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Cerebellar Degeneration Anatomy — MRCPsych Paper B MCQ

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ModerateSubstance MisuseCerebellar Degeneration AnatomyMRCPsych Paper B

A 55-year-old with a long history of alcohol dependence and poor nutrition develops a progressive broad-based gait and impaired tandem walking. Finger–nose testing is normal and there is no nystagmus. Which anatomical and clinical pattern is most characteristic of alcohol-related cerebellar degeneration?

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Correct answer: E — Anterosuperior vermis involvement causing predominant gait and truncal ataxia

Alcohol-related cerebellar degeneration characteristically involves the anterosuperior cerebellar vermis. This region is important for axial stability and bipedal locomotion, so the typical presentation is gait and truncal ataxia, including a broad-based gait and impaired tandem walking. Lower-limb incoordination may occur, whereas upper-limb dysmetria and nystagmus are less prominent. Flocculonodular disease would more strongly suggest vestibular symptoms and nystagmus, while lateral hemisphere disease produces ipsilateral limb dysmetria. Dentate involvement does not usually present as an isolated intention tremor. Cognitive impairment can coexist because of other forms of alcohol-related brain damage, but preserved cognition is not a defining feature of cerebellar degeneration and was therefore removed from the original answer.

Reference: Mitoma H, Manto M, Shaikh AG. Mechanisms of Ethanol-Induced Cerebellar Ataxia: Underpinnings of Neuronal Death in the Cerebellum. International Journal of Environmental Research and Public Health. 2021;18:8678. https://pubmed.ncbi.nlm.nih.gov/34444449/