The Cerebellum

Annabelle Y. Lao MD
Neurology-Psychiatry

Cerebellar anatomy
The cerebellum (little brain), within the posterior fossa,
straddles the brainstem and forms the roof of the fourth
ventricle.
The tentorium cerebelli (tent of the cerebellum) dura matter
separates the cerebellum from the occipital lobes of the
cerebrum.

The Cerebellum
A "Motor Control" Region
No Direct Projections to the Spinal Cord
Massive Sensory Tract Input

Phylogenetically an ancient structure

Develops early in ontogeny

Best known for motor functions: coordination,

adaptation, motor learning but also involved in
cognitive and perceptual behaviors as well
Damage to cerebellum results in characteristic
abnormalities of coordination, timing and learning,
not paralysis

Balance

Motor Skill

Pablo Casals

CEREBELLUM
MOTOR
FUNCTIONS

MOTOR
DYSFUNCTIONS

Maintenance of
muscle tone
Maintenance of
posture and
balance
Coordination of
voluntary motor
activities

Hypotonia
Disequilibrium
Dysynergy
Ataxia
Nystagmus

Anatomy of the Cerebellum

Folium

Cerebellar Divisions
Primary fissure
Ant Lobe

nodulus

Post Lobe

Lobes and fissures

Lobules
Folia
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Cerebellum: Gross Anatomy

It consists of cerebellar cortex and and
deep cerebellar nuclei, with white medulla
in between
Cerebellum is uninterrupted across the
midline
The cortex consists of ridges called folia.

Ventral View
flocculus
nodulus

tonsil

The white matter of the medulla

resembles a branching tree called Arbor
Vitae
The cerebellum consists of three parts:
A small inferior part Flocculonodular
lobe (floccular, means a tuft of wool);
A narrow central vermis (worm shaped)
Two large lateral hemispheres

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Divisions of the Cerebellum

Ventral View

Superior Surface

Ant Lobe
flocculus
nodulus

Ant Lobe

Post Lobe

Post Lobe
tonsil

Schematic

Ant Lobe

hemisphere
Post Lobe

flocculus

nodulus

v
e
r
m
i
s
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Anatomic subdivisions
Transverse plane Anterior lobe

Posterior lobe

Flocculonodolar l

Longitudinal
plane

vermis

Paravermis

Hemispher

functional

spinocerebellum

Cerebro
cerebellum

Vestibulo
cerebellum

Control muscle
tone and axial
and limb
movement

Planning and
initiation of
movement
Discreet limb
movement

Control body
equilibrium and
eye movement

neocerebellum

paleocerebellum

archicerebellum

Phylogenetic

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Cerebellar Subdivisions
Archicerebellum-vestibulocerebellum
Paleocerebellum-spinocerebellum
Neocerebellum-pontocerebellum/cerebrocerebellum

Multiple nomenclatures have been

used to describe the various lobules
Larsell (1952) used Roman
Numerals I-X (anterior to
posterior)
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Cerebellar Nuclei
4 pairs, white matter core
Fastigial (medial cerebellar) nuclei- medially adjacent to the
midline, functionally related to the overlying medial zones
2 interposed nuclei
Globose (posterior interposed),
Emboliform (Anterior interposed)
- functionally related to the intermediate zones
Dentate (lateral cerebellar) nuclei- large,
undulating,
shaped like partially crumpled paper bag, hilus- directed
anteromedially, functionally related to the lateral zone of
the cortex

Cerebellum: the Structure

3 Layered
Cerebellar
Cortex

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Stellate cells - Usually

small cells with short
dendrites and fine
unmyelinated axons
that run in the
superficial molecular
layer.
Larger stellate cells in
the vicinity of Purkinje
cells are known as
basket cells. Situated
deeper in the
molecular layer. Each
basker cell axon cover
the territory of 10
purkinje
Receive afferent input
and act on purkinje
cells .
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Purkinje Cell (cerebellum) 100X

Purkinje cells

silver stain
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* Purkinje Cells (cerebellum) 400X

Purkinje Cells

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Granule cell layer: Closely packed

with chromatic nuclei of small granule
cell neurons. Major input to the
cerebellum projects into this layer.
Golgi Type II: This type of cerebellar
neuron is found in the upper part of
the granule cell layer close to the
Purkinje cell layer. Larger than the
granule cell neuron. Dendrites
arborize extensively in the molecular
layer. Axons establish synapses with
dendrites of granule cells in the
glomeruli of the granule cell layer. It is
estimated that there is one Golgi Type
II cell for every 10 Purkinje cells.

