NEURO LECTURE NOTES – CEREBELLUM - Separates the anterior from the

posterior
Cerebellum or “Little Brain”
- Once thought to be simply for motor Tonsilar Herniation
coordination - When tonsils are pushed towards the
- Takes 11% of the brain’s mass foramen magnum and will press on the
- Contains about half of all neurons in the medulla
brain
- Located in the posteroinferior side of Superior Cerebellar Peduncle
the cerebrum - Connects the midbrain to the
- Thalamus -> midbrain -> two cerebellar cerebellum
hemispheres
- Primary fissure: divides cerebellum to Superior medullary velum
anterior and posterior - Contains glial tissues
- Vermis: divides cerebellum to right and
left Inferior cerebellar velum
Tentorium Cerebelli - Formed by pile tissue which contains
- Separates the cerebrum from the the choroid plexus
cerebellum

When there is swelling on the tonsils (at the

inferior part of the cerebellum), it will also put
pressure on the medulla (which is responsible
for respiration and consciousness)

Posterolateral fissure
- First one to develop during embryonic
development
- Separates the flocculonodular lobe

Cerebellar Nuclei Mnemonics (lateral to medial)

Primary fissure Don’t – Dentate nucleus
Eat – Emboliform nucleus
Greasy – Globose nucleus Cavity of 4th ventricle
Food – Fastigial nucleus (for postural reactions) - Between brainstem and cerebellum

Nucleus Interpositus: Emboliform + Globose Cerebellum

- At the posterior cranial fossa
LECTURE: - Ovoid in shape
Functions of the Cerebellum - Convolutions of cerebellum (folia)
- Unconscious control of posture and - Depressions in between the folia
voluntary movements (sulcus/fissures)
- Influences the smooth contraction of - Arbor vitae (tree of life)
voluntary muscles and carefully
coordinates their actions with
relaxation of the antagonists
- Movements do not start from the
cerebellum but it is actually modifying
your movements (which comes from
the corticospinal tract)
- Controls movements on the same side Cerebellum can be divided into 3 parts
of the body vertically:
- Does not have direct contact to the - Right and left cerebellar hemispheres
lower motor neuron but exerts its - Midline area (vermis)
control via the cerebral cortex and
brainstem
- Lower motor neuron: is the anterior
horn cell, peripheral nerve, myoneural
junction
Cerebellum can be divided into 3 parts - Also called the neocerebellum or
horizontally: corticocerebellum
- Anterior/Superior lobe - Majority of the outputs go to the
- Middle/posterior lobe cerebral cortex
- Flocculonodular lobe
Two important fissure separating it: 3 cerebellar peduncles:
- Primary fissure (separating anterior - Superior Cerebellar Peduncle (Brachium
from posterior lobe) Conjunctivum): connects midbrain to
- Uvulonodular fissure (separating the cerebellum
middle lobe from flocculonodular lobe) - Middle Cerebellar Peduncle (Brachium
Cerebellar tonsils Pontis): connects pons to cerebellum
- Eto yung bumabagak or nagcocompress - Inferior Cerebellar Peduncle (Restiform
sa foramen magnum Body): connects the medulla to the
cerebellum
Horizontal fissure
- Divides the cerebellum into an anterior Outer portion of the cerebellum is gray
and posterior surface (neurons) while the inner is white (nerve fibers)
matter
Flocculonodular lobe
- Oldest part of cerebellum
- Also called the vestibulocerebellum or
archicerebellum
- For balance reactions
- Outputs go to the vestibular nucleus
- In animals, they have a well developed
archicerebellum
Anterior lobe or Vermis
- Also called paleocerebellum or
spinocerebellum
- Outputs go to spinal cord
Posterior lobe
Cells of the Cerebellum; The gray portion or  Granular cells (only cell whose
cerebellar cortex contains 3 layers (from outside axons go towards the molecular
going inside): layer; once it reaches the
1. Molecular Layer molecular layer, it forms a T-
 Stellate cells fiber so that whatever impulse
 Basket cells it receives, it actually sends it to
2. Purkinje Layer different cells)
 Purkinje cells (functional unit of  Golgi Type II cells
cerebellum; all the outputs of
the cerebellum will come from
this cell; inhibitory in nature) Functional Areas of the Cerebellum:
 The purkinje cells, from the 1. Vermis (midline area)
purkinje layer, will go now to  In control of the head, neck,
the deep cerebellar nuclei trunk
 Output of cerebellum: from  Movement of the long axis of
cerebellar cortex -> deep nuclei the body (neck, shoulders,
-> going to either cerebrum or thorax, abdomen, hips)
spinal cord but the axons will 2. Intermediate Zone (just lateral to
either pass through the vermis)
superior or inferior cerebellar  Also called Paravermis
peduncles  Movement of the hands and
3. Granular Layer feet
3. Lateral Zone (most lateral part)
 Planning of sequential
movements
 Assessment of movement
errors

