Cerebellum

Chona H. Araga, M.D.

 Overview - The Cerebellum

• It is located within the

posterior fossa
• It lies between the
temporal and the
occipital lobes and the
brainstem
 Overview - The Cerebellum

Has 3 primary functions:

1. The maintenance of
posture and balance
2. The maintenance of
muscle tone
3. The coordination of
voluntary motor
activity
 General Features of Cerebellum :
The cerebellum consists of a midline
vermis and 2-lateral hemispheres.
Anatomically , it is divided into
anterior , posterior & flocculo-nodular
lobes.
It controls equilibrium, it influences
posture & muscle tone and coordinates
the movements
Its surface is high convoluted, forming
folds or folia, being oriented transversely
Lateral aspect of brain It lies behind Pons & M.O. , separated
stem & cerebellum ,
from them by the cavity of 4th ventricle.
showing cerebellar
peduncles. It is connected to brain stem (medulla,
pons& midbrain) by inferior, middle &
superior cerebellar
 External Features of Cerebellum :
It has anterior notch ,which is
wider and lodging the back of pons
& medulla. It is separated from
them by cavity of 4thventricle
 It has also posterior notch
Superior surface
occupied by falx cerebelli, which
separates the 2 cerebellar H.
Inferior surface : rounded
on each side and presents :
a deep groove (vallecula)
between the 2-cerebellar
hemispheres,which is occupied by
the inferior vermis. -Tonsil is
a small part of cerebellar
Inferior surface
hemisphere that lies lateral to
External Features of Cerebellum :
Superior surface : lies beneath
tentorium cerebelli and has a raised
superior vermis + a large cerebellar
hemisphere on each side + primary &
horizontal fissures.
1- Primary fissure V-
shaped,well defined fissure, lies on
superior surface and separates the small
anterior lobe from the larger middle lobe
(or posterior lobe).
2- Horizontal fissure lies along the
sides of cerebellum, extending from
anterior notch to posterior notch, separates
3- Secondary (posterolateral) fissure
the superior from the inferior surfaces.
lies on inferior surface and separates
flocculo-nodular lobe from the remainder
of cerebellum.
 4.Postclival fissure

 separates declive from folium in vermis

 Separates posterior quadrangular lobule

from superior semilunar lobule in the
hemisphere
 5.Prepyramidal Fissure

 separates tuber from pyramis in vermis;

 Separates inferior semilunar lobule

from biventral lobule in hemisphere
 Overview - The Cerebellum
Posterior view Superior view
Anterior
lobe

Posterior
lobe

Horizontal fissure Primary fissure

OverviPosterior Cerebellum

Horizontal fissure
Separates the superior from the inferior surface
(No morphological or functional significance)
 vermisThe Vermis
• Lies in the midline
between the 2
lateral cerebellar Arbor vitae
hemispheres
nodule

uvula

pyramid
 ANTERIOR LOBE:
 VERMIS  CEREBELLAR
HEMISPHERE
 LINGULA  -
 CENTRAL LOBULE  ALA LOBULI CENTRALIS
 CULMEN  ANTERIOR
QUADRANGULAR LOBULE
 POSTERIOR LOBE
 POSTERIOR
 DECLIVE QUADRANGULAR
 ---POSTCLIVAL LOBULE
FISSURE  POSTCLIVAL OR POST-
 FOLIUM SUP FISS
 SUPERIOR SEMILUNAR
 TUBER  Horizontal fissure
 PYRAMIS  INF. SEMILUNAR
 UVULA  BIVENTER
 POSTEROLATERAL  TONSIL
FISSURE
 FLOCCULONODULAR LOBE

NODULUS FLOCCULUS

Schematic drawing of cerebellum
showing the relationships between
the anatomical & functional divisions
of cerebellum.
Green =archi-cerebellum,
blue=paleo-cerebellum.
Pink= neo-cerebellum
Functional subdivision of
cerebellum :
1- Archi-cerebellum =
(flocculonodular
lobe) :
_ It is formed of the
flocculo-nodular lobe + associated
fastigial nuclei, lying on inf. Surface
in front of postero-lateral fissure.
_Embryologically, it is
the oldest part of cerebellum.
_It receives afferent Fs.
From vestibular apparatus of
internal ear Via vestibulo-
cerebellar tracts.
_It is concerned with
equilibrium and posture.
 I- Archicerebellum
It is concerned with equilibrium.
It represents flocculo-nodular lobe.

