CEREBELLUM

Some Terminologies
White matter : myelinated fibre tracts Gray matter : areas of neuronal cell bodies Tracts : collections of axons subserving similar function or location in CNS Nerves : peripheral axons Nucleus : collection of neurons subserving similar function in CNS e.g., caudate nucleus, red nuclei Brainstem: Midbrain (Mesencephalon) + Pons + Medulla Oblongata

Folia : Leaves Vermis: Worm

Brain components

Table 5.3 (1) Page 144

Cerebral cortex
Basal nuclei (lateral to thalamus)

Cerebral cortex

Basal nuclei Thalamus (medial) Thalamus

Diencephalon Hypothalamus
Hypothalamus

Cerebellum
Cerebellum Midbrain
(Mesencephalon)

Brain stem

Pons Medulla oblongata Spinal cord

Brain stem (midbrain, pons, and medulla)

THE CEREBELLUM

Located dorsal to the pons and medulla Makes up 11% of the brains mass Cerebellar activity occurs subconsciously Provides precise timing and appropriate patterns of skeletal muscle contraction
Programming ballistic movements

Acts as comparator for movements

Comparing intended and actual movement

Correction of ongoing movements

Internal & external feedback Deviations from intended movement

Motor learning Shift from conscious ---> unconscious

Anatomy of the Cerebellum

2 symmetrical hemispheres connected medially by the Vermis
Folia: Transversely oriented gyri 3 lobes in each hemisphere: Anterior, Posterior, Flocculonodular (FN)

Neural arrangement: Gray matter (Cortex), White matter (Internal), Scattered cerebellar nuclei: dentate, globose, emboliform, fastigial
Arbor vitae (tree of life): distinctive treelike pattern of the white matter
Folium

Cerebellum
Primary fissure

Anterior Lobe
Regulation of muscle tone, coordination of skilled voluntary movement

Posterior Lobe

Planning and initiation of voluntary activity

Flocculo-Nodular Lobe (FN lobe)

Maintenance of balance, control of eye movements

Vestibulocerebellum Spinocerebellum

Folia

Cerebrocerebelum

Cerebellum
Intermediate part

Lateral part

CEREBELLUM: THE STRUCTURE

Inputs to the cerebellar cortex: Climbing fibers & Mossy fibers Climbing fibers: originate in the inferior olive of the medulla Mossy fibers: originate in all the cerebellar afferent tracts apart from inferior olive Purkinje cells: The final output of the cerebellar cortex
3 Layered Cerebellar Cortex

Cerebellum: 3 layered cortex

Climbing fibers: excite the Purkinje cells Mossy fibers: excite the granule cells Granule cells: make excitatory contact with the Purkinje cells Purkinje cells: Tonic inhibition on the activity of the neurons of the cerebellar nuclei => All excitatory inputs will be converted to the inhibition => Removing the excitatory influence of the cerebellar inputs (erasing)

Cerebellar Peduncles
Three paired fiber tracts connect the cerebellum to the brainstem:

Superior peduncles connect the cerebellum to the midbrain;

Middle peduncles connect the cerebellum to the pons and to the axis of the brainstem; Inferior peduncles connect the cerebellum to the medulla.

Cerebellar Peduncles

Cerebellar Peduncles
Superior peduncles (to the midbrain): Fibers originate from neurons in the deep cerebellar nuclei & communicates with the motor cortex via the midbrain and the diencephalon (thalamus)

Middle peduncles (to the pons):

Cerebellum receives information advising it of voluntary motor activities initiated by motor cortex

Inferior peduncles (to the medulla):

Afferents conveying sensory information from muscle proprioceptors throughout the body & from the vestibular nuclei of the brainstem (Spinal cord)

Cerebellar Input

Inputs to cerebellum from spinocerebellar tracts have a somatotopic organization.

2 maps of body

Primary fissure

Signals from the motor cortex, which is also arranged somatotopically, project to corresponding points in the sensory maps of the cerebellum.

