Cerebellum and Basal Ganglia

Presented by-
Dr. Nashid Islam
Dr. Jheelam Biswas
Dr. Sabikun Naher Urmy

Residents (Phase-A),
Palliative Medicine
BSMMU
Anatomy of Cerebellum

Presented by-
Dr. Nashid Islam
Resident (Phase-A)
Dept. of Palliative Medicine
BSMMU
 Cerebellum
 Latin for ‘little brain’
 Largest part of hindbrain
 Occupies most of posterior cranial fossa lying
on the cerebellar fossa of occipital bone
 Lies behind pons & upper medulla forming
the roof of 4th ventricle
 Separated from posterior part of cerebrum
by tentorium cerebelli
Development
Primary vesicle Primary Division Subdivision Adult structure
Forebrain vesicle Prosencephalon Telencephalon Cerebral hemisphere
, basal ganglia, hipp
ocampus

Diencephalon Thalamus, hypothala

mus, pineal body, inf
undibulum

Midbrain vesicle Mesencephalon Mesencephalon Tectum, tegmentum,

crus cerebri

Hindbrain vesicle Rhombencephalon Metencephalon Pons, Cerebellum

Myelencephalon Medulla oblongata
Development
• Cerebellum is formed from the posterior part of the alar plates of
metencephalon
• On each side, alar plates bend medially to form rhombic lips
• As they enlarge, the lips project caudally over the roof plate of fourth
ventricle & unite with each other in the midline to form cerebellum
• At the 12th week, a small midline portion, the vermis and two lateral
portion, the cerebellar hemispheres, may be recognized
• The neuroblasts derived from matrix cells in the ventricular zone migrate
toward the surface of cerebellum and give rise to neurons forming
cerebellar cortex
Development of Cerebellum
 External Features

 Two cerebellar hemispheres

 Median vermis
 Two surfaces : superior and inferior
 3 fissures:
– Primary fissure (fissura prima)
– Horizontal fissure and
– Posterolateral fissure
 Anatomical Divisions
 Anterior lobe
 Middle or Posterior lobe
 Flocculonodular lobe
Lobes Vermis Hemisphere
Anterior L Lingual No lateral projectio
obe n
Central lobule Alae
Culmen Quadrangular lobu
le
Primary Fissure
Posterior Declive Lobules Simplex
(Middle) L Folium Vermis Superior Semilunar
obe Lobule
Horizontal Fissure
Tuber Vermis Inferior Semilunar l
obule
Pyramid Biventral Lobule
Secondary Fissure
Uvula Tonsil
Postero-lateral Fissure
Flocculo- Nodule Flocculus
nodular L
obe
Arbor vitae cerebelli

• In Latin “ tree of life” it is the white

matter of the white matter of
cerebellum.
• It is so called because of the tree like
appearance.
• It brings sensory and motor
sensation to and from cerebellum.
Cerebellar peduncles

• Superior cerebellar peduncles -

connect to midbrain,
• Middle cerebellar peduncles-
connect to the pons,
• Inferior cerebellar peduncles-
connect to the medulla oblongata.
Functional division of cerebellum
 Functionally the anterior and posterior lobes o
f cerebellum are organized into 3 areas
1. Lateral zone:
connected with association areas of brain and
involved in planning and programming muscular
activities
2. Intermediate zone:
control muscles of hands, fingers feet & toe
3. Vermis:
control muscles of trunk, neck, shoulders and hips
Phylogenetic Subdivisions
Archi-cerebellum (Vestibular part)

• It is formed of the flocculonodular lobe+ adjacent

vermis
• Embryologically, it is the oldest part of cerebellum.
• It receives afferent fibres from vestibular
apparatus of internal ear via vestibulo -cerebellar
tracts.
• It is concerned with equilibrium and eye
movements.
• Lesions of the vestibulocerebellum cause
disturbances of balance and gait
Paleo-cerebellum ( Spinal Part)