It has connections with vestibular &

reticular nuclei of brain stem
through the inferior cerebellar
peduncle.
Afferent vestibular Fs. Pass from
vestibular nuclei in pons & medulla to the
cortex of ipsilateral flocculo-nodular lobe.
Efferent cortical (purkinje cell) Fs.
Connections of Project to fastigial nucleus, which projects to
vestibular nuclei & reticular formation.
archicerebellum
It affects the L.M.system bilaterally via

Schematic drawing of cerebellum
showing the relationships between the
anatomical & functional divisions of
cerebellum.
Green =archi-cerebellum,
blue=paleo-cerebellum.
Pink= neo-cerebellum
2- Paleo-cerebellum=
anterior lobe
-_it is formed of midline vermis
+ surrounding paravermis +
globose & emboliform nuclei.
_It receives afferent
proprio-ceptive impulses from
Ms.& tendons Via spino-
cerebellar tracts (dorsal &
ventral) mainly. -it sends
efferents to red nucleus of
midbrain.
-it is concerned with muscle tone
 2-Paleo-cerebellum
It is concerned with muscle tone
Afferents spinal Fs. consist of
dorsal & ventral spino-cerebellar
tract from muscle, joint &
cutaneous receptors to enter the
cortex of ipsilateral vermis & para
vermis Via inferior & superior
cerebellar peduncles .
Efferents cortical fibres pass to
globose & emboliform nuclei, then
Via sup. C. peduncle to contra-
lateral red nucleus of midbrain to
give rise descending rubro-spinal
Connections of Paleo-cerebellum.
tract.
 3- Neo-cerebellum=
posterior lobe :
_It is the remaining largest part
of cerebellum.
_It includes the most 2-
cerebellar hemispheres + dentate
nuclei. _It
receives afferent impulses from
Schematic drawing of cerebellum the cerebral cortex+pons Via
showing the relationships between the cerebro-ponto- cerebellar
anatomical & functional divisions of
cerebellum. pathway.
-it sends efferents to V.L.nucleus
Green =archi-cerebellum,
of thalamus.
blue=paleo-cerebellum.
Pink= neo-cerebellum -it controls voluntary
movements (muscle
coordination).
 3- Neo-cerebellum
It is concerned with muscular
coordination.
It receives afferents from cerebral
cortex involved in planning of
movement- to pontine nuclei ,cross to
opposite side Via middle Cerebellar
peduncle to end in lateral parts of
cerebellum (cerebro-ponto-cerebellar
tract).
Neo-cerebellar efferents project to
dentate nucleus,which in turn projects to
contra-lateral red nucleus & ventral
lateral nucleus of thalamus ,then to
motor cortex of frontal lobe, giving rise
descending cortico-spinal & cortico-
bulbar pathways.
Connections of Neo-cerebellum. Efferents of dentate nucleus form a
major part of superior C. peduncle.
 CEREBELLAR PEDUNCLES
 1. Superior cerebellar peduncle
(Brachium conjunctivum)
 – connects cerebellum to midbrain;

 forms largest cerebellar efferent bundle;

 formed of fibers originating from

dentate,emboliform and globose nuclei
 Cerebellar peduncles
Superior cerebellar peduncle

Efferent pathways:
1. Dentatrubrothalamic
tract
2. Interpositorubrothala
mic tract
3. Fastgiothalamic tract
4. Fastigiovestibular
tract

reticulocerebellar
cuneocerebellar
 2. Middle cerebellar peduncle
(Brachium pontis)
 Connects cerebellum to pons

 Fibers arise from pons thru the

pontocerebellar tract
 Projects fibers from the pontine nuclei
to the contralateral neocerebellum
 Consists mainly of afferent fibers
 Cerebellar peduncles
Middle cerebellar peduncle