CEREBELLAR INPUTS
Vermis

Receives input from spinal cord regarding somatosensory and kinesthetic information (intrinsic knowledge of the position of the limbs) Damage leads to difficulty with postural adjustments (cerebellar ataxia)

Intermediate Zone

Receives input from the red nucleus and somatosensory information from the spinal cord Damage results in rigidity & difficulty in moving limbs

Lateral Zone
Receives input from the motor and association cortices through the pons Projects to the dentate nucleus, which projects back to primary and premotor cortex Damage leads to 4 types of deficits: - Ballistic movements (cerebellar ataxia) - Coordination of multi-joint movement (lack of coordination: asynergia) - Muscle learning (loss of muscle tone: hypotonia) - Movement timing

Outputs of the Cerebellum

Cerebellar nuclei: dentate, globose, emboliform, fastigial
Dentate nuclei: project contralaterally through the superior cerebellar peduncle to neurons in the contralateral thalamus & from thalamus to motor cortex Func.: influence planning and initiation of voluntary movement Emboliform & Globose nuclei: project mainly to the contralateral red nuclei & a small group is projected to the motor cortex
Red Nuclei Rubrospinal Tract control of proximal limb muscles

Fastigial nuclei: project to the vestibular nuclei & to the pontine and medullary reticular formation
Vestibulospinal & Reticulospinal tracts

Inputs and outputs of the Cerebellum

Clinical Findings and Localization of Cerebellar Lesions

Ataxia refers to disordered contractions of agonist and antagonist muscles and lack of coordination between movements at different joints typically seen in patients with cerebellar lesions. Normal movements require coordination of agonist and antagonist muscles at different joints in order for movement to have smooth trajectory. In ataxia movements have irregular, wavering course consisting of continuous overshooting, overcorrecting and then overshooting again around the intended trajectory.

Dysmetria = abnormal undershoot or overshoot during movements toward a target (finger-nose-finger test).

Cerebellum and Motor Learning

Deficits in learning complex motor tasks after cerebellar lesions fMRI studies : cerebellum active during learning of novel movements Postulated that cerebellar nuclei store certain motor memories May be involved in cognitive functions

Cerebellum: Control of Voluntary Movement

Cerebellum has no direct connection to the spinal motoneurons (indirect effect).

Information sources: lesions & damages & experimental stimulation of cerebellar nuclei Primary function: 1. To supplement & correlate the activities of other motor areas 2. Control of posture 3. Correction of rapid movements initiated by cerebral cortex 4. Motor learning (Frequency of nerve impulses in the climbing fibers almost doubles when a we earns a new task) Movement Control: a. Inputs from motor cortex inform the cerebellum of an intended movement before it is initiated b. Sensory information is then received via the spinocerebellar tract c. An error signal is generated and is fed back to the cortex

Cerebellar Processing Cerebellum receives impulses of the intent to initiate voluntary muscle contraction Proprioceptors and visual signals inform the cerebellum of the bodys condition Cerebellar cortex calculates the best way to perform a movement A blueprint of coordinated movement is sent to the cerebral motor cortex

Cerebellar Cognitive Function Plays a role in language and problem solving Recognizes and predicts sequences of events

GENERAL FEATURES OF CEREBELLUM :

The cerebellum consists of a midline vermis and 2-lateral hemispheres. Anatomically , it is divided into anterior , posterior & flocculo-nodular lobes.

It controls equilibrium, it influences posture & muscle tone and coordinates the movements Its surface is high convoluted, forming folds or folia, being oriented transversely Lateral aspect of brain stem & cerebellum , showing cerebellar peduncles. It lies behind Pons & M.O. , separated from them by the cavity of 4th ventricle. It is connected to brain stem (medulla, pons& midbrain) by inferior, middle & superior cerebellar peduncles respectively.

EXTERNAL FEATURES OF CEREBELLUM : is It has anterior notch ,which

wider and lodging the back of pons & medulla. It is separated from them by cavity of 4thventricle It has also posterior notch occupied by falx cerebelli, which separates the 2 cerebellar H.