Intracerebellar Nuclei:
1. Cerebellar Nuclei
 Large, multipolar neurons with
simple branching dendrites
  Axons form the outflow fibers
to pass via SUPERIOR and
INFERIOR CEREBELLAR
PEDUNCLE

White Matter of the Cerebellum:

1. Intrinsic Fibers
 Nerve fibers which connect the
different lobes of the
cerebellum
connect with the lateral
 Internal to cerebellum
vestibular nucleus
2. Afferent Fibers
 Most enter via the Middle and
Cerebellar Cortical Mechanisms
Inferior CP
1. Climbing Fibers

 Will only come from the
3. Efferent Fibers
olivocerebellar tract (from
 Pass through either the
inferior olives; bag-shaped
Superior or Inferior CP
nucleus in the medulla)
 Coming from the different parts
 1 purkinje cell connects with
of the nervous system going to
only one climbing fiber
the cerebellum
 1 climbing fiber connects to 1-
 Originates from the purkinje
10 purkinje neuron
cell
 Few side branches of the
 To the dentate, emboliform and
climbing fibers synapse with
globose nucleus -> lalabas sa
stellate and basket cells
Superior CP
 Also sends a branch to the deep
 To the fastigial nucleus ->
cerebellar nuclei
lalabas sa Inferior CP
2. Mossy fibers
 Some purkinje cell from
 Spinocerebellar tracts will
flocculonodular lobe and vermis
become this fiber
bypass the deep cerebellar
 Attaches to the granule cells
nuclei without synapsing to
  Diffuse effect via the granule
cells
 Granule cells will send its axons
towards the molecular layer to
become a T-fiber
 It now affects the different cells
in the molecular layer
All the cells in the cerebellum are excitatory
except for the purkinje cells
If may pinasok na output either sa climbing fiber
or mossy fiber, it will alert the deep nuclei
Deep nuclei modifies the cells that pass through
it
Cerebellar Cortical Mechanisms cont.
 The stellate, basket and golgi cells are
inhibitory interneurons which limit the
area of the cortex which gets excited. It
also influences the degree of purkinje
cell excitation by climbing and mossy
fiber inputs
 Fluctuating inhibitory impulses
transmitted by the purkinje cells to the
intracerebellar nuclei which in turn
modify muscular activity through the
motor control areas of the brainstem
and cerebral cortex
 All of the neurons will use glutamate
except purkinje cells (releases GABA
since it is inhibitory)
Intracerebellar Nuclear Mechanisms
Deep Cerebellar Nuclei Afferents
- Receives inhibitory axons from purkinje
cells
- Receives excitatory axons from Climbing
and Mossy fibers
A give sensory input to the cerebellum sends
excitatory information to the nuclei, which a
short time later receive cortically processed
inhibitory information from the Purkinje cells.
Efferent information from the deep cerebellar
nuclei leaves the cerebellum to be distributed
to the remainder of the brain and spinal cord.
CEREBELLAR AFFERENTS
are
From the Cerebral Cortex
1. Corticopontocerebellar pathway
  Cortex -> pons -> cerebellum
 Purely decussation
 spindles, tendon organs, joint
2. Cerebroolivocerebellar pathway
(climbing)
 Cerebrum -> olives
cerebellum
 Becomes the climbing fibers
 Inferior CP
3. Cerebroreticulocerebellar pathway
 Cortex -> reticular formation ->
cerebellum
 Middle and inferior CP
*All of these are for control of voluntary
movement – monitoring and adjusting muscle
activity
*All will become mossy fiber except for
cerebroolivocerebellar
From the Spinal Cord
1. Anterior Spinocerebellar tract
 Ipsilateral and crossed fiber
 Convey muscle joint
information from the muscle
receptors of UE and LE
 Double decussation; decussates
-> at level of spinal cord then it
will decussate again at SCP
2. Posterior Spinocerebellar tract
 Ipsilateral fiber
 Proprioception of lower trunk
& LE
3. Cuneocerebellar tract
 From nucleus cuneatus to
cerebellum
 Ipsilateral fiber
 Proprioception of upper thorax
and UE
From the Vestibular Nerve
1. Inner ear receptors
 Semicircular canal – detects
motion
 Utricle/saccule – perceives
position relative to gravity
2. Vestibular afferents
 Go directly to the cerebellum
via ICP
 Or pass through inputs from the
vestibular nuclei in the
brainstem, then ICP
  Vestibular nucleus: inferior,
superior, medial and lateral
vestibular nucleus
*Afferents from inner ear end as mossy fibers in
the flocculonodular lobe (vestibulocerebellar).
*Other afferents come from the Red Nucleus
and Tectum
CEREBELLAR EFFERENTS: (cerebellar cortex ->
deep nuclei)
Globose-Emboliform Rubral
- Influences ipsilateral motor activity
- Globose-Emboliform nucleus -> red
nucleus of the opposite side
- From red nucleus, you have the
rubrospinal tracts
- From R deep nuclei to L red nucleus
then from the red nucleus to the
opposite spinal cord
- R cerebellum controls R side of the
body
Dentatothalamic
- Influences ipsilateral motor activity
- Dentate nucleus -> thalamus on the
opposite side -> nerve fibers will send
inputs to the parietal lobe
- Response: corticospinal tract which will
cross in the medulla going to the
opposite side
- R side of cerebellum control movement
of the R side of the body
Fastigial Vestibular pathway
- Influences ipsilateral extensor muscle
tone
- Fastigial nucleus -> ipsilateral vestibular
nucleus -> vestibulospinal tract also on
the same side
Fastigial Reticular pathway
- Influences ipsilateral muscle tone
- Fastigial nucleus -> reticular formation
on same side & on opposite side
- It has both ipsilateral (majority) and
contralateral control