• Connects the cerebellum

to the pons
• Is an afferent fiber system
containing pontocerebellar
fibers to the cerebellum

reticulocerebellar
cuneocerebellar
 3. Inferior cerebellar peduncle

 ( Brachium restiformis)

 Connects cerebellum with the

medulla
 Conveys unconscious
proprioceptive and exteroceptive
information to the cerebellum
 Cerebellar peduncles
Inferior cerebellar peduncle

Restiform body

Is an afferent fiber system

containing:
• Dorsal spinocerebellar
tract
• Cuneocerebellar tract
• Olivocerebellar tract
• Reticulocerebellar

reticulocerebellar
cuneocerebellar
 Cerebellar peduncles
Inferior cerebellar peduncle

Juxtarestiform body
Contains afferent and
efferent fibers:
• Vestibulocerebellar fibers
(afferent)
• Cerebellovestibular
fibers (efferent)
• Cerebelloreticular
(efferent)

reticulocerebellar
cuneocerebellar
 Cerebellar peduncles

Superior cerebellar peduncle

Middle cerebellar peduncle

Inferior cerebellar peduncle

 Internal Structure of
cerebellum : It consists of an outer
layer of grey matter
(cerebellar cortex) , &
inner layer of white
matter containing 4-pairs
of cerebellar nuclei :
above roof of 4th V. from
medial to lateral :
1-Fastigeal
nucleus. 2-
Sagittal section of cerebellum.
Globose nucleus.
T.S.of cerebellum & brain at level 3-Emboliform nucleus.
of 4th V. to show cerebellar nuclei. 4-Dentate nucleus.
(the only one that can be
seen clearly with the naked
Fastigeal nucleus
- Most medial; contains small and large multipolar
neurons
Globose nucleus
- lateral to fastigeal and medial to emboliform
contains small and large multipolar neurons
Emboliform nucleus – wedge shaped mass
- Located close to the hilus of dentate nucleus

-composed mostly of large multipolar neurns

Dentate nucleus- largest and most lateral
“ crumpled bag” appearance; large multipolar neurons
 Cerebellar nuclei
• The hemispheres contain four cerebellar nuclei

Dentate nucleus
Cerebellar nuclei

Emboliform nucleus
 Cerebellar nuclei

Globose nucleus Emboliform nucleus

Interposed nuclei
Cerebellar nuclei

Fastigial nucleus

T.S of cerebellar folia showing
layers of cerebellar cortex.
Afferent & Efferent connecltions and
their relationships to principal
cells of cerebellar cortex.
Cerebellar cortex
It is highly convoluted,
forming numerous transversely
oriented folia.
It contains nerve cells,
dendrites and synaptic
connections of cellular
neurones.
The cellular organization of
the cortex consists of 3-layers :
1-Outer molecular layer.
2-Intermediate, purkinje cell
layer.
3-Inner granular layer, which is
dominated by granule cell.
 Cerebellar cortex
Molecular layer : contains
1-Cells : molecular cells (stellate
cells) & basket cells.
2-Nerve Fibres :
a- dendrites of
Purkinje cells (arborisations).
b-axons of granule
cells. ( bifurcate to produce 2-parallel
fibres , oriented along long axis of
folium). c-ending of
climbing fibers.
Purkinje cell layer : it is formed
of one layer (unicellular) of large flask-
shaped purkinje cells. Their
arborisations are at right angles to long
axis to folium.

