight for vermal and hemispheric patients respectively. The resected volume, age at surgery and the time between surgery-evaluation correlated with some neuropsychological executive variables. CONCLUSION Results suggest a differential prefrontal-like deficit due to cerebellar lesions and/or cerebellar-frontal diaschisis, as indicate the results in astrocytoma group (without treatments), that also can be generated and/or increased by treatments in the medulloblastoma group. The need for differential rehabilitation strategies for specific clinical groups is remarked. The results are also discussed in the context of the Cerebellar Cognitive Affective Syndrome.
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BACKGROUND: Until recently, neurosurgeons eagerly removed cerebellar lesions without consideration of future cognitive impairment that might be caused by the resection. In children, transient cerebellar mutism after resection has lead to a diminished use of midline approaches and vermis transection, as well as reduced retraction of the cerebellar hemispheres. The role of the cerebellum in higher cognitive functions beyond coordination and motor control has recently attracted significant interest in the scientific community, and might change the neurosurgical approach to these lesions. The aim of this study was to investigate the specific effects of cerebellar lesions on memory, and to assess a possible lateralisation effect. METHODS: We studied 16 patients diagnosed with a cerebellar lesion, from January 1997 to April 2005, in the "Centre Hospitalier Universitaire Vaudois (CHUV)", Lausanne, Switzerland. Different neuropsychological tests assessing short term and anterograde memory, verbal and visuo-spatial modalities were performed pre-operatively. RESULTS: Severe memory deficits in at least one modality were identified in a majority (81%) of patients with cerebellar lesions. Only 1 patient (6%) had no memory deficit. In our series lateralisation of the lesion did not lead to a significant difference in verbal or visuo-spatial memory deficits. FINDINGS: These findings are consistent with findings in the literature concerning memory deficits in isolated cerebellar lesions. These can be explained by anatomical pathways. However, the cross-lateralisation theory cannot be demonstrated in our series. The high percentage of patients with a cerebellar lesion who demonstrate memory deficits should lead us to assess memory in all patients with cerebellar lesions.