Superior surface

Inferior surface : rounded on each side and presents :

a deep groove (vallecula) between the 2-cerebellar hemispheres,which is occupied by the inferior vermis. -Tonsil is a small part of cerebellar hemisphere that lies lateral to inferior vermis.

Inferior surface

EXTERNAL FEATURES OF CEREBELLUM :

Superior surface : lies beneath
tentorium cerebelli and has a raised superior vermis + a large cerebellar hemisphere on each side + primary & horizontal fissures. 1- Primary fissure V-shaped,well defined fissure, lies on superior surface and separates the small anterior lobe from the larger middle lobe (or posterior lobe). 2- Horizontal fissure lies along the sides of cerebellum, extending from anterior notch to posterior notch, separates the superior from the inferior surfaces. 3- Secondary (posterolateral) fissure lies on inferior surface and separates flocculo-nodular lobe from the ramainder of cerebellum.

Functional subdivision of cerebellum :

1- Archi-cerebellum = posterior lobe (Vestibular part) : _ It is formed of the flocculo-

Schematic drawing of cerebellum showing the relationships between the anatomical & functional divisions of cerebellum. Green =archi-cerebellum, blue=paleo-cerebellum. Pink= neo-cerebellum

nodular lobe + associated fastigial nuclei, lying on inf. Surface in front of postero-lateral fissure. _Embryologically, it is the oldest part of cerebellum. _It receives afferent Fs. From vestibular apparatus of internal ear Via vestibulo-cerebellar tracts. _It is concerned with equlibrium.

I- Archicerebellum
It is concerned with equilibrium. It represents flocculo-nodular lobe.

It has connections with vestibular & reticular nuclei of brain stem through the inferior cerebellar peduncle.
Afferent vestibular Fs. Pass from
vestibular nuclei in pons & medulla to the cortex of ipsilateral flocculo-nodular lobe.

Efferent cortical (purkinje cell) Fs. Connections of archicerebellum

Project to fastigial nucleus, which projects to vestibular nuclei & reticular formation. It affects the L.M.system bilaterally via descending vestibulo-spinal & reticulo-spinal

2- Paleo-cerebellum= (spinal part) : -_it is formed of midline vermis

+ surrounding paravermis + globose & emboliform nuclei. _It receives afferent proprioceptive impulses from Ms.& tendons Via spino-cerebellar tracts (dorsal & ventral) mainly. -it sends efferents to red nucleus of midbrain. -it is concerned with muscle tone

Schematic drawing of cerebellum showing the relationships between the anatomical & functional divisions of cerebellum. Green =archi-cerebellum, blue=paleo-cerebellum. Pink= neo-cerebellum

2-Paleo-cerebellum
It is concerned with muscle tone & posture. Afferents spinal Fs. consist of dorsal & ventral spino-cerebellar tract from muscle, joint & cutaneous receptors to enter the cortex of ipsilateral vermis & para vermis Via inferior & superior cerebellar peduncles . Efferents cortical fibres pass to globose & emboliform nuclei, then Via sup. C. peduncle to contralateral red nucleus of midbrain to give rise descending rubro-spinal tract.

Connections of Paleo-cerebellum.

3- Neo-cerebellum= (cerebral part) : _It is the remaining largest part

of cerebellum. _It includes the most 2-cerebellar hemispheres + dendate nuclei. _It receives afferent impulses from the cerebral cortex+pons Schematic drawing of cerebellum showing Via cerebro-ponto- cerebellar the relationships between the anatomical & pathway. functional divisions of cerebellum. -it sends efferents to V.L.nucleus Green =archi-cerebellum, of thalamus. blue=paleo-cerebellum. -it controls voluntary movements Pink= neo-cerebellum (muscle coordination).