*Tectocerebellar tract – sight
*Vestibular nuclei – balance
*Cerebral cortex, muscles, tendons & joints –
voluntary movement
All of these inputs will become either a mossy
or climbing fiber
*Once the cerebellum is alerted, it processes
the information ad the output is through the
Purkinje cells
*The Purkinje Cell output will either go directly
to the lateral vestibular nucleus or go to the
deep nuclei
*The outputs:
 From the lateral part of the cerebellum
will go to the Dentate nucleus
 From the vermis will go to the Fastigial
nucleus
 From the intermediate will go to the
Globose Emboliform nucleus
Purkinje Axons
- Inhibitory influence on deep cerebellar
nuclei and lateral vestibular nuclei
Main functions of the Cerebellum
- Influences motor activity to take place
smoothly with precision and economy
of effort
- Coordinates precision movement by
continually comparing the output of the
motor cortex with proprioceptive input
thereby making fine adjustments to the
movement
- Gradates and harmonizes muscle tone
and maintains muscle posture
- Has no direct connection with the lower
motor neuron
- Controls the timing and sequence of
firing of the alpha and gamma motor
neurons
- Cerebellum is able to send back
information to the motor cerebral
cortex to inhibit the agonist muscles
and stimulate the antagonist, thus
limiting the extent of voluntary
movement
Cortex is the command center -> sends input to
the cerebellum -> cerebellum will have
feedback to the cerebrum to stimulate the
muscles (muscles also send input to the
cerebellum for feedback but not for movement)
1. Superior cerebellar artery
2. Anterior inferior cerebellar artery
3. Pontine arteries
4. Labyrinthine artery
5. Posterior cerebellar artery

