NAME: Chico, James Knowell E.

BLOCK; 7

University of Cebu School of Medicine

Department of Physiology

Individual Learning Output

Case 2

A 34-year-old woman with a long-standing history of seizure disorder presents to her

neurologist with difficulty walking and coordination. She has been on phenytoin for several
days after having been switched from valproic acid. She states she has had an acute change in
gait, unclear speech, blurring of vision, tremor with movement, and loss of hand coordination.
She has never had symptoms like this before. She denies headache and vertigo or any other
complaints. On examination, she has an unstable gait and poor hand-eye coordination. She is
noted to have nystagmus along with a fine tremor of the hand when she is moving it. A urine
drug screen is negative. She has a computed tomography (CT) scan and lumbar puncture, which
are both normal. Phenytoin levels are slightly elevated. She is diagnosed with cerebellar ataxia,
probably as a side effect of phenytoin.

A. What is cerebellar ataxia? What can cause cerebellar ataxia?

Cerebellar ataxia is a form of ataxia, defined as a loss of muscle coordination,
originating in the cerebellum. The etiology of cerebellar ataxia may be:
 Genetic (inherited diseases)
 Congenital (present at birth)
 Viral or bacterial infections
 Due to drugs or alcohol
 Brain tumors
 Strokes
 Injuries
Symptoms may include:
 unsteady gait or movements
 dysarthria (difficulty in pronouncing words)
 headache and dizziness
 nausea and vomiting
 nystagmus (uncoordinated eye movements)
B. Which part of the cerebellum is responsible for planning and initiation of movement?
Cerebrocerebellum. Also known as neocerebellum, it is the lateral part of the
cerebellar hemisphere it receives input solely from the cerebral cortex. It projects by the
way of the dentate nucleus and ventrolateral nucleus of the thalamus to cerebral
cortical areas involved in motor control. Function-wise, it helps in planning complex
motor actions and consciously assessing errors in movement.

C. Describe the general organization and functions of the cerebellum in a concept map.
D. Describe the cellular organization of the cerebellar cortex.
As mentioned in the concept map above, the cerebellar cortex contains an
enormous number of neurons, but it is composed of only three layers (external
molecular, Purkinje cell, and internal granular) and five types of neurons and five types
of neurons (Purkinje, granule, basket, stellate, and Golgi II).
1. Molecular layer – outermost, composed mainly of axons & dendrites of
neurons in the cortical layers
- contains two types of neurons: stellate and basket cells which serve
as inhibitory interneurons
- both are small neurons whose processes are confined to the
molecular layer
2. Purkinje cell layer – middle layer of a single row of large flask-shaped cells,
called Purkinje cells
- among the largest neurons of the CNS
- possess numerous dendrites that branch in fanlike manner towards
the molecular layer
- axons arise on the opposite side; acquire myelin sheaths in the white
matter and terminate in the deep cerebellar nuclei
- cells are strongly excited by climbing fibers
o from the inferior olivary nuclei; less numerous
o each action potential in a climbing fiber causes each
postsynaptic Purkinje cell to reach action potential threshold
simultaneously in the soma and dendrites (generating a
complex spike)
3. Granular layer – innermost layer composed of densely packed small neurons:
granule and Golgi II cells
- Granule cells – with short claw-like dendrites
o their axons go into the molecular layer; each axon divides into
two branches which run parallel to long axis of folia – thus
called parallel fibers
o parallel fibers enable granule cells to synapse with numerous
Purkinje fibers in a row
o excited by mossy fibers, which provide weak excitatory input
to many Purkinje cells through parallel fibers
- Golgi II cells – small neurons that serve as inhibitory interneurons