CEREBELLUM AND

ITS CONNECTIONS
CEREBELLUM
LOCATION
 Situated in posterior cranial fossa.
 Largest part of hindbrain.
 Covered superiorly by tentorium cerebelli.
 Posterior to 4th ventricle, pons, medulla.
FUNCTIONS
 It is mainly concerned with control of voluntary
movements, balance, muscle tone and posture.
 Each cerebellar hemisphere controls muscular
movements on ipsilateral side of the body.
 It has no direct pathway to the LMNs but exerts its
control via the cerebral cortex and the brainstem.
 GROSS FEATURES
 Cerebellum is somewhat Ovid shape .
 It consists of 2 cerebellar hemispheres connected
by a narrow median vermis.
 Cerebellum is connected to posterior aspect of
brainstem by 3 bundles of nerve fibers called
superior, middle and inferior cerebellar
peduncles.
LOBES OF
CEREBELLUM
 It is divided into three main lobes:
a. Anterior lobe.
b. Middle / Posterior lobe.
c. Flocculonodular lobe.
SUPERIOR VIEW
• ANTERIOR LOBE
 It may be seen on the superior surface of
cerebellum.
 It is separated from middle / posterior lobe by a
wide V-shaped fissure called primary fissure.
• MIDDLE / POSTERIOR
LOBE
 It is situated between the primary and
posteriolateral fissure (uvulonodular
fissure).
 It is the largest part of cerebellum .
• FLOCCULONODULAR
LOBE
 It is situated posterior to uvulonodular fissure.
 It is the most primitive part of cerebellum in
evolution and is also called archicerebellum or
vestibulocerebellum.
 It is mainly concerned with maintaining balance.
 Horizontal fissure : found along margin of
cerebellum ,separated superior from inferior
surfaces.
 STRUCTURE
 Cerebellum is composed of

1. Gray matter (Cortex): is the outer covering

2. White matter: inner contents
3. Intracerbellar nuclei: are the masses of gray
matter within the white matter
STRUCTURE OF THE CEREBELLAR
CORTEX

 . Cerebellum is made up of folds (Folia).

 Each fold or folium contains a core of white matter
covered superficially by gray matter.
 Folia give branched appearance Called arbor
vitae
• MOLECULAR LAYER OF CEREBELLAR
CORTEX

  This layer contains 2 types of neurons

 1. The outer stellate cell
 2. The inner basket cell
OUTER GRAY MATTER
 Outer gray matter or cerebellar cortex is made up of
neurons.
 Three cell layers
1. Molecular layer (external layer)
2. Purkinje cell layer(middle layer)
3. Granular layer(internal layer)
• MOLECULAR LAYER
 The molecular layer contains two types of
neurons: the outer stellate cell and the inner basket
cell.
 These neurons are scattered among dendritic
arborizations and numerous thin axons that run
parallel to the long axis of the folia.
 Neuroglial cells are found between these
structures.
• PURKINJE CELL LAYER
 The Purkinje cells are large Golgi type I neurons.
 They are flask shaped and are arranged in a single layer.
  The dendrites of these cells pass to the molecular
layer and are branched.
 The primary and secondary branches are smooth, and
subsequent branches are covered by short, thick
dendritic spines.
 It has been shown that the spines form synaptic contacts
with the parallel fibers derived from the granule cell
axons.
CONTINUE…
 At the base of the Purkinje cell, the axon arises and passes
through the granular layer to enter the white
matter.
 The axons of these cells synapse with the cells of
one of the intracerebellar nucle
 The collateral branches of their axons also
synapse with the dendrites of basket & stellate cells
 A few of the Purkinje cell axons pass directly to
end in the vestibular nuclei of the brainstem.
• GRANULAR LAYER
 . This layer contains many small cells
 The dendrites of these cells synapse with the
mossy fibers
 Their axons pass into the molecular layerand
bifurcate at a T-junction.
 The branches run parallel (hence called parallel
fibers) to the cerebellar folium & the purkinje cells
 FUNCTIONAL AREAS OF
CEREBELLUM
a. Vermis influences the movements of the long axis of the
body i.e. neck, shoulders, thorax, abdomen & hips
b. Intermediate zone controls the muscles of the distal parts
of the limbs i.e. hands and feet
c. Lateral zone of each cerebellar hemisphere is concerned
with the planning of sequential movements of the entire
body & conscious assessment of movement errors.
 INTRACEREBELLAR
NUCLEI
 Within the inner white matter are masses of gray matter.
 From lateral to midline, these nuclei are
1. dentate
2. Emboliform
3. Globose
4. fastigial
• DENTATE
 Largest of cerebellar nuclei.
 Shape of a crumpled bag.
 Efferent fibers form a large part of superior
cerebellar peduncle.
 It mainly influences motor activity by acting on
motor neurons of opposite cerebral cortex.
• EMBOLIFORM AND
GLOBOSE
 Emboliform is ovoid in shape , situated medial to dentate
and Globose is present medial to emboliform.
 Efferents from emboliform and globose nuclei pass through
superior cerebellar peduncles, synapse with contralateral
red nucleus and influence the lower motor neurons via
rubrospinal pathway.
 The globose nucleus consists of one or more rounded cell
groups that lie medial to the emboliform nucleus.
FASTIGIAL
 It lies near midline in vermis and close to the roof
of 4th ventricle.
 Efferents from this nucleus travel via inferior
cerebellar peduncles and end by projecting in
lateral vestibular nuclei on both sides.
 It exerts a facilitatory influence on ipsilateral
extensor muscle tone via vestibulospinal pathway.
WHITE MATTER
TYPES
 White matter is made up of 3 groups of fibers:

