CEREBELLUM

Derives its name from the diminutive of the word

cerebrum
Occupies ~ 10% of the total brain volume, but
contains ~ of all the neurons in the brain
Is concerned witch the coordination of
somatic motor activity
- the regulation of muscle
tone
- influence and maintain
equilibrium
 Three important points must be grasped for a proper
understanding of cerebellar
function:

The cerebellum receives a very large amount of

general and special sensory input, but does not
participate to any significant extent in conscious
perception or discrimination.
Although the cerebellum influences motor
function, cerebellar lesions do not produce
paralysis.
The cerebellum is unimportant for most
cognitive processes but nonetheless plays a
major role in motor learning and memory.
 Forms the roof of the forth ventricle
Is attached to the medulla, the pons and
the midbrain by three paired cerebellar
peduncles
Is divided into a median portion = the
cerebellar vermis
- two lateral lobes =
cerebellar hemispheres
 Structurally consists of a superficial gray
mantle = the cerebellar cortex
- an internal white
mass = medullary substance
- four pairs of
intrinsic nuclei
 The cerebellar cortex is composed of numerous
narrow laminae or folia. Five deep fissures
divide the cerebellum into lobes and lobules.
The main fissures are the primary fissure and
the posterolateral fissure.
Caudal to the posterolateral fissure is situated
the flocculonodular lobe
Rostral to the primary fissure is situated the
anterior lobe
Between the primary and the posterolateral
fissures is the posterior lobe
 Embryologically, hodologically and
functionally the cerebellum can be divided
into three parts
1. The archicerebellum
2. The paleocerebellum
3. The neocerebellum
 Archicerebellum
= The flocculonodular lobe
The oldest part of the cerebellum
Closely related to the vestibular system =
vestibulocerebellum concerned
essentially with equilibrium
 Paleocerebellum
The anterior lobe of the cerebellum (lies
rostral to the primary fissure)
It has intimate connections with the spinal
cord = spinocerebellum regulation of
muscle tone
 Neocerebellum
The posterior lobe
Philogenetically the newest and the largest
portion = parts of the cerebellum between the
primary and posterolateral fissure in both the
vermis and the hemispheres
Receives major inputs from the contralateral
cerebral cortex via relays in the pontine nuclei =
cerebrocerellum or pontocerebellum
coordination of somatic motor function
 Cerebelar cortex
Is composed of free well defined layers. These layer
from the surface are : 1. the molecular layer; 2. the
Purkinje cell layer and 3. the granular layer
The Purkinje cell were the first neurons to be identified.
Their axons are myelinated and establish synaptic
contacts witch the cerebellar nuclei and reprezent the
sole output pathway of the cerebellar cortex
The granular layer receive the afferents of the
cerebellum. The predominant afferent input to the
cerebellum is via the mossy fibers. The other main
afferent input is via the climbing fibers.
 Mossy fiber are the axons of the
vestibular, pontine and reticular nuclei,
and of the spinocerebellar tracts
Climbing fibers are the axons of cells in
the inferior olivary nucleus
These two inputs use glutamate as
neurotransmitter and their excitatory
action determines the activity of the only
cortical output system, the Purkinje cells
 Cerebellar nuclei
Enbedded in the white matter of each half of the cerebellum are four nuclear
masses
From medial to lateral are the: fastigial
globose
emboliform
dentate
The efferent fibers of the cerebellar cortex, which consist essentially of the
axons of Purkinje cells, project into the deep cerebellar nuclei. According to
the scheme of Iansen and Brodal, cells of the vemis project mainly to the
fastigial nucleus; those of the anterior lobe to the globose and emboliform
nuclei; and those of the neocerebellum to the dentate nucleus
There are three longitudinal zones : the vermian
the paravermian or intermediate zone
the lateral zone
The vermian zone coordinate the equilibrium of the entire body, coordinates
movements of the eyes and body with respect to gravity and movement of the
head in space.
The intermediate zone influences postural tone and also individual movement
of the ipsilateral limbs
The lateral zone is concerned mainly with coordination of movements of the
ipsilateral limbs
 Cerebellar connections
Afferent fibers
There are forty times more afferent axons then efferent axons ( enormous
amount of information that is required for the control of motor function)
Most afferents enter the cerebellum through the inferior and middle
cerebellar penduncles
These are : 1.vestibulocerebellar fiber classified as
: primary from vestibular ganglion
: secondary fibers from the inferior and medial nucleus, enter
the cerebellum through the ICP, and pass to flocculonodular lob, uvula, and
the fastigial nuclei
2. spinocerebellar tracts: posterior spinocerebellar tracts
conveys impulses from stretch receptors, exteroceptive impulses from touch
and pressure; enter the ICP and projects upon the rostromedial part of the
anterior lobe;
: the anterior spinocerebellar
conveys impulses from group 1b and flexsoreflex afferent fiber from the hind
limb and lower trunk tracts enter the cerebellum witch the SCP . The
majority of the fiber of this tract terminate in cerebellum contralaterally
 3. Cuneocerebellar fibers arise from accessory cuneate nucleus; conveys
impulses from muscle afferents and exteroceptive impulses from cutaneous
afferents. They enter the ICP and pass to the posterior part of the anterior
lob
4. Olivo cerebellar fibers arise from the contralateral inferior olivary nucleus
and are distributed to all parts to the cerebellar cortex
5. Pontocerebellar projections
- the pontine nuclei represent a larges connection of precerebellar nuclei
and constitute the most important relay in the conduction of impulses from
the cerebral cortex to the cerebellum
Corticopontine fibers arise from all of the four major lobs of the cerebrum
and terminate on the ipsilateral pontine nuclei. All cells of the pontine nuclei
project their axons to the cerebellum via the MCP and most of this fiber are
crossed
Other precerebellar afferent:projections from the raphe nuclei
reticulocerebellar fibers
trigeminocerebellar fibers
projections from the tectum
 Efferent fibers
Arise from all of the cerebellar nuclei and
from specific regions of the cerebellar
cortex
The major efferent system are the SCP
and the fastigial efferent projection
1. SCP the largest cerebellar efferent
bundle. It is formed by fibers from the
dentate, emboliform and globose nuclei.
Efferent from the dentate nucleus enters the upper pontine
tegmentum as the brachium conjunctivum, decussate
completely and ascend
A. to VL and IL talamic nuclei the suplementary motor cortex of that
side