Granular layer : it is formed of

small granule cells & ending of
MThere are 3-types of
Nerve Fibres in white
Matter :
1-Axons of purkinje cells :
the only axons to leave
cerebellar cortex to end in deep
cerebellar nuclei specially dentate
nucleus.
2-Mossy Fibres : end in the
granular layer.
3-Climbing Fibres :
end in the molecular layer.
 Afferent Fibres to cerebellum :
Mostly end in cerebellar cortex,
excitatory to cortical neurons,
as mossy or climbing Fs.
passing through the cerebellar
peduncles.
The following are Afferent fibres:
(In M.O)
1-
dorsal & ventral spino-cerebellar
tract. (passing via I.C.P & S.C.P)
Cuneocerebellar- via I.C.P
2-
vestibulo-cerebellar Fs. (via I.C.P)
3-
olivo-cerebellar Fs. (via I.C.P)/
(extrapyramidal fibres), (end as
Efferent Fibres of the
cerebellum :
M
It sends the following fibres :
1-Cerebello-vestibular Fs. to
vestibular nuclei of pons & M.O.
2-Cerebello-
olivary Fs. To M.O.
3-Dentato-rubro-
thalamic tract To red nucleus of
midbrain & ventro-lateral
nucleus of the thalamus and finally
to motor cortex of frontal lobe to
coordinate movement via cortico-
spinal & corticobulbar tracts.
 Cerebellar Lesions
 Are usually vascular, maybe traumatic or tumour.
 Manifestations of unilateral cerebellar lesions :
1-ipsilateral incoordination of (U.L) arm = intention tremors : it is a
terminal tremors at the end of movement as in touching nose or button
the shirt.
2-Or ipsilateral cerebellar ataxia affects (L.L.) leg, causing wide-based
unsteady gait.
 Manifestations of bilateral cerebellar lesions (caused by alcoholic
intoxication, hypothyrodism, cerebellar degeneration & multiple
sclerosis) :
1-dysarthria : slowness & slurring of speech.
2-Incoordination of both arms.= intention tremors.
3-Cerebellar ataxia : intermittent jerky movements or
staggering , wide-based, unsteady gait.
4-Nystagmus : is a very common feature of
multiple sclerosis. It is due to impairment coordination of eye movements
/so, incoordination of eye movements occurs and eyes exhibit a to-and-
fro motion.
 Combination of nystagmus+ dysarthria + intention tremors constitutes
Charcot’s triad, which is highly diagnostic of the disease.
 Cerebellar Dysfunction

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Cerebellar Dysfunction
 Cerebellar Dysfunction
Hypotonia

•is a loss in the resistance normally

offered by muscles to palpation or to
passive manipulation.
•results in a floppy, loose-jointed, rag-
doll appearance with pendular reflexes;
the patient appears inebriated.
 Cerebellar Dysfunction
Disequilibrium

Refers to loss of balance, characterized by gait

and trunk dystaxia.
 Cerebellar Dysfunction
Dyssynergia
Is a loss of coordinated muscle
activity and includes:
Dysarthria
is slurred or scanning speech.
Dystaxia
• is a lack of coordination in
the execution of voluntary
movement (e.g., gait, trunk,
leg, and arm dystaxia).
 Cerebellar Dysfunction
Dyssynergia

Dysmetria
• Is the inability to arrest
muscular movement at the
desired point (past
pointing).
Intention tremor
• Occurs during a voluntary
movement (a type of
dysmetria).
 Cerebellar Dysfunction
Dyssynergia

Dysdiadochokinesia
• is the inability to
perform rapid
alternating movements
(rapid sup- pination and
pronation of the hands
 Cerebellar Dysfunction
Dyssynergia

Nystagmus
• is a form of dystaxia
of eye movements
(ocular dysmetria).
 Cerebellar Dysfunction
Dyssynergia

Nystagmus
• is a form of dystaxia
of eye movements
(ocular dysmetria).
 Cerebellar Dysfunction
Dyssynergia

Decomposition of movement
(“by-the-numbers" phenomenon)
consists of breaking down a smooth muscle
act into a number of jerk awkward
component parts.
 Cerebellar Dysfunction
Dyssynergia

Rebound or lack of check

• results from the inability to adjust to changes
in muscle tension.
• is caused by loss of the cerebellar
component of the stretch reflex.
• may be tested for by having the patient flex
his forearm at the elbow against resistance;
sudden release results in the forearm striking
the patient's chest.
 Cerebellar Lesions

1. Anterior vermis syndrome

2. Posterior vermis syndrome
 Cerebellar Lesions
Anterior vermis syndrome

• involves the leg region of the anterior lobe.

• results from atrophy of the rostral vermis, most
commonly caused by alcohol abuse.
• results in gait, trunk, and leg dystaxia.
• *dystaxia- difficulty controlling voluntary mvts
 Cerebellar Lesions
Posterior vermis syndrome

• involves the flocculonodular lobe.