• It is formed of midline vermis + surrounding

paravermis.
• It receives afferent proprioceptive
impulses from muscles & tendons via spino-
cerebellartracts (dorsal & ventral)mainly.
• It sends efferents to red nucleus of midbrain.
• it is concerned with muscle tone and
posture.
• Lesions of the spinocerebellum cause
disturbances of muscle tone & posture.
Neo-cerebellum(cerebral part)
• It is the remaining largest part of cerebellum.
• It includes the Lateral parts of cerebellar
hemispheres
• It receives afferent impulses from the cerebral
cortex+ pons via cerebro-ponto- cerebellar
pathway.
• It sends efferents to ventro lateral nucleus of
thalamus.
• It is involved in planning movement and
evaluating sensory information for action.
• It receives input exclusively from the cerebral
cortex
Histological Structure
 Gray mater
– Molecular layer.
– Purkinje cell layer.
– Granule cell layer.
 White mater
– Intrinsic fibers.
– Afferent fibers.
– Efferent fibers
 Gray Matter
 Microscopically composed of three layers:
• Outer molecular
• Middle ,Purkinje cell layer and
• Inner , Granule cell layer
 Contains five types of neurons:
Stellate cells (outer) Molecular
• Basket cell (inner) layer
• Pukinje cell – Purkinje cell layer
• Granule cell &
Granule cell layer
• Golgi cell
 Purkinje cell axons, are the only output from
the cerebellar cortex, to the deep nuclei
Intracerebellar Nuclei

•Dentate nucleus - largest of the cerebellar

nuclei, contains efferent fibers to sup.
Cerebellar peduncle.

•Emboliform nucleus - situated medial to the

dentate nucleus

•Globose nucleus- consists of one or more

rounded cell groups that lie medial to the
emboliform nucleus

•Fastigial nucleus- lies near the midline in

the vermis and close to the roof of the fourth
ventricle
Neuronal Activity & Connections
with Cerebellum

Presented by-
Dr. Jheelam Biswas
Resident (Phase-A)
Dept. of Palliative Medicine
BSMMU
White Matter

• 3 Types of fibers:
– Intrinsic fibers
– Afferent fibers
– Efferent fibers
Intrinsic Fibers

• They remain in the cerebellum

• Do not leave cerebellum
• Pass between cerebellar cortex & vermis
• Also pass from one cerebellar hemisphere to other
Afferent Fibers
• 2 TYPES:
– CLIMBING FIBERS (come
from inferior olivary
nucleus)

– MOSSY FIBERS (all the

other afferent fibers
except the climbing are
called Mossy fibers).
 Efferent Fibers
• Start as axons of Purkinje cells.
• Most of these axons synapse with
deep nuclear cells.
• From deep nuclear cells, efferent
fibers arise  go to different parts of
CNS .
• Only few purkinje fibers bypass deep
nuclear cells  go to vestibular
nuclei (these are from flocculo-
nodular lobe).
Cerebellar Afferent Fibers
From the Cerebral Cortex
• This connection between cerebellum & cerebral hemisphere is important in
control of voluntary movement.
• Information regarding initiation of movement in cerebral cortex is transmitted to
the cerebellum so that movement can be monitored & appropriate adjustment
of muscle activity can be made.
Cerebellar Afferent Fibers From
the Spinal Cord

•Also receive Afferent Fibers From the vestibular nerve,

red nucleus and tectum
• Anterior spinocerebellar tract:
– conveys informatiom from muscle & joint of upper & lower limbs
• Posterior spinocerebellar tract:
– conveys information from muscle & joint of trunk & lower limbs.
• Cuneocerebellar tract:
– conveys information from muscle & joint of upper limb & upper part of
thorax.
The Efferent Cerebellar Pathways
• Globose-emboliform-rubral and Dentothalamic tracts:
- Influences ipsilateral motor activity
• Fastigial vestibular tract:
- Influences ipsilateral extensor muscle tone
• Fastigial reticular tract:
- Influences ipsilateral muscle tone.
Blood Supply
• Superior cerebellar artery-
-branch of basilar artery, supplies the sup
erior surface
• Anterior inferior cerebellar artery-
-Branch of basilar artery, supplies anterior
and inferior parts
• Posterior inferior cerebellar artery-
-Largest branch of vertebral artery, supply
inferior surface of vermis, central
nuclei of cerebellum, undersurface of
cerebellum
Functions of the cerebellum
1) CONTROL OF TONE & POSTURE:
Mainly function of Spinocerebellum(Pyramid of the vermis and the adjacent
medial portion of the hemisphre.