Intrinsic fibers – Do not leave cerebellum but connect

different regions of cerebellum
-some connect t folia of the cerebellar cortex with vermis.
Others connect the two cerebellar hemispheres together
Afferent fibers – They form the greater part of white
matter. Proceed to the cortex. Enter cerebellum through
inferior and middle cerebellar peduncles.
.
Efferent fibers – These are the axons of intracerebellar nuclei
or Purkinje cells.
 Output of cerebellum
 Their majority of fibers pass to & synapse with the neurons
of the cerebellar nuclei (i.e.fastigial, globose, emboliform &
dentate)
 Their minority of fibers bypass the cerebellar nuclei & leave
the cerebellum without synapsing
 Fibers from dentate, emboliform & globose nuclei leave the
cerebellum through the superior cerebellar peduncle
 Fibers from the fastigial nucleus leave the cerebellum
through the inferior cerebellar peduncle
CEREBELLAR CORTICAL
MECHANISMS
 Cerebellar cortex also consists of:
 1. Climbing fibers
 2. Mossy fibers
 These fibers are excitatory to the Purkinje cells
 A single Purkinje neuron makes synaptic contact with only
one climbing fiber
 One climbing fiber makes contact with 1 to 10 Purkinje
neurons
CONTINUE..
 The stellate, basket & Golgi cells serve as
inhibitory interneurons and influence the degree
of Purkinje cell excitation produced by the
climbing & mossy fiber input
 Therefore the Purkinje cells form the center of a
functional unit of the cerebellar cortex
INTRACERBELLAR
NUCLEAR
MECHANISMS
 The deep cerebellar nuclei receive information
from two sources:
1. Inhibitory axons from the Purkinje cells of the
cortex
2. Excitatory axons from the climbing & mossy
fibers that are passing to the cortex
CEREBELLAR CORTICAL
NEUROTRANSMITTERS
 The excitatory climbing & mossy fibers use glutamate i.e.
GABA (gamma aminobutyric acid) as the excitatory
neurotransmitter
 Other fibers liberate norepinephrine & serotonin as the
neurotransmitter
 CEREBALLAR PEDUNCLES
 The cerebellum is linked to other parts of CNS by afferent
and efferent fibers that are grouped together on each side
into three large bundles or peduncles
 1. Superior cerebellar peduncles: connect the cerebellum
to the midbrain
 2. Middle cerebellar peduncles: connect the cerebellum to
the pons
 3. Inferior cerebellar peduncles: connect the cerebellum to
the medulla oblongata
CEREBELLAR AFFERENT
FIBERS
 These include:
 1. From the cerebral cortex
 2. From the spinal cord
 3. From the vestibular nerve
 4. Other afferent fibers
1. CEREBELLAR AFFERENT FIBERS FROM
THE CEREBRAL CORTEX

