Neuroscience II: Cerebellum

CEREBELLUM disrupted, the effect of compression of the 4th

Comprises about 10-10.5% of the weight
of the whole CNS
Considered as the coordinator and
predictor of movement & cognition
ventricle by cerebellar mass lesions or edema
can actually cause obstructive
hydrocephalus which in turn can lead to
increased intracranial pressure.

Originated embryologically from the

metencepaholon (rhombic lip)

2 Major Functions

Coordinate skilled voluntary movements

Controls equilibrium posture and muscle

tone (kung bakit kayo may muscle tone
ngyaon, nakakaupo ng straight ngayon,
thats how the cerebellum acts).
Cerebellum is also responsible in
monitoring or modulating motor activities
originating in the brain centers.
It also regulates muscle tone, posture and
equilibrium.
It has automatic excitation of antagonistic
muscles at the end of movement, with
simultaneous inhibition of agonist muscles
that initiated movement.
So where is the location of your cerebellum?
!
Signs and symptoms of increased
intracranial pressure
Headache/ Vomiting with
a. Papilledema
b. Diplopia (double vision) with internal
squint (lateral rectus palsy secondary
to abducens nerve lesion)
c. Deterioration in the level of
consciousness (naiipit ang activating
reticular system which is located in
the brainstem)

It is located in the posterior fossa of the d. Bulging fontanel, separation of sutures,

skull rapid enlarging head size.

Dorsal to the brainstem 2 Major parts of the cerebellum

Roof of 4th ventricle

Separated from the occipital lobes by the

tentorium cerebelli.

Also comprised of highly convoluted

extensively folded cortex which is known
as your folia
!
It has a core of white matter which
contains the nuclei Vermis midline

Since the location of the cerebellum is located Hemisphere lateral

near the 4th ventricle, when 4th ventricle gets

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 Neuroscience II: Cerebellum

Primary fissure divides cerebellum into

anterior and posterior lobes

Posterolateral fissure separates

flocculobodular lobe from corpus cerebelli

Anterior lobe color red;

(paleocerebellum)
Posterior lobe (neocerebellum),
Flocculonodular lobe color green;
(archicerebellum/
vestibulorcoerebellum)

On the other hand, if patient has ipsilateral

limb ataxia cerebellar hemisphere is
affected

Clinical manifestation: uncoordinated clumsy

movement of the lower limb

Neurological test (upper extremities)

Alternating pronation-supination test

- dapat may sound and dahan-

dahan if you demonstrate it to
the patient

Finger to nose test determine if may

dysmetria (cerebellar problem)

Neurological test (lower extremities)

Heel shin test

! Cerebellar tonsils

What if you have a problem in the vermis?

Clinical manifestation: Truncal ataxia

leaning of the trunk from side to side or px
stands on wide based gait.

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 Neuroscience II: Cerebellum

Why is it important?

- In times of cerebellar tonsillar

herniation, there would be compression
of the medulla which leads to you
respiratory arrest.

Overview of afferent and efferent tracts

from the cerebellum (very important)

Afferent Efferent

*Anterior *Dentatorubro
Superior Spinocerebellar thalamic tract
Cerebellar tract
peduncle Acoustic & Optic *Dentatothala
information mic tract

- This is the most medial surface, inferior Middle *Pontocerebellar None

Cerebellar tract
surface of the cerebellum that sits Peduncle
above the foramen magnum
*Vestibulo- *Cerebellovest
cerebellar tract ibular tract
Chiari Malformation Inferior *Olivocerebellar *Cerebellooliv
Cerebellar tract ary tract
- Downward displacement of the Peduncle *Posterior
cerebellum into the foramen magnum spinocerebellar
tract
with resulting obstructive
hydrocephalus.
Vestibulocerebellar connections
Cerebellar Peduncles
Contains feed forward and feedback
- Connect cerebellum to the brainstem loops that provide continuous
correction to and anticipation to
- 3 main structures changes in stability and balance.

