Cerebellum and Basal Ganglia

David Roman Renner, MD

Suzanne Stensaas, PhD
2009 Kenya Curriculum
 BG

CBLM

Courtesy of Stephen C. Voron, MD

 BG

CBLM

Courtesy of Stephen C. Voron, MD

 pyramidal cell
in the motor
homunculus
of the frontal
BG lobe

CBLM

Courtesy of Stephen C. Voron, MD

 corticospinal
tract

BG

CBLM

Courtesy of Stephen C. Voron, MD

 BG

CBLM
decusation at
the pyramids
(spino-
medullary
junction

Courtesy of Stephen C. Voron, MD

 thalamus:
AKA the
“gate keeper”
prevents
unwanted
BG movements
T

CBLM

Courtesy of Stephen C. Voron, MD

 BASAL
GANGLIA

consultant on
BG automatic
T movements

provides
CBLM input into the
thalamus

Courtesy of Stephen C. Voron, MD

 Cerebellum:

consultant on
rapid
BG movements

provides
input into the
CBLM thalamus

Courtesy of Stephen C. Voron, MD

Basal Ganglia Cerebellum

• resting tremor • intention tremor

• postural instability • dysmetria
• festination • dysdiadochokinesia
• rigidity • hypotonia
• masked facies • heal to shin
• bradykinesia • finger to nose
• dyskinesia • rebound
• torticollis • ataxic gait
• chorea • titubation
• athetosis • nystagmus
• hemiballismus • dysmetric saccades
• akathisia
Basal ganglia lesions produce
contralateral signs.

Cerebellar lesions produce

ipsilateral signs.
Most movement disorders produced by
cerebellar and basal ganglia pathology
disappear during sleep.

Cerebellar and basal ganglia signs are

usually not present if the corticospinal tract
is damaged.
The cerebellum is the great comparator:

1. It compares cortical willful command

with muscle tension, joint position, &
tone (via ipsilateral spinocerebellar tracts)
2. Advises the cortex on how much,
how many, how fast
3. The motor cortex sends the revised
command down the corticospinal
tract
The BASAL GANGLIA are the autopilot

for procedural movements.

The CEREBELLUM is the refiner of

finely controlled movements
(particularly of fingers).
COMPARISON OF MOTOR SYSTEMS
http://library.med.utah.edu/neurologicexam/html/home_exam.html
Lower Motor Neuron Upper Motor Neuron Cerebellum Basal Ganglia
Spinal Cord Corticospinal Tract
Normal
Efferent part of Voluntary movement Rapid coordinated alternating Facilitates intentional
monosynaptic reflex skilled movements that are movements and inhibit
learned extraneous movements
Muscle tone by Muscle tone Eye-head movements Autopilot for motor activities
inhibiting antagonists
Maintains muscle Fine control, espec. finger Posture and Gait
fibers (trophic factors) flexors
Inhibitory to Lower motor Balance, equilibrium, Voluntary movements in an
neurons orientation in space automatic manor.
Weakness or paralysis Weakness or paralysis timing, duration, and amplitude
Abnormal
Areflexia Hyperreflexia Truncal ataxia, gait ataxia Shuffling or festinating gait,
Hyperactive deep tendon small steps, hard to turn
reflexes
Fasciculation Babinski- extensor plantar Nystagmus, Dizziness, Masked facies, few blinks
reflex
Muscle Atrophy Spasticity Decomposition of movement Difficulty turning or starting,
hypokinetic = bradykinesia
Flaccid paralysis Dysmetria- ataxia of arms Paucity of associated
movements
Dysynergia
Dysdiadochokinesia- inability Chorea, athetosis,
to do rapid alternating hyperkinetic
movements
Hypotonia- pendular reflexes Rigidity ( lead-pipe )
(cogwheel),
Intention tremor Resting tremor
Scanning speech Soft speech
Courtesy of Stephen C. Voron, MD