3- Neo-cerebellum
It is concerned with muscular coordination. It receives afferents from cerebral cortex involved in planning of movement- to pontine nuclei ,cross to opposite side Via middle Cerebellar peduncle to end in lateral parts of cerebellum (cerebro-pontocerebellar tract).

Neo-cerebellar efferents project to dendate nucleus,which in turn projects to contra-lateral red nucleus & ventral lateral nucleus of thalamus ,then to motor cortex of frontal lobe, giving rise descending cortico-spinal & cortico-bulbar pathways. Efferents of dentate nucleus form a major Connections of Neo-cerebellum. part of superior C. peduncle.

CEREBELLAR LESIONS
Are usually vascular, may be traumatic or tumour. Manifestations of unilateral cerebellar lesions : 1-ipsilateral incoordination of (U.L) arm = intention tremors : it is a terminal tremors at the end of movement as in touching nose or button the shirt. 2-Or ipsilateral cerebellar ataxia affects (L.L.) leg, causing wide-based unsteady gait. Manifestations of bilateral cerebellar lesions (caused by alcoholic intoxication, hypothyrodism, cerebellar degeneration & multiple sclerosis) : 1-dysarthria : slowness & slurring of speech. 2-Incoordination of both arms.= intention tremors. 3-Cerebellar ataxia : intermittent jerky movements or staggering , wide-based, unsteady gait. 4-Nystagmus : is a very common feature of multiple sclerosis. It is due to impairment coordination of eye movements /so, incoordination of eye movements occurs and eyes exhibit a toand-fro motion. Combination of nystagmus+ dysarthria + intension tremors constitutes Chacottriad, which is highly diagnostic of the disease.

INTERNAL STRUCTURE OF CEREBELLUM :

It consists of an outer layer of grey matter (cerebellar cortex) , & inner layer of white matter containing 4-pairs of

cerebellar nuclei :
above roof of 4th V. from medial to lateral : 1-Fastigial nucleus. 2-Globose nucleus. 3-Emboliform nucleus. 4-Dendate nucleus. (the only one that can be seen clearly with the naked eye).

Sagittal section of cerebellum.

T.S.of cerebellum & brain at level of 4th V. to show cerebellar nuclei.

Cerebellar cortex
It is highly convoluted, forming numerous transversely oriented folia.

T.S of cerebellar folia showing layers of cerebellar cortex.

It contains nerve cells, dendrites and synaptic connections of cellular neurones. The cellular organization of the cortex consists of 3-layers : 1-Outer molecular layer. 2-Intermediate, purkinje cell layer. 3-Inner granular layer, which is dominated by granule cell.

Afferent & Efferent connecltions and their relationships to principal cells of cerebellar cortex.

Cerebellar cortex
Molecular layer : contains
1-Cells : molecular cells (stellate cells) & basket cells. 2-Nerve Fibres : a- dendrites of Purkinje cells (arborisations). B-axons of granule cells. ( bifurcate to produce 2-parallel fibres , oriented along long axis of folium). C-ending of climbing fibers.

Purkinje cell layer : it is formed

of one layer (unicellular) of large flaskshaped purkinje cells. Their arborisations are at right angles to long axis to folium.

Granular layer : it is formed of

small granule cells & ending of mossy fibres.

There are 3-types of Nerve Fibres in white Matter :

1-Axons of purkinje cells : the only axons to leave cerebellar cortex to end in deep cerebellar nuclei specially dendate nucleus. 2-Mossy Fibres : end in the granular layer. 3-Climbing Fibres : end in the molecular layer.

Afferent Fibres to cerebellum : Mostly end in cerebellar cortex, excitatory to cortical neurones, as mossy or climbing Fs. passing through the cerebellar peduncles. The following are Afferent fibres: 1-dorsal & ventral spino-cerebellar tract. (passing via I.C.P & S.C.P) 2-vestibulo-cerebellar Fs. (via I.C.P) 3-olivo-cerebellar Fs. (via I.C.P)/ (extrapyramidal fibres), (end as climbing or mossy fibres) 4-ponto-cerebellar Fs. (via M.C.P).