• is usually the result of brain tumors in
children. mostly medulloblastomas
• results in truncal dystaxia.
VENTRICULAR
SYSTEM:
 1. Lateral Ventricles
 Cavities of the cerebral hemisphere

 Parts:

 A. anterior horn (frontal)

 B.body

 C. collateral trigone

 D. posterior horn (occipital)

 E. inferior horn (temporal)

2. Third ventricle
 Narrow, slit-like cavity between the 2
halves of the diencephalons
 Roof: formed of the choroid plexus

 Floor: extends into the optic

recess,infundibular recess and into the
aqueduct of Sylvius
3. The Fourth Ventricle
It is a cavity of hindbrain.
Position : lies between pons & M.O.
anteriorly and the cerebellum
posteriorly.
It is a diamond-shaped space which
is lined by ependyma.
Its superior angle is continuous with
cerebral aqueduct of midbrain.
inferior angle is continuous with
central canal of closed M.O.
Its lateral angles extend laterally to
form a lateral recess on each side to
open into subarachnoid space.
The Boundaries of 4 Ventricle
th

Superiolateral boundary :
-it is formed by superior
cerebellar peduncle on each side.
Inferiolateral boundary :
-it is formed by inferior
cerebellar peduncle + gracile &
cuneate tubercles on each side.
The Roof of 4th Ventricle
-it is a tent-shaped when seen
laterally, and diamond-shaped when
seen behind.
-it is formed of superior
& inferior medullary vela, which
are thin sheets of white matter
/consists of : ependyma
covered by pia mater.
-Sup.medullary velum
connects the 2 sup.cerebellar
peduncles.
-Inf.medullary velum connects the 2
inf.cerebellar peduncles.
-Inferior vermis of cerebellum :
lies in the middle of roof of 4th
The Roof of 4th Ventricle
The lower part of roof is
invaginated by tela choroidea of
4th ventricle.
The tela choroidea is a double
layer of pia mater which encloses
the choroid plexus of 4th ventricle.
The choroid plexus is a
vascular capillary tuft covered by
ependymal cells and secretes C.S.F.
into the lumen of 4th ventricle.
The Openings of 4th Ventricle
The roof contains 3 aperatures
which transmit C.S.F. from ventricular
lumen to subarachnoid space.
Median aperature (foramen of
Magendie) : lies in the median plane at
lower end of inferior medullary velum,
and opens into subarachnoid space at
cistrna magna at cerebello-medullary
angle
2 lateral openings (foramina of
Luschka) : each one lies at the lateral
end of lateral recess to open into
subarachnoid space at cerebello-
pontine angle. choroid plexus partly
protrudes out through each lateral
 The Floor of 4 Ventricle th

It is called rhomboid fossa.

It is diamond-shaped and is
divided into right & left halves
by the median sulcus.
It is crossed in the middle by
transvere Fs. (ponto-cerebellar
Fs.)called medullary stria,
which divide floor of 4th
ventricle into upper (pontine)
& lower (medullary) part.

A diagram to show the floor & lateral

boundaries of 4th ventricle.
 The Floor of 4 Ventricle th

Upper pontine part : presents

on each side of median sulcus.
1-Median eminence : a
rounded elevation produced by the
abducent nucleus.
2-Facial colliculus
: an elevation on the top of lower
part of median eminence. It is
produced by the fibres of facial
nerve which surround abducent
nucleus.
3-Superior fovea : a groove
lateral to facial colliculus.
4-Vestibular area :
A diagram to show the floor & lateral lateral to superior fovea. It
boundaries of 4th ventricle.
 The Floor of 4 Ventricle th

Lower medullary part :

presents on each side of the
median sulcus. 1-Inferior
fovea : inverted V-shaped groove.
2-
Hypoglossal area : medial to
inferior fovea. It overlies
hypo-glossal nucleus.
3-Vagal area (triangle) :
between limbs of inferior fovea.It
overlies dorsal nucleus of vagus.
4-Vestibular area :
lateral to inferior fovea. It overlies
inferior vestibular nucleus.
A diagram to show the floor & lateral
boundaries of 4th ventricle.
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