Superior Cerebellar Peduncle Vestibulocerebellum

(Brachium Conjunctivum) caudal
to the exit of CN IV o Oldest part

Middle Cerebellar Peduncle o Also called archicerebellum

(Brachium Pontis) superior to the o Main components are vestibular
exit of CN V
nuclei, flocculonodular lobe,
Inferior Cerebellar Peduncle inferior parts of paravermal area
(Restiform body or Juxtarestiform) & fastigial nucleus
located at the dorsolateral aspect of
the medulla

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Clinical application: Flocculonodular Lobe
Syndrome
Result of a lesion of the flocculonodular
lobe or its afferent/efferents.
Most commonly seen in children with
medulloblastoma
Characterized by truncal ataxia due to
inability to stabilize or balance the axial
musculature
Results in a wide-based stance as well
as swaying
Nystagmus is often diagnosed due to
damage to the vestibuloocular pathways.
Spinocerebellar connections
Ensures the fluidity of limb movements
while maintaining stability of trunk.
Spinocerebellum
o Second oldest part
o Also called paleocerebellum
o Comprises anterior lobe, vermis
w/o nodule, superior
paravermal area
Clinical application: Anterior Lobe
Syndrome
Characterized by gait ataxia due to
inability to process proprioceptive
information from the limbs
Friedrich ataxia
Autosomal recessive disorder
Lesion of the post. Columns of the
spinal cord and the post.
Spinocerebellar tracts
Afferents to the anterior lobe are
affected, leads to degenerative
changes in anterior lobe.
Ethanol induced gait ataxia
Canlas-Capitulo-Cardona
Neuroscience II: Cerebellum
Ethanol toxicity to Purkinje cells,
particularly in the anterior lobe.
NEOCEREBELLUM
comprises the lateral aspects of the
posterior lobes
Input
pontine nuclei fibers cross midline
enter contralateral neocerebellum
(MCP)
Additional afferents
contralateral olivary nuclear complex
Reciprocal connections
Output from the neocerebellar cortex is
mainly to the dentate nucleus, which in
turn projects to the red nucleus and
from there to the VL of the thalamus,
called dentatorubrothalamic tract
there are also direct projections from
the dentate nucleus to the thalamus,
called dentatothalamic tract
from the thalamus, information projects
back to motor and sensory areas of the
cortex
these reciprocal connections with the
cerebral cortex put the cerebellum in a
position to coordinate and streamline
motor output from the cortex
Functions
necessary for hand-eye coordination;
uses visual input and calculates the
trajectory of movement needed to
reach or manipulate a target
involves both feedback and feed-
forward mechanisms that allow
learning and experience to influence
movement
A. Sensory consequence
Neocerebellum also predicts the
sensory consequence of
movement through comparison
with the past experience
E.g. why you cannot tickle
yourself; the neocerebellum
already predicted the sensory
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consequence of this self-
generated motor command and
has attenuated the response in
the sensory cortex
B. Voluntary movement
Neocerebellum is involved in the
planning and automatisation of
voluntary movements
Responsible for the fine-tuning of the
motor patterns, such that with
practice a new skill comes to be
performed automatically
E.g. handwriting, playing the piano;
we do not think about how individual
letters should be written, but we think
about concepts
This automatisation by the
cerebellum affectively frees up the
cerebrum for higher order cognitive
activity
C. Coordination of motor activity and
cognition
Input to the cerebellum is not only
from motor area but also from cortical
areas related to cognitive and
