The Cerebellum

Cerebellum
Describe the external anatomy of the cerebellum and identify the parts on a diagram.

Differentiate between the longitudinal divisions of the cerebellum and the anterior-posterior divisions of the cerebellum and ascribe
a general function to each.

Describe the cerebellar peduncles.

List the layers of the cerebellar cortex and the cells contained within each.

List the fiber types of the cerebellum and the cells/systems associated with each.

Describe the major cerebellar pathways.

Describe the results of cerebellar dysfunction, including hypotonia, disequilibrium, and

Overview

located has three primary

infratentorially within functions: the
develops from the the posterior cranial maintenance of posture
alar plates (rhombic fossa and lies and balance, the
lips) of the between the maintenance of muscle
metencephalon. temporal and occipital tone, and the
lobes and the coordination of voluntary
brainstem. motor activity.
MAJOR DIVISIONS OF THE CEREBELLUM

contains a central
medullary core, the
white matter that
covered by a The emboliform and
consists of a midline contains myelinated
three-layered cortex, globose nuclei are
vermis and two axons and the four
formed into folia and collectively the
lateral hemispheres. cerebellar nuclei
fissures. interposed nucleus.
(dentate,
emboliform, globose,
and fastigial).
Cerebellar Lobes
Phylogenetic and functional divisions
Anterior lobe (spinocerebellum)
• lies anterior to the primary fissure.
• receives input from stretch receptors (muscle spindles) and
Golgi tendon organs via the
• spinocerebellar tracts.
• Plays a role in the regulation of muscle tone.

Posterior lobe (neocerebellum)

• lies between the primary fissure and the posterolateral fissure.
• receives input from the neocorteX via the
corticopontocerebellar fibers.
• plays a role in the coordination of voluntary motor activity.

Flocculonodular lobe (vestibulocerebellum)

• consists of the nodulus (of the vermis) and the flocculus.
• receives input from the vestibular system.
• plays a role in the maintenance of posture and balance.
Longitudinal Organization of Cerebellum
associated with specific cerebellar nuclei

Median (vermal) zone

• Projects to the fastigial nucleus.

Paramedian (paravermal) zone

• projects to the interposed nuclei
(emboliform and globose nuclei).

Lateral zone
• projects to the dentate nucleus.
Cerebellar peduncles
Inferior cerebellar peduncle
• connects the cerebellum to the rostral
medulla and caudal pons.
• consists of two divisions:
• a. Restiform body
• an afferent fiber system containing
• (1) Posterior spinocerebellartract
• (2) Cuneocerebellartract
• (3) Olivocerebellartract
• b. Juxtarestiform body
• contains afferent and efferent fibers:
• (1) Vestibulocerebellarfibers
(afferent)
• (2) Cerebellovestibular fibers
(efferent)
Middle cerebellar peduncle
• the largest cerebellar peduncle.
• connects the cerebellum to the pons.
• an afferent fiber system containing
pontocerebellar fibers to the
neocerebellum.
Superior cerebellar peduncle
• connects the cerebellum to the rostral
pons and caudal midbrain.
• the major output pathway from the
cerebellum.
• a. Efferent pathways
• Dentatorubrothalamic tract
• lnterpositorubrothalamic tract
• Fastigiothalamic tract
• Fastigiovestibular tract
• b. Afferent pathways
• Anterior spinocerebellar tract
• Trigeminocerebellar fibers
• Ceruleocerebellar fibers
CEREBELLAR CORTEX
Neurons and Fibers of the cerebellum
Purkinje cell
• conveys the only output from the cerebellar cortex.
• projects inhibitory output (gamma-aminobutyric acid [GABA]) to the
cerebellar and vestibular
• nuclei.
• excited by parallel and climbing fibers.
• inhibited (by GABA) by basket and stellate cells.

Granule cell
• excites (by glutamate) Purkinje, basket, stellate, and Golgi cells Via
parallel fibers.
• inhibited by Golgi cells.
• excited by mossy fibers.

Mossy fibers
• the afferent excitatory fibers of the spinocerebellar and
pontocerebellar tracts.
• terminate as mossy fibers on granule cells.
• excite granule cells to discharge Via their parallel fibers.