B. some of the fibers synaps in the red nucleus

C. small parts of fibers descend and terminate in oculomotor complex
D. small parts of fibers descend and terminate in reticular nuclei of the pons
E. small parts of fibers descend and terminate in inferior olivary nuclei of the
medulla
Fibes from the interposed nuclei
( the emboliform and globose nuclei project)
Primarily to cells in the caudal 2/3 of the
red nucleus
A smaller number of fibers pass beyond te
red nucleus to the same thalamic nuclei
Fastigial efferent projections are
Uncrossed vestibulari nuclei
Crossed fibers emerge from the
cerebellum via the uncinate fasciculus
Russell, which arces around the SCP and
project to vestibular nuclei, into reticular
formation and upper cervical spinal cord
(C 2- C3)
 Clinical considerations
The cerebellum is concerned with the
coordination of somatic motor activity, the
regulation of muscle tone, and
mechanisms that influence and maintain
equilibrium
 Archicerebellar lesions
Lesions involving portions of the posterior cerebellar vermis and portions of
the flocculus
Produce disturbances of locomotions and equilibrium bilatellary. The patient
has variable degrees of dificulty in standing and walking
Standing with feet together may be impossible or maintained only with a
large basis; considerable swaying of the body
Closing the eyes worsens this difficulty slightly the Romberg sign is absent
The gate is jerky, uncoordinated, and resembles that of a drunk individual
=TRUNKAL ATAXIA
Muscle tone is not altered
Involvement of the posterior vermis and its connections with the pontine and
mesencephalic reticular formations have caused abnormalities of ocular
movement
Frequently occures in children witch tumors in the posterior cerebellar
vermis (medulloblastomas)
 Oculomotor disturbances, nystagmus.

