1. What is the relations between chief complains and his other complain?

The relationship between complaints of dizziness and impaired coordination and

dismetria is due to the presence of lesions / abnormalities in the cerebellum from
patients in the scenario. Cerebellar lesions manifest clinically in the form of
movement and balance disorders.

The cerebellum is the central organ for fine motoric control. This structure
processes information from various sensory pathways (especially vestibular and
proprioceptive), along with motor impulses, and modulates the activity of the motor
nuclear area in the brain and spinal cord.

Functionally, the cerebellum is divided into three components

vestibuloserebelum, spinoserebelum, and cerebroserebelum. Vestibulosity before
receiving afferent impulses, especially from the vestibular organs, and its function
is to regulate balance, especially processing proprioceptive impulses from the
spinoserebellar tract and regulating posture and gait, cerebroserebellum has a
functional relationship close to the telensefalon motor cortex and plays a role in
smoothness and accuracy of all controlled movements smooth.

Dizziness complaints, coordination disorders, and dysmetria are disorders due to

lesions located in the cerebroserebellum. Cerebroserebellum receives part of its
neural input indirectly from the broad cerebral cortex, especially from the
Broadman area 4 and 6 (motor and premotor area) through the corticopontic tract,
but also a small portion, from the olive through the olivaserebellar tract. The
cerebellum receives further warnings of all planned voluntary movements that
begin in the cerebral cortex, so that the cerebellum can immediately send
modulatory and corrective impulses back to the motor cortex through the
dentothical cortical denture pathway.

Complex cerebroserebellar connections allow these structures to smoothly and

precisely move all directional movements. Through afferent spinocerebral
pathways that deliver very rapidly, the cerebroserebellum continuously receives the
latest information regarding peripheral motor activity. Thus he can correct any
errors in the voluntary movement to ensure that the movements are carried out
smoothly and precisely.

The very large pattern of executing various types of movements is likely to be

stored in the cerebellum, like on a computer, throughout an individual's life, so that
it can be recalled at any time. Thus, once we have reached a certain stage of
development, we can make difficult movements that have been learned quickly,
require relatively little effort, and are in accordance with the will by calling the
precision regulation function in the cerebellum.

The cerebellum function ranges from coordinating movements to processing

sensory stimuli and information relevant to memory.

Cerebroserebellum lesions. Cerebroserebellar lesions do not cause paralysis, but

cause severe damage to the execution of volunteer movements. Clinical
manifestations are always ipsilateral to lesions causing them.

Voluntary Movement decomposition. Ataximitas extremity movement and not

coordinated with dysmetria, disinergia, disdiakokinesis, and tremor when carrying
out voluntary movements (the intention of tremor). This abnormality is more
pronounced in the upper extremity than the lower extremity, and the complex
movements are more severe than simple movements.

Dismetria, which is the inability to stop directional movements in time, manifests

(for example) as finger movements past the target location (past-pointing: overshot;
hypermetria).

Disinergia is the loss of proper cooperation in several muscle groups in the

execution of certain movements; each muscle group contracts, but it cannot work
together properly.

Disdiadokokinesia is a disorder of rapid alternating movements due to damage to

the coordination of the timeliness of several antagonistic muscle groups:
movements such as pronation and supination of the hands quickly become slow,
disjointed, and not rhythmic.

Intention tremor, or more popular action tremors, especially seen in direct

movements become heavier when the fingers get closer to the target. Postural
tremor can also be found with a frequency of 2-3 Hz, especially when the patient
tries to maintain the pronated hand right in front, with the arm raised.

Rebound phenomenon. When the post presses the examiner's hand with maximum
strength and the examiner suddenly pulls his hand away, the patient's movements
cannot be stopped as in normal circumstances and the arm will swing and hit the
examiner.

Hypotonia and hyporeflexia. In acute cerebellar hemisphere lesions, muscle

resistance to passive movements disappears, and abnormal postures can occur (for
example, on the hands). Intrinsic muscle reflex also disappears in hypotonic
muscles.
Disatria and disartrofonia broken (scanning). This manifestation mainly arises
as a result of paravermic lesions and describes the disruption of the synergy of the
muscles to speak. The patient speaks slowly and disjointedly, with poor articulation,
and with abnormal and flat emphasis on each syllable.

Reference : Duus, Peter. 2010. Diagnosis Topic Neurologi DUUS 4th edition.
Goettingen and Freiburg; Germany. Page 214, 226-227