Climbing fibers
• the afferent excitatory fibers of the olivocerebellar tract.
• terminate on neurons of the cerebellar nuclei and on dendrites of
Purkinje cells.
Neurons and Fibers of the cerebellum
Purkinje cell
• conveys the only output from the cerebellar cortex.
• projects inhibitory output (gamma-aminobutyric acid [GABA]) to the
cerebellar and vestibular
• nuclei.
• excited by parallel and climbing fibers.
• inhibited (by GABA) by basket and stellate cells.

Granule cell
• excites (by glutamate) Purkinje, basket, stellate, and Golgi cells Via
parallel fibers.
• inhibited by Golgi cells.
• excited by mossy fibers.
Mossy fibers
• the afferent excitatory fibers of the spinocerebellar and
pontocerebellar tracts.
• terminate as mossy fibers on granule cells.
• excite granule cells to discharge Via their parallel fibers.

Climbing fibers
• the afferent excitatory fibers of the olivocerebellar tract.
• terminate on neurons of the cerebellar nuclei and on dendrites of
Purkinje cells.
Major Cerebellar Pathways
Vestibulocerebellar Pathway
plays a role in the maintenance
of posture, balance, and the
coordination of eye
movements.
receives its major input from
the vestibular receptors of the
kinetic and static labyrinths.
Semicircular ducts and otolith organs
• project to the flocculonodular lobe and the vestibular
nuclei.
Flocculonodular lobe
• receives visual input from the superior colliculus and the
striate cortex.
• projects to the vestibular nuclei.
Vestibular nuclei
• project via the medial longitudinal fasciculi to the ocular
motor nuclei of CN 111, CN IV, and CN VI to coordinate
eye movements.
• project via the medial and lateral vestibulospinal tracts
to the spinal cord to regulate neck and antigravity
muscles, respectively.
Major Cerebellar Pathways
Vermal Spinocerebellar Pathway
Vermis

maintains muscle • receives spinocerebellar and labyrinthine input.

• projects to the fastigial nucleus.

tone and postural Fastigial nucleus

• has excitatory output.
control over truncal • projects via the vestibular nuclei to the spinal cord.
• projects to the ventral lateral nucleus of the thalamus.

(axial) and proximal Ventral lateral nucleus of the thalamus

(limb girdle) • receives input from the fastigial nucleus.

• projects to the trunk area of the precentral gyrus.

muscles. Precentral gyrus

• gives rise to the anterior corticospinal tract, which regulates
muscle tone of the truncal and proximal muscles.
Major Cerebellar Pathways
Paravermal Spinocerebellar Pathway
• maintains muscle tone and postural
control over distal muscle groups
lnterposed nuclei (emboliform and
Paravermis
globose)

have excitatory
project to:
receives output.
spinocerebellar input projects to the
from distal muscles. interposed nuclei. Ventral lateral
Red nucleus
nucleus

projects to the extremities

area of the precentral gyrus.
The precentral gyrus gives
rise to the lateral
corticospinal tract, which
regulates distal muscle
groups.
gives rise to the crossed rubrospinal tract, which
mediates control over distal muscles.
receives input from the contralateral nucleus
interpositus and bilateral input from the
motor and premotor cortices.
Major Cerebellar Pathways
Lateral hemispheric cerebellar pathway
Also called the neocerebellar or pontocerebellar pathway

Regulates the initiation, planning, and timing of volitional motor

activity

Cerebellar
hemisphere

projects via Purkinje cell

axons to the dentate
receives input from the contralateral motor
nucleus.
and sensory cortex via the
corticopontocerebellar tract.
Major Cerebellar Pathways
Lateral hemispheric cerebellar pathway
Dentate nucleus

has excitatory output. projects via the superior cerebellar peduncle t0 the contralateral
red nucleus, ventral lateral nucleus of the thalamus, and the
inferior olivary nucleus.

Red nucleus pathway

The red nucleus projects to the inferior olivary nucleus.

The interior olivary nucleus projects via the

contralateral inferior cerebellar peduncle to the
cerebellum.
Major Cerebellar Pathways
Lateral hemispheric cerebellar pathway
Dentate nucleus

Ventral lateral nucleus pathway

The motor and Interior olivary nucleus pathway

The ventral lateral premotor cortices
nucleus of the give rise to the The inferior olivary nucleus receives direct input from the dentate
thalamus projects to following tracts: nucleus via the crossed descending fibers of the superior cerebellar
the motor (4) and peduncle.
premotor (6)
Corticobulbar
cortices.
tract innervates The inferior olivary nucleus projects directly to the dentate nucleus
cranial nerve via the contralateral inferior cerebellar peduncle.
nuclei.