(2) CONTROL OF EQUILIBRIUM:

Mainly function of Vestibulocerebellum (Flocculonodular lobe and nodule of
the vermis)

(3) PLANNING AND CONTROL OF VOLUNTARY MOVEMENT:

is chiefly done by neocerebellum(Lateral portion of cerebellar hemisphere).

(4) LEARNING NEW SKILLED VOLUNTARY MOVEMENTS

Clinical Aspects
Common causes of cerebellar dysfunction

• Vascular disorders such as thrombosis of the cerebellar arteries

• Infections(abscess from otitis media, HIV)
• Drugs(phenytoin and carbamazepine)
• Toxins(CO poisoning, solvent abuse, lead poisoning)
• Alcohol
• Demyelinating(MS)
• Injury to head
• Neoplastic(haemangioblastoma,medulloblastoma etc.)
• Developmental- Congenital agenesis / Hypoplasia
 Cerebellar dysfunction
• Mainly two basic defects:
--Hypotonia
-- Loss of influence of the cerebellum on the activities of the cerebral
cortex.

• Symptoms associated with cerebellar lesions are expressed ipsilaterally .

Signs of Cerebellar Dysfunction

• Hypotonia: The muscle lose resilience to palpation.

• Postural Changes & Alteration of Gait: The head is often rotated & flexed, and t
he shoulder on the side of lesion is lower than on the normal side. Stance is wid
e based & when he walks , he lurches & staggers toward the affected side.

• Disturbances of Voluntary Movement:

 Ataxia
 Intention Tremor
 Decomposition of movement
 Dysmetria/ Past-pointing
 Signs of Cerebellar Dysfunction

• Dysdiadochokinesia: Inability to perform alternating movements regularly

& rapidly.
• Disturbances of Reflexes: Because of loss of influence on the stretch reflexe
s, the movement continues as a series of flexion & extension (Pendular knee
jerk)
• Disturbances of Ocular Movement: Nystagmus
• Disorders of Speech: Dysatrhria because of ataxia of the muscles of the
larynx.
Signs of Cerebellar Dysfunction
Vermis Syndrome
• Trunkal Ataxia
• A wide base when standing
• Tendency to fall backward / forward
• Difficulty to hold head in upright position(Titubation)
• Drunken/Ataxic Gait
Cerebellar Hemispheric Syndrome

– Movements of the limb specially the arms are disturbed

– Swaying & falling to the side of the lesion

– Dysarthria

– Nystagmus

– Delay in initiating movements

– Inability to move all limb segments together

Clinical Tests of Cerebellar Dysfunction

 Head:  Upper limb: Lower limb:

Tone
- Nodding (titubation)  Intention tremor
Coordination
 Eye:  Tone
(Heel Shin
- Nystagmus  Finger nose test
test)
 Mouth:  Disdiadochokinesia Pendular jerk

- Scanning speech  Rebound Gait

phenomenon Tandem gait
Basal Ganglia

Presented by-
Dr. Sabikun Naher Urmy
Resident (Phase-A)
Dept. of Palliative Medicine
BSMMU
 Basal Ganglia

• - The term basal nuclei or basal ganglia is applied to a collection of masses

of gray matter situated within each cerebral hemisphere.
• - The term basal has been used in the past to denote the position of the
nuclei at the base of the forebrain.
• - Develops from Telencephalon.
 Components

1. CORPUS STRIATUM
a) CAUDATE NUCLEUS
b) LENTIFORM NUCLEUS
- PUTAMEN
- GLOBUS PALLIDUS

2. CLAUSTRUM
3. AMYGDALOID BODY (archistriatum)

The subthalamic nuclei, the substantia nig

ra are considered as functional compon
ents.
Caudate nucleus

• - Highly curved, C- shaped

band of grey matter.
• - Consists of Head, body & Tail.
• - Almost completely separated
from lenticular nucleus by
internal capsule.
• - It’s tail terminates anteriorly
in the amygdaloid body.
Lentiform Nucleus
• Wedge-shaped mass of grey
matter with broad convex base
directed laterally.
• Divided into 2 parts by
external lamina of white
matter:
-Putamen (outer darker portion)
-Globus Pallidus (inner lighter)
 Amygdaloid Nucleus

• Situated in the temporal lobe close

to the uncus.
• Considered to be part of limbic system.
• Through its connections, it can influence
body`s response to environmental change.
Claustrum