sensory function
Therefore can automatise not only
motor but also sensory and cognitive
skills
The neocerebellum modulates but
does not generate language and
cognition
With its connections, it is an interface
between cognition and motor output
E.g. Language, which requires both
mental and motor activity
Responsible for linguistic
coordination, fluidity of language,
automatisation of syntax and
grammar, as well as prediction of
sentence structure and flow
Canlas-Capitulo-Cardona
Neuroscience II: Cerebellum
Posterior Lobe Syndrome
result of a lesion of the posterior lobe of
the cerebellar hemispheres or their
afferents and efferents
most commonly seen in demyelinating
diseases, such as multiple sclerosis,
and midbrain infarctions affecting the
dentatorubrothalamic tract (cerebellar
efferent) or infarcts to the cerebellar
hemispheres
characterised by deficits in hand-eye
coordination, ability to calculate the
trajectory to a target (dysmetria) and
the inability to coordinate agonist-
antagonist movements of the
extremities (dysdiadochokinesia).
may also have typical language
disorders characterised by linguistic
incoordination, which refers to the
inability to use grammar and syntax
appropriately
FUNCTIONAL ANATOMY OF THE
CEREBELLUM
Layers of the Cerebellar Cortex
1. Molecular
2. Purkinje
3. Granular
Cells of the Cerebellum
1. Granule cell
very abundant at the granular layer
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receives afferent input from mossy
fibres within the cerebellar glomerulus
axons travel to molecular layer where
they branch in a T junction to form the
parallel fibres
2. Golgi cell
located in the granule cell layer
radiate into all other layers
inhibitory interneurons that synapse in
the cerebellar glomerulus as well as
parallel, mossy and climbing fibers
3. Purkinje cell
largest cell in the cerebellar cortex
receives input from granule cells and
climbing fibres
axon is the only efferent pathway of the
cortex
projects via deep cerebellar nuclei
located at the Purkinje cell layer
dendrites fan out in one plane into the
molecular layer where they form
excitatory synapses with climbing fibres
and parallel fibres (from granule cells)
activity is modulated through inhibitory
synapses with the basket and stellate
cells
GABA (inhibit cerebellar nuclei and
vestibular area)
4. Basket and Stellate cells
inhibitory GABAergic neurons
located in the molecular layer
branching is perpendicular to the
Purkinje cell dendritic tree
receive input from mossy and climbing
fivers and synapse with the Purkinje
cells
one basket cells synapses with about
70 Purkinje (1:70)
Neurons of the Cerebellar Cortex
Unipolar brush cells
within granular layer of vermis and
flocculonodular lobe
Canlas-Capitulo-Cardona
Neuroscience II: Cerebellum
receive mossy fibre rosettes via their
dendrioles
- which are excitatory to the cell type
in these cortical neurons
Fibers of the Cerebellar Cortex
1. Mossy fibres
all cerebellar afferents originating from
all sources except inferior olivary
nuclear complex
spinal cord, posterior column nuclei,
trigeminal, pons, vestibular nuclei
synapse with golgi cells and granule
cell dendrites in the glomerulus
2. Climbing fibres
origin: inferior olivary nuclear complex
forms excitatory synapse with one
specific Purkinje cell (1:1)
1 neuron gives rise to 10 climbing
fibres
constitute a sensory feeback loop
indicating any motor error in current
movement
key in motor learning
3. Parallel fibres
synapse with Purkinje cell dendrites
run perpendicular to the plane of the
Purkinje dendritic tree
Cerebellar Glomerulus
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 Neuroscience II: Cerebellum