(In M.O)

Efferent Fibres of the cerebellum :

M
It sends the following fibres : 1-Cerebello-vestibular Fs. to vestibular nuclei of pons & M.O. 2-Cerebello-olivary Fs. To M.O. 3-Dendato-rubro-thalamic tract To red nucleus of midbrain & ventrolateral nucleus of the thalamus and finally to motor cortex of frontal lobe to coordinate movement via cortico-spinal & corticobulbar tracts.

THE FOURTH VENTRICLE

It is a cavity of hindbrain. Position : lies between pons & M.O. anteriorly and the cerebellum posteriorly. It is a diamond-shaped space which is lined by ependyma. Its superior angle is continuous with cerebral aqueduct of midbrain. inferior angle is continuous with centeral canal of closed M.O. Its lateral angles extend laterally to form a lateral recess on each side to open into subarachnoid space.

THE BOUNDARIES OF 4TH VENTRICLE

Superiolateral boundary : -it is formed by superior cerebellar peduncle on each side. Inferiolateral boundary : -it is formed by inferior cerebellar peduncle + gracile & cuneate tubercles on each side.

THE ROOF OF 4TH VENTRICLE

-it is a tent-shaped when seen laterally, and diamond-shaped when seen behind. -it is formed of superior & inferior medullary vela, which are thin sheets of white matter /consists of : ependyma covered by pia mater. -Sup.medullary velum connects the 2 sup.cerebellar peduncles. -Inf.medullary velum connects the 2 inf.cerebellar peduncles. -Inferior vermis of cerebellum : lies in the middle of roof of 4th ventricle.

THE ROOF OF 4TH VENTRICLE

The lower part of roof is invaginated by tela choroidea of 4th ventricle. The tela choroidea is a double layer of pia mater which encloses the choroid plexus of 4th ventricle.

The choroid plexus is a vascular capillary tuft covered by ependymal cells and secretes C.S.F. into the lumen of 4th ventricle.

THE OPENINGS OF 4TH VENTRICLE

The roof contains 3 aperatures which transmit C.S.F. from ventricular lumen to subarachnoid space.

Median aperature (foramen of Magendie) : lies in the median plane at lower end of inferior medullary velum, and opens into subarachnoid space at cistrna magna at cerebello-medullary angle
2 lateral openings (foramina of Luschka) : each one lies at the lateral end of lateral recess to open into subarachnoid space at cerebello-pontine angle. choroid plexus partly protrudes out through each lateral aperture.

THE FLOOR OF 4TH VENTRICLE

It is called rhomboid fossa. It is diamond-shaped and is divided into right & left halves by the median sulcus. It is crossed in the middle by transvere Fs. (ponto-cerebellar Fs.)called medullary stria, which divide floor of 4th ventricle into upper (pontine) & lower (medullary) part.

A diagram to show the floor & lateral boundaries of 4th ventricle.

THE FLOOR OF 4TH VENTRICLE

Upper pontine part : presents on each side of median sulcus. 1-Medial eminence : a rounded elevation produced by the abducent nucleus. 2-Facial colliculus : an elevation on the top of lower part of medial eminence. It is produced by the fibres of facial nerve which surround abducent nucleus. 3-Superior fovea : a groove lateral to facial colliculus. 4-Vestibular area : lateral to superior fovea. It overlies superior, A diagram to show the floor & lateral medial & lateral vestibular nuclei. boundaries of 4th ventricle.

THE FLOOR OF 4TH VENTRICLE

Lower medullary part : presents on each side of the median sulcus. 1-Inferior fovea : inverted V-shaped groove. 2-Hypoglossal area : medial to inferior fovea. It overlies hypo-glossal nucleus. 3-Vagal area (triangle) : between limbs of inferior fovea.It overlies dorsal nucleus of vagus. 4-Vestibular area : lateral to inferior fovea. It overlies inferior vestibular nucleus. A diagram to show the floor & lateral boundaries of 4th ventricle.