Lateral corticospinal tract regulates volitional synergistic motor activity.

Corticopontocerebellar tracts regulate the output of the neocerebellum.

Cerebellar Dysfunction
(hypotonia, disequilibrium, and dyssynergia)
Hypotonia
• a loss of the resistance normally offered by muscles to palpation or to passive manipulation.
• results from the loss of cerebellar facilitation of the motor cortex via tonic firing of the
cerebellar nuclei.
• results in a floppy, loose-jointed, rag-doll appearance with pendular reflexes

Disequilibrium
• refers to loss of balance, characterized by gait and trunk dystaxia.

Dyssynergia
• Loss of coordinated muscle activity
Dyssynergia

Dysarthria • slurred or scanning speech.

• a lack of coordination in the execution of voluntary

Dystaxia movement (e.g., gait, trunk, leg, and arm dystaxia).

• the inability to arrest muscular movement at the

Dysmetria desired point (past-pointing).

• a type of dysmetria that occurs during a voluntary

Intention tremor movement.
Dyssynergia
• the inability to perform rapid alternating movements
Dysdiadochokinesia (e.g., rapid supination and pronation of the hands).

• a form of dystaxia consisting of to-and-fro eye

Nystagmus movements (ocular dysmetria).

Decomposition of movement • consists of breaking down a smooth muscle act into a

(by-the-numbers phenomenon) number of jerky awkward component parts.

• results from the inability to adjust to changes in muscle tension.

• caused by loss of the cerebellar component of the stretch reflex.
Rebound or lack of check • may be tested for by having the patient flex the forearm at the elbow against resistance;
• sudden release results in the forearm striking the patient’s chest.
Cerebellar Lesions
Anterior Vermis Posterior Vermis Phenytoin (Antiepileptic
Hemispheric Syndrome
Syndrome Syndrome drug) intoxication
• involves the lower • involves the • usually involves one • may cause ataxia,
limb region of the flocculonodular lobe. cerebellar nystagmus, gait
anterior lobe. • usually the result of hemisphere. disturbances, and
• results from atrophy brain tumors in • frequently the result dysarthric speech.
of the rostral children. of a brain tumor or an
vermis—most • most frequently abscess.
commonly caused by caused by • results in arm, leg,
alcohol abuse. medulloblastomas or trunk, and gait
• results in gait, trunk, ependymomas. dystaxia.
and leg dystaxia. • results in truncal • results in cerebellar
dystaxia. signs that are
ipsilateral to the
lesion.
Tumors of the cerebellum

• high mortality rate.

Astrocytomas • low-grade most common in children, high-grade most common in adults.
• after a surgical removal, survival for many years is common.

• most common primary brain tumor in children.

• occur most frequently in the cerebellum.
Medulloblastomas • may obstruct passage of cerebrospinal fluid (CSF) and cause hydrocephalus.
• may disseminate throughout the CSF.

• arise from ependymal cells.

• found intracranially in children and most often in the spinal cord in adults.
Ependymomas • occur most frequently in the fourth ventricle.
• may obstruct passage of CSF and cause hydrocephalus.
Cerebellar Atrophies (inherited disorders)
Friedreich ataxia
the most common hereditary ataxia, with an autosomal recessive mode of
inheritance.
involves the posterior columns, corticospinal tracts, spinocerebellar tracts, and
dentate nuclei.

has the same spinal cord pathology as subacute combined degeneration

frequently associated With chronic myocarditis.

https://youtu.be/JJvAehi8I0s
Cerebellar Atrophies (inherited disorders)
Cerebello-olivary degeneration (Holmes disease)
has an autosomal dominant mode of inheritance.

results in a loss of Purkinje and granule cells, followed by a

loss of neurons in the inferior olivary nuclei.

results in gait ataxia, dysarthria, and intention tremor.

https://youtu.be/oiM0UsFvNOQ
Cerebellar Atrophies (inherited disorders)
Olivopontocerebellar degeneration (Dejerine—Thomas
syndrome)
has an autosomal dominant mode of inheritance.

results in a loss of Purkinje cells, neurons of the inferior olivary nucleus, and neurons in
the pontine nuclei; results in demyelination of the posterior columns and the
spinocerebellar tracts.

frequently results in a loss of neurons in the substantia nigra and basal nuclei.

results in gait ataxia, dysarthria, and intention tremor; may show parkinsonian signs
(rigidity and akinesia).