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Cerebellar glomerulus

Granule
Golgi

A cerebellar glomerulus is the

synaptic complex formed by:

Mossy

acentralmossyfiberaxon
terminal(rosette)
granulecelldendriticterminals
Golgiaxonterminals

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Major Cell Types

Granule cells

Glutamate

Purkinje cells

GABA

Golgi cells

GABA

Stellate cells

GABA

Basket cells

GABA

***The Purkinje cell is the only output of the cerebellar cortex

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Purkinje Cell

Recieves + inputs from parallel fibers and climbing fibers

Recieves - inputs from basket cells, Golgi cells, stellate cells
Heavily invested with glial processes
27

Calcium handling machinery

Purkinjes cells are
notable for their
extensive calcium
handling machinery

28

Two inputs: Climbing fibers and

Parallel fibers
Parellel fibers: each
parallel fiber makes
only a few synapses on
a Purkinje cell = weak
influence
Each Purkinje cell is
contacted by MANY
parallel fibers
Climbing fibers: each
climbing fiber makes
~100 synapses on a
single Purkinje cell:
very powerful
excitiation

http://aids.hallym.ac.kr/d/kns/tutor/medical/unified/cereb
ellum/cbimg010.gif

Each Purkinje cell is

contacted by a single
climbing fiber
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Internal circuitry of the cerebellum

AFFERENT pathways
Two main AFFERENT pathways to the Purkinje cells,
Both are excitatory (glutamate).
Pathway

Divergence and convergence

Climbingfiber

extensive

MossyfiberParallelfiber

weak

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Cerebellum: 3 layered cortex

Climbing fibers: excite the Purkinje cells
Mossy fibers: excite the granule cells
Granule cells: make excitatory contact with the Purkinje cells
Purkinje cells: Tonic inhibition on the activity of the neurons of the cerebellar nuclei
=> All excitatory inputs will be converted to the inhibition
=> Removing the excitatory influence of the cerebellar inputs ( erasing)

Internal circuitry
A.

Organization of
cortex is uniform
across different
subdivisions

B.

AFFERENT
pathways to the
cerebellar cortex
excite Purkinje
cells.

C.

Basket, stellate
and Golgi cells
regulate Purkinje
cell activity.

D.

EFFERENT
pathways from the
cortex originate
from Purkinje
cells.

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Cerebellar Peduncles
Three paired fiber tracts connect the cerebellum to the brainstem:
Superior peduncles connect the cerebellum to the midbrain;
Middle peduncles connect the cerebellum to the pons and to the
axis of
the brainstem;
Inferior peduncles connect the cerebellum to the medulla.

Cerebellar
Peduncles

Cerebellar Peduncles
Superior peduncles (to the midbrain):
Fibers originate from neurons in the deep cerebellar
nuclei & communicates with the motor cortex via the
midbrain and
the diencephalon (thalamus)
Middle peduncles (to the pons):
Cerebellum receives information advising it of voluntary
motor activities initiated by motor cortex
Inferior peduncles (to the medulla):
Afferents conveying sensory information from muscle
proprioceptors throughout the body & from the
vestibular nuclei of the brainstem (Spinal cord)

Cerebellar Input

Inputs to cerebellum from spinocerebellar tracts have a

somatotopic organization.
2 maps of body

Primary fissure

Signals from the motor cortex, which is also arranged somatotopically,

project to corresponding points in the sensory maps of the cerebellum.

