A chronic alcoholic presents with truncal instability and an uncoordinated gait. An MRI confirms alcoholic degeneration of the cerebellar vermis. Which of the following cells is most notably destroyed in this patient ?

Alcohol is directly toxic to the cerebellum, causing degeneration primarily of the anterior superior vermis. This is due to either shrinkage or atrophy of Purkinje cells. Chronic alcoholism results in a risk of significant loss of Purkinje cells. This is worsened by associated vitamin B1 deficiency, resulting from both a poor diet and a direct toxic effect on vitamin B1 metabolism. Golgi(2) cell exes an inhibitory influence on the synapse between the mossy fiber and the granule cell, within the cerebellar glomerulus. Basket(1) cells provide direct inhibitory influences on the Purkinje cells. In the cerebellar glomerulus, the mossy fiber afferents synapse with the granule cell (4). After this first processing stage, the granule cell conveys this afferent information to the Purkinje cell and the Golgi cell (through excitatory parallel fibers).