impaired ability to hold ones gaze on a

stationary
or moving target (lesions of the flocculus
and paraflocculus).
saccadic pursuit movements
gaze-evoked nystagmus
if the patient tries to follow a
moving object with his or her eyes,
square-wave jerks can be observed
 Paleocerebellar syndrome
Is not established in humans, but lesions of the anterior
lobe of the cerebellum in the experimental animals
produce severe disturbances of posture and greatly
increased extensor muscle tone
Trunkal ataxia and hypotonia
hypotonia = decrees in the normal resistance that is
offered by muscles to palpation or to passive
manipulation
= hypotonia is much more apparent with
acute than with chronic lesions and may be
demonstrated number of ways (to tap the wrist of the
outstretched arm, wrist shoulder test,Stewart - Holmes
test=Holmess rebound phenomen, pendulary patelar
reflex)
 Neocerebellar syndrom
Lesions involving the cerebellar hemispheres and dentate nucleus affect
primarily skilled voluntary and associated movements = cerebellar
incoordination or ataxia
There are severe disturbances of coordinate movement, refered as :
asynergia = the range directions, amplitude and force of muscle
contractions are inappropriate (Stewart - Holmes test, Draganescu-
Voiculescu test)
Dysmetria = the excursion of the limb may be arrested prematurely and the
target is then reached by a series of jerky movements or the limb
overschoots the mark due to delay activation and dimished contraction of
antagonist muscles = hypermetria (finger to nose or toe to finger test,,
running the heel down the oposite shin
Intention tremor. The tremor seen in association with neocerebellar lesions
occurs primarlly during voluntary movements
Adiadochokinesis = defects in volitional movement are more evident in acts
that require alternation or rapid change in direction of movement, such as
pronation supination of the forearm or successive touching of each
fingertip to the thumb
Decomposition of movement and delayed initiation of movement
 Neocerebellar syndrom
Disorder of speech = cerebellar dysarthria
explosive speech, speech is slow,words
are broken up into syllables
Written words are larger and bigger than
normaly
Acute lesions may cause hypotonia of the
limb
Differential diagnosis of cerebellar
ataxia
1. Spinal ataxia
Severe sensory neuropathy may simulate
cerebellar ataxia; is due to involvement of the
large peripheral spinocerebellar afferent fibers.
Clinically absence of associated cerebellar
signs such as dysarthria or nystagmus,
loss of tendon reflexes,
corrective effects of vision on sensory ataxia
Romberg test = +
abnormalities of positions sense
 Differential diagnosis of cerebellar
ataxia
2. Vertiginous ataxia
Presence of vertigo
Ataxia of gait with listing to one side
Horizontal, rotatory nystagmus
Diagnosis of generalized cerebellar
ataxia
Mode of development Causes
Acute-transitory Intoxication with alcohol,
lithium,barbiturate,phenytoin or
other anticonvulsants

Postinfections,with mild
Acute but usually reversible
inflammatory changes in CSF

Hyperthermia with coma at

Acute-enduring onset. Intoxication with
mercury compounds or toluene
Diagnosis of generalized cerebellar
ataxia
Mode of development Causes

Subacute - Brain tumors such as

medulloblastoma,
astrocytoma,
hemangioblastoma
- alcoholic-nutritional
- paraneoplastic,often with
opsoclonus ans specific
anticerebellar antibodies
(particularly with breast and
ovarian carcinoma),
Creutzfeld-Jakob disease
Diagnosis of generalized cerebellar
ataxia
Mode of development Causes

Chronic (Months to years) Friedreich ataxia and other

spinocerebellar degenerations;
other hereditary cerebellar
degeneration(olivopontocerebe
llar degenerations;cerebellar
cortical degenerations.
Hereditary metabolic diseases,
often with myoclonus.
Childhood ataxia, including
ataxia telangiectasia,
cerebellar agenesis, and
dyssynergia cerebellaris
myoclonica of Ramsay Hunt
Diagnosis of generalized cerebellar
ataxia
Mode of development Causes
Chronic (Months to years)
Friedreich ataxia and other
spinocerebellar degenerations;
other hereditary cerebellar
degeneration(olivopontocerebe
llar degenerations;cerebellar
cortical degenerations.
Hereditary metabolic diseases,
often with myoclonus.
Childhood ataxia, including
ataxia telangiectasia,
cerebellar agenesis, and
dyssynergia cerebellaris
myoclonica of Ramsay Hunt
 In the case of alcohol

it inhibits the glutamate, that is one of

the main excitatory neurotransmitters in
the brain and
stimulates in the same time the effects
the gamma-aminobutyric acid (GABA),
that is an inhibitory neurotransmitter
responsible for causing sluggish
movements and a slurred speech.
The mnemonic DANISH can help remind you of
the key parts of the cerebellar exam:

Dysdiadochokinesia
Ataxia (gait and posture)
Nystagmus
Intention tremor
Slurred, staccato speech
Hypotonia/Heel-shin test