Cerebellar Inputs
Vermis
Receives input from spinal cord regarding somatosensory and
kinesthetic information (intrinsic knowledge of the position of the limbs)
Damage leads to difficulty with postural adjustments (cerebellar ataxia)

Intermediate Zone
Receives input from the red nucleus and somatosensory information
from the spinal cord
Damage results in rigidity & difficulty in moving limbs

Lateral Zone
Receives input from the motor and association cortices through the pons
Projects to the dentate nucleus, which projects back to primary and
premotor cortex
Damage leads to 4 types of deficits:
- Ballistic movements (cerebellar ataxia)
- Coordination of multi-joint movement (lack of coordination: asynergia)
- Muscle learning (loss of muscle tone: hypotonia)
- Movement timing

Outputs of the Cerebellum

Cerebellar nuclei: dentate, globose, emboliform, fastigial
Dentate nuclei: project contralaterally through
the superior cerebellar peduncle to
neurons in the contralateral thalamus &
from thalamus to motor cortex
Func.: influence planning and initiation of
voluntary movement
Emboliform & Globose nuclei: project mainly
to the contralateral red nuclei & a small
group is projected to the motor cortex
Red Nuclei Rubrospinal Tract
control of proximal limb muscles
Fastigial nuclei: project to the vestibular nuclei
& to the pontine and medullary reticular
formation
Vestibulospinal & Reticulospinal
tracts

Inputs and outputs of the Cerebellum

EFFERENT pathways

Purkinjecells

Inhibitory

CerebellarandVestibularNuclei

CerebellarNuclei

Excitatory

Rednuc,Thalamus,VestNuc,RF

Inhibitory

ContralateralInfOlivaryNucleus

Allcerebellaroutputoriginatesfrom
PurkinjecellsorCerebellarnuclei
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Cerebellar
Peduncles

SCP
MCP

ICP

Peduncle Connects
to
Superior
(SCP)
Middle
(MCP)
Inferior
(ICP)

Midbrain

Pons

Medulla

SCP

SCP

MCP
ICP

MCP
ICP

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Peduncles
Inferior - Restiform body
Medulla
Input and Output

Middle - Brachium Pontis

Pons
Input from Pons

Superior - Brachium
Conjunctivum
Midbrain
Output to Midbrain and
Thalamus (mostly)

Overview of cerebellar afferents and efferents

Cerebellar peduncles and fibers
Afferents
Peduncle Mossy
SCP

[minor]

MCP

pontocerebellar
tract

Climbing

Efferents
rednucleus,thalamus

olivocerebellar
tract

ICP

spinocerebellar
tract
vestibulo
cerebellartract

vestibularnuclei,RF
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Clinical Findings and Localization of Cerebellar Lesions

Ataxia refers to disordered contractions of agonist and antagonist
muscles and lack of coordination between movements at
different joints typically seen in patients with cerebellar
lesions.
Normal movements require coordination of agonist and antagonist
muscles at different joints in order for movement to have
smooth
trajectory.
In ataxia movements have irregular, wavering
course consisting of continuous
overshooting, overcorrecting and
then overshooting
again around the intended trajectory.
Dysmetria = abnormal undershoot or overshoot
during movements toward a target
(finger-nose-finger test).

Cerebellar dysfunction
1. Cerebellar signs are generally due to disease of the cerebellum
or its afferent or efferent tracts
2. Cerebellar dysfunction improves after acute lesions

Hemispherediseaseprimarilyaffectsipsilaterallimbcoordination
Disturbed stance and gait
Limb ataxia (abnormalities in execution of voluntary movement)
Decomposition of movement
Dysmetria (errors in the metrics of movement)
Hypotonia (diminished resistance to passive limb displacement)
Impaired check and excessive rebound
Tremor: Intention (goal-directed)

Vermisdiseaseprimarilyaffectsposture&gait,&eyemovements
Disturbed stance and gait ataxia
Head and truncal titubation (tremor during standing/sitting)
Head tilt
Eye movement disorders (saccadic dysmetria)

Vestibulocerebellardiseaseprimarilyaffectseyemovements
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Branches of the Vertebral Artery

1. Posterior Inferior Cerebellar Artery
(PICA), the largest branch of the
vertebral, arises at the caudal end of
the medulla on each side.
Runs a course winding between the
medulla and cerebellum
Distribution:
a. posterior part of cerebellar
hemisphere
b. inferior vermis
c. central nuclei of cerebellum
d. choroid plexus of 4th ventricle
e. medullary branches to
dorsolateral medulla

Branches of the Basilar Artery

1. Anterior Inferior Cerebellar Arteries
(AICA), originates near the lower border
of the Pons just past the union of the
vertebral arteries.
Distribution:
a. supplies anterior inferior surface and
underlying white matter of cerebellum
b. contributes to supply of central
cerebellar nuclei
c. also contributes to upper medulla
and lower pontine areas

Thank you

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