• Claustrum is a thin sheet of gray matter that is s

eparated from the lateral surface of the
lentiform nucleus by the external capsule.
• Lateral to claustrum is subcortical white matter
is insula.
• Function is unknown.
 Sub Thalamic Nucleus

• Biconvex mass of grey matter

caudal to the lateral half of
thalamus & inferomedial to
globus pallidus.
 Substantia Nigra

• It is a curved pigmented band

of grey matter situated between
tegmentum & crus cerebri.
• Contains melanin.
• Divided into 2 parts:
• a) Pars compacta – Dorsal part;
contains dopaminergic (75%) &
cholinergic(25%) neurons.
• b) Pars reticularis Ventral Part.
Connections of the Basal Ganglia

• Main input – To Corpus Striatum ( Caudate Nucleus & Putamen)

• Main Output – From Globus Pallidus.
Connections of Corpus striatum
Afferent Efferent

Corticostriate Striatopallidal

Thalamostriate Striatonigral

Nigrostriate

Brainstem striatal fibres

Connections of the Corpus striatum
Corticostriate Fibers ( most projections are from cortex of same side)
• Primary motor area : Bilateral Putamen
• Premotor area: Ipsilateral Caudate Nucleus and Putamen
• Prefrontal cortex: Ipsilateral Caudate Nucleus
• Neurotransmitter: Glutamate
Connections of the Corpus striatum
• Thalamostriate Fibers
Intra laminar Thalamic nucleus to Striatum

• Nigrostriate Fibers (inhibitory)

Pars compacta of Substancia nigra to Striatum
Neurotransmitter: Dopamin

• Brainstem Striatal Fibers (inhibitory)

Mainly from Dorsal Nucleus of Raphe
Neurotransmitter : Serotonin
Afferent Fibers
 Connections of Globus pallidus
Afferent Efferent

Striatopallidal Ansa lenticularis

Fasciculus lenticularis

Pallidotegmental

Pallidosubthalamic
Connections of the Globus pallidus
• Striatopallidal Fibers
Pass to Globus pallidus
Neurotransmitter: GABA
• Striatonigral Fibers
Pass to Pars reticulata of Substantia nigra
Neurotransmitter: GABA, Acetylcholine,
Substance P
Connections of the Globus pallidus

• Pallidofugal fibres
• Ansa lenticularis (thalamic nuclei)

• Fasciculus lenticularis (subthalamus)

• Pallidotegmental (caudal tegmentum; midbrain)

• Pallidosubthalamic (subthalamic nuclei)

Connections of the Globus pallidus
 Function of basal ganglia: Mechanism

• Basically, corpus striatum receives afferent

information from cerebral cortex, thalamus,
subthalamus, brainstem, suntantia nigra.

• The information is integrated within corpus

Striatum and the outflow passes back to area
listed above is channeled through the globus
pallidus.
• The outflow then influences activities of motor
area of cerebral cortex or other motor center
in brainstem.
• Thus, the basal ganglia control muscular
movement by influencing cerebral cortex and
have no direct control through decending
Pathway to brainstem and spinal cord.
 Functions of Basal Ganglia

• Voluntary movement
– Initiation of movement
– Control of ramp movement
– Change from one pattern to other
– Timing & scaling of intensity of movements
– Programming and correcting movement while in progress
• Postural control
– Automatic associated movement (walking, swimming)
• Control of muscle tone
 Disorders of Basal Ganglia
Hyperkinetic disorders Hypokinetic disorders

Chorea Parkinson’s Disease

Athetosis

Ballism
Chorea

 Rapid , jerky involuntary

movements , nonrepititive.
 Swift grimaces and sudden
movements of the head or
limbs
 Due to damage to caudate
Nucleus
 Athetosis

 Slow, sinuous, writhing

movements of the extremities.
 Mainly fingers & wrist.
 Due to damage to Putamen.
Ballism
 Involves the proximal extremity musculature and the limb suddenly flies
about out of control in all directions.
 Due to damage of subthalamic Nucleus.
Parkinson Disease

 Progressive disease of unknown cause

with neuronal degenaration in the substantia nigra
and to a lesser extent, in the globus pallidus,
putamen and caudate nucleus.
 Characteristic signs and symptoms:
a) Tremor b) Rigidity c) Bradykinesia
d) Postural disturbance
e) No loss of muscle power & sensibility.