first processing station for cerebellar Synaptic Circuitry of Cerebellum

afferents
mossy fibre afferents terminate here and
synapse with Golgi cell and granule cell
dendrites
synapse with granule cell is under
inhibitory control of Golgi cell axons

Wiring of the Cerebellar Cortex

Mossy fibre afferents project to the
cerebellar glomerulus in the granular layer Cerebellar Nuclei
In the glomerulus, the mossy fibre afferents
synapse with granule cell and Golgi cell
dendrites
The Golgi cell exerts an inhibitory influence
on the synapse between the mossy fibre
and granule cell.
After this first processing stage, the
granule cell conveys this afferent
information to the Purkinje cell

1. Dentate
2. Emboliform
3. Globose
4. Fastigial

*globose and emboliform= INTERPOSED

NUCLEUS

Functional Zones of the Cerebellum

1. Vermal
2. Paravermal (intermediate)
3. Lateral

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 Neuroscience II: Cerebellum

Functional Divisions of the Cerebellum - cells in the spinal cord that give
rise to ventral spinocerebellar tract
receive primary sensory inputs
and descending reticulospinal and
corticospinal fibres
- provides afferent signals and
feedback to the cerebellum
regarding motor circuits in the
spinal cord
2. From Lower Brainstem
Olivopontocerebellar
Functional Regions of the Cerebellum Reticulocerebellar
(Memorise!) Vestibulocerebellar
Regions Functions Motor - fibres convey information
Pathways concerning the position of head
influenced
and body in space
Lateral Motor planning Lateral - as well as information useful in
hemispheres for extremities corticospinal orienting eyes during movement
tract
3. From Cerebral Cortex
Intermediate Distal limb Lateral Corticopontocerebellar tract
hemispheres coordination corticospinal
tract,
rubrospinal tract Cerebrocerebellar Tract
Vermis Proximal limb Anterior In planning movement, sensory and
and trunk corticospinal motor CORTICOPONTINE projections
coordination tract, provide the spinocerebellar and
reticulospinal pontocerebellar via
tract,
PONTOCEREBELLAR connections
vestibulospinal
tract,
with feed forward information about
medial an intended movement
longitudinal
spinal tract
This plan can be evaluated in relation
to current activity and correction
Flocculonodular Balance and Medial formulated and relayed back to motor
lobe vestibulo-ocular longitudinal cortex via thalamus
reflexes fasciculus
Cerebrocerebellar Pathway

Cerebellar Inputs Via Middle Cerebellar Peduncle

1. From Spinal Cord (Signals from the frontal and parietal
Dorsal Spinocerebellar tract lobes & temporal lobe -> crosses the
- inform the cerebellum of limb midline going to the cerebellum ->
planned movement)
position and movement
- after processing in the cerebellum
and their connections with motor
cortex, they influence movement
of the extremities and muscle tone
Ventral Spinocerebellar tract

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 Neuroscience II: Cerebellum

molecular and granular layers -> modulate

output in the crebellum

Excitatory Inputs from:

Granule cells (Parallel fibers)

Mossy fibers

Climbing fibers

Aminergic fibers
Inhibitory inputs from:
!
Purkinje cells
CEREBELLAR CIRCUITS
Stellate and basket cells
Mossy Fibers:
Golgi cells
- Formed by the afferent axons from

Pontine Nuclei
CEREBELLAR OUTPUT
Vestibular Nuclei
Dentate Nucleus
Spinal Cord

Reticular Formation
- Synapse with granule cell dendrites

- Nuerotransmitter: GLUTAMATE

Climbing Fibers:

- Formed by afferent axons from Inferior

Olivary Nucleus

- Synapse with purkinje cells dendrites

- Neurotransmitter: ASPARTATE !

*BOTH FIBERS ARE EXCITATORY! Thalamic Nuclei

! !

*The multilayered fibers are derived from the

locus ceruleus raphei nuclei -> terminate in the
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 Neuroscience II: Cerebellum

Cerebellar Output (FLOCCULONODULAR Majority from the pontine nuclei

LOBE)
Superior Cerebellar Peduncle
Main pathway for efferent cerebellar
Flocculonodular Lobe fibers to brainsem, red nucleus,
Purkinje Cells
thalamus
0.8 milion fibers
Some afferent fibers

Lateral Vestibular o Spinal cord (ventral

Nuclei spinicrebellar)
(Brainstem)
Vascular Supply of the Cerebellum

Artery Region Supplied

Anterior Inferior -All cerebellar

Cerebellar Artery peduncles
Vestibulospinal Tract
(AICA) -Flocculus
(Spinal Cord)
-All deep cerebellar
nuclei
Posterior Inferior -Inferior two thirds of
Cerebellar Artery the posterior lobe
(PICA) -Tonsils
-Nodulus
Axial and Proximal
Muscles Superior Cerebellar -Anterior lobe
Artery (SCA) -Superior third of the
! posterior lobe
-Vermis
Cerebellar Input and Output
*dentate nucleus-AICA
Inferior Cerebellar Peduncle
*interposed nucleus-AICA
0.5 million fibers
*A 43 yr old male presented with truncal
Two Divisions
ataxia. Diagnosis: Stroke of the
- Restiform body Cerebellum. What artery is affected? SCA
because vermis is affected
- Juxtarestiform body
Cerebellar Vascular Supply
Mostly afferent

- Inferior Olive

- Spinal Cord (dorsal

spinocerebellar)
Some efferent

Middle Cerebellar Peduncle

Most massive
Only afferent fibers to the cerebellum
20 million fibers !

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 Neuroscience II: Cerebellum

Rebound - overshooting
Tongue movement
Eye movement

TANDEM GAIT

Part of the Nervous System Tested in

Neurological Examination
Mental Status cerebroponocerebellar
tract (voluntary movement)- if a patient
is obtunded the pt cannot properly
perform any movement !