*PICA, AICA & SCA come from the

vertebrobasilar system

SIGNS AND SYMPTOMS OF CEREBELLAR

DISEASE
Hypotonia
- Decrease in muscle tone

Postural changes and alteration of gait

BLOOD SUPPLY OF THE CEREBELLUM
Comes from the branches of the Vertebral
Artery:
1. Meningeal branches
2. Posterior spinal artery
3. Anterior spinal artery
4. Posterior inferior cerebellar artery
5. Medullary artery
Branches of Basilar Artery
- Head is rotated and flexed to the side fo
the lesion
- Shoulder on the side of the lesion is
lower than the normal side
- Wide base of support and gait
- Stiff-legged
- Lurching and staggering toward the
affected side
- Testing for the vermis portion of the
cerebellum
Disturbances of Voluntary Movement
- Ataxia: loss of coordination or control
(not because of weakness)
- Intention tremor: whenever they move
the hands, there is a tremor
 - Decomposition of movement: Disorder of Speech
movement of pt is not smooth - Speech is explosive, articulation is jerky,
- Dysmetria (difficulty in doing syllables are separated from one
movement) manifested either another and is slurred
hypometria, hypermetria (finger to nose
test, heel-shin-knee test)

Dysdiadochokinesia VERMIS SYNDROME

- Alternate pronation-supination test  D/t a tumor called medulloblastoma of
the vermis in children
Dysdiadochokinesia & Dysmetria  Flocculonodular lobe: vestibular
- We are testing the cerebellar symptoms (nausea, vomitting, dizzy,
hemispheres nystagmus)
- The functional area of the hemispheres  Muscle incoordination of the head and
is related to the limb movements neck
 Tendency to fall forward or backward
Disturbances of Reflexes  Difficulty holding the head steady and in
- Pendular knee jerk upright position
- When there is cerebellar lesion, knee  Difficulty in holding the trunk erect
jerk moves like a pendulum and is non
stop CEREBELLAR HEMISPHERE SYNDROME
 S/Sx on the same side of the lesion
Disturbance of Ocular Movement  Movement of the limbs are disturbed
- Nystagmus: tremors of the eyes  Swaying and falling to the same side of
the lesion
 Dysarthria and nystagmus
 Lateral hemisphere
 Delays in initiating movements
 Inability to move all limb
segments together in a
coordinated manner
  Tendency to move one joint at - Paleocerebellum: posture and muscle
a time tone
- Neocerebellum: for coordination
COMMON DISEASES INVOLVING THE Functional
CEREBELLUM - Vestibulocerebellum
1. Acute Alcohol Poisoning - Spinocerebellum
 Wide-based gait - Cerebrocerebellum
 Moving side to side Anatomic
2. Cerebellar - Flocculonodular lobes
 Congenital agenesis, Hypoplasia - Vermis & anterior lobe
(inborn) - Cerebellar hemispheres & posteriorlobe
 Trauma Nuclei (from medial to lateral)
 Multiple sclerosis (affectation of - Fastigial
oligodendrocytes causing - Globose
demyelination) - Emboliform
 Vascular disorders - Dentate
 Poisoning with heavy metals
Inverted man (homunculus of cerebellum)
3. Main manifestations of Cerebellar
Diseases Signs and symptoms:
 Hypotonia Balance and equilibrium
 Loss of influence of the Coordination
cerebellum on the activities of - Can have ataxia (no coordination)
the cerebral cortex - Cerebellar ataxia: affectation of the
cerebellum; with or w/o the use of
SGD NOTES CEREBELLUM: vision
Question #1 - Sensory ataxia: affectation of
- Cerebellar hemispheres are affected proprioception d/t DCML; w/o the
vision or pagtingin sa floor, panget yung
Phylogenetic lakad ni pt
- Archicerebellum/vestibulocerebellum:
balance, equilibrium, eye movements
Upper motor lesions – hyperreflexia or Nucleus propious
hypertonic - Conscious proprioception
Clark’s column (cerebellum)
*In cerebellum it will manifest hypotonia Unconscious proprioception
because:
 hypertonicity usually results from a
problem from coricospinal tract but it
doesn’t go to the cerebellum
 cerebellum is only for refinement of
movement. The one that will act as the
leader of the movement comes from
cerebrum
 If you have problem in cerebrum =
hyperreflexia and hypertonicity because
of renshaw cells
 walang corticospinal that pass through
the cerebellum which is why it results to
hypotonicity

Renshaw cells
- Responsible in sending impulses in the
spinal cord

Question #2
Globose and emboliform = interposed nuclei

Cerebellar Peduncles
- Connects the cerebellum to the
brainstem and to the outside of the
cerebellum

Question #3