Cranial Nerves
o *MCP located near the exit of DYSMETRIA
CN 5- if affected
manifestations: loss of
sensation in the tongue, or in
the face (ophthalmic or V1,
maxillary or V2 and mandibular
or V3)
o *SCP located near the CN 4
manifestations would be related
to extraocular muscles
o Cerebellar manifestations with
CN manifestations
Motor Corticospinal tract !
manifestations: plegia (weakness) or
paresis (paralysis) REBOUND TEST

Coordination function of the

cerebellum
Reflexes
Sensory

Cerebellar Examination
Stance and gait *wide based gait
with cerebellar dysfunction
Finger to nose test and heel to shin test
!
Alternating movements

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HEEL TO SHIN TEST
! -
FINGER TO NOSE TEST
!
Clinical Manifestations of Cerebellar
Disease
A. Hypotonia function of the
spinocerebellar tract is for muscle tone
B. Ataxia
- Dysmetria
- Intention tremors->pag may
ginagawa ka dun lumalabas
- Decomposition of movement
- Dsydiadochokinesia
- Rebound
- Speech disturbance scanning
dysarthria (para silang galit na
nagiging explosive)
- Nystagmus figure of H
General Principles of Cerebellar Syndrome
Canlas-Capitulo-Cardona
Neuroscience II: Cerebellum
1. Ipsilateral signs with lateralized
lesions
- Double decussation of efferent
cerebellar pathways
- e.g. Right cerebellar
hemisphere lesion right limb
ataxia
- e.g. Midline lesion in the Vermis
truncal ataxia
2. All deficits are motor
Are superimposed on normal
motor movements (no
paralysis) -> incoordination
- No loss of sensory perception
3. Gradual but definite recovery in time
- If disturbances are due to non
progressive pathology
4. Somatotopy of deficits
- Laterally placed lesions
limbs are affected
- Medially placed lesions trunk
affected
5. Severity of deficits
- Considerably increased if
lesions involved the superior
cerebellar peduncle or deep
cerebellar nuclei
Cerebellar Lesion
Cerebellar hemisphere lesions result in
IPSILATERAL LIMB ATAXIA
Midbrain Lesion - CLAUDE SYDROME
Oculomotor Nerve (Ipsilateral)
o Diplopia with external squint
o Ptosis
o Dilated pupil, non reactive to
light
Red Nucleus
o Contralateral cerebellar signs
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 Neuroscience II: Cerebellum

- Ataxia, intention tremor, Vestibular Nucleus

dysmetria,
dysdiadochokinesia o Vertigo with nystagmus

- Contralateral cerebellar Nucleus Ambiguus

signs
o Dysphagia, dysphonia
Lateral Medullary Lesion
Spinal Trigeminal Nucleus
50-year old male
o Ipsilateral loss of pain and
Chronic smoker with hyperlipidemia temperature in the face

On waking up today Lateral Spinothalamic Tract

o Sudden vertigo, vomiting o Contralateral loss of pain and

temperature in the face
o Numbness of left face, right UE,
right LE Inferior Cerebellar Peduncle

Difficulty swallowing o Ipsilateral limb ataxia

PE: BP Cervical Sympathetic

150/90 mmHg, CR/PR 80/min regular o Horners Syndrome

Conscious, left ptosis Clinical Differentiation

Left pupil 2 mm RTL, right pupil 5 mm Cerebellar hemisphere lesion

RTL
o Clinical manifestations are
EOM intact referable to LIMB ATAXIA

Absent pain and temperature over left Cerebellar peduncle lesion

face, right UE, right LE
o Clinical manifestations are
Uvula deviated to right: Absent left gag referable to limb ataxia PLUS
reflex BRAISTEM MANIFESTATION
(Cranial nerve deficits, long
LEFT LIMB ATAXIA with normal sensory tract signs)
strength

MEDULLA
Lesion at dorsolateral medulla
affecting:

1. VESTIBULAR NUCLEUS

2. Nucleus ambiguous

3. Spinal Trigeminal Nucleus/Tract

4. Lateral Spinothalamic

5. INFERIOR CEREBELLAR
PEDUNCLE

6. Cervical Sympathetic
Wallenberg Syndrome

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