 The cerebral cortex sends information to the cerebellum by

3 pathways
 a. Corticopontocerebellar pathway
 b. Cerebro-olivocerebellar pathway
 c. Cerebro-reticulocerebral pathway
CORTICOPONTOCEREBEL
LAR PATHWAY
 Origin:
Theses fibers run from all the lobes of the cerebral
cortex to the pons (frontal, parietal, temporal and occipital
lobes)
 Destination:
Via pontine nuclei to the cerebellar cortex
 Function:
Conveys control from cerebral cortex.
PATHWAY
Cerebral cortex
Internal capsule
Corona radiata
Pons
Relay in pontine nuclei
Middle cereberal peduncle
cerebellum
CEREBRO-
OLIVOCEREBELLAR
PATHWAY
 Origin:
 Frontal, parietal, temporal and occipital lobes
 Destination:
 Via inferior olivary to the cerebellar cortex
 Function:
 Conveys control from cerebral cortex.
PATHWAY
 Cerebral cortex
 Internal capsule
 Corona radiata
 Inferior olivary nucleus (decussate to opposite side)
 inferior cereberal peduncle
 cerebellum
CEREBRO-
RETICULOCEREBELLAR
PATHWAY
PATHWAY
 Cerebral cortex
 Corona radiata
 Internal capsule
 Reticular formation(pons , medulla)
 Middle and inferior cerebellar peduncle
 cerebellum
2. CEREBELLAR AFFERENT
FIBERS FROM
THE SPINAL CORD
 Includes 3 pathways:
 a. Anterior spinocerebellar tract
 b. Posterior spinocerebellar tract
 c. Cuneo-cerebellar tract
ANTERIOR
SPINOCEREBELLAR TRACT
 Origin: Sensory axons enter the spinal cord via osterior
root and synapse with the neurons of the nucleus dorsalis
(Clarke’s column)
 Most of the fibers cross to the opposite side as the anterior
spino-cerebellar tract in the contralateral white column
 The fibers enter the cerebellum through the superior
cerebellar peduncle & terminate as mossy fibers in the
cerebella
CONTINUE..
 It is believed that those fibers that cross over to the
opposite side in the spinal cord cross back within the
cerebellum
 function : This tract conveys muscle joint information
from the muscle spindles, tendon organs and joint receptors
of the upper, lower limbs, skin & superficial fascia
POSTERIOR
SPINOCEREBELLAR TRACT
 Sensory axons enter the spinal cord via posterior root and
synapse with the neurons of the nucleus dorsalis (Clarke’s
column)
 The fibers run on the same side as the posterior spino-
cerebellar tract in the lateral white column & reach to the
medulla oblongata
 The tract then enters the cerebellum through the inferior
cerebellar peduncle & terminate as mossy fibers in the
cerebellar
 Function:This tract conveys muscle joint information from
the muscle spindles, tendon organs and joint receptors of the
trunk and lower limbs
PATHWAY
 Posterior gray column
 Nucleus dorsalis
 Will not decussate
 Medulla
 Inferior cerebellar peduncle
 cerebellum
CUNEOCEREBELLAR
TRACT
 The fibers originate in the nucleus cuneatus of the medulla
oblongata
 Then enters the cerebellar hemisphere on the same side
through the inferior cerebellar peduncle
 The fibers terminate as mossy fibers in the cerebellar cortex

 Function: This tract conveys muscle joint information

from the muscle spindles, tendon organs and joint receptors
of the upper limbs and trunk
PATHWAY
 Fasiculus cunateus
 Cunate nucleus in medulla
 Internal arcuate fibers
 Inferior cerebellar peduncle
 cerebellum
PATHWAY
 Sensory fibers
 Inferior cerebellar peduncle
 Cerebellum
 Control hearing , balance
4. OTHER AFFERENT FIBERS
TO THE
CEREBELLUM
 Origin:These include the fibers from the:
 1. Red nucleus and
 2. Tectum of midbrain
 Destination
cerebellar cortex
 Function:
conveys information from midbrain
CEREBELLAR EFFERENT FIBERS

 The entire output of the cerebellar cortex is through the

axons of the Purkinje cells
 These mostly influence through the cerebellar nuclei. Few
may influence directly on the lateral vestibular nucleus
 The efferent fibers from the cerebellum connect with the:
 1. Red nucleus 2. Thalamus
 3. Vestibular complex 4. Reticular formation
CEREBELLAR EFFERENT
FIBERS
 The cerebellar efferent pathways include:
 1. Globose-Emboliform-Rubral pathway
 2. Dentothalamic pathway
 3. Fastigial vestibular pathway
 4. Fastigial reticula pathway
GLOBOSE-EMBOLIFORM-
RUBRAL
PATHWAY
 Axons of neuron in the globose & emboliform nuclei travel through the
superior cerebellar peduncles & cross to the opposite side in the
decussation of the superior cerebellar peduncles
 From here the fibers cross back the midline again to the red nucleus to
influence the rubrospinal tract
 Therefore, the globose-emboliform nuclei influence motor activity on
the same side of the body
Origin – globose and emboliform nuclei.
Destination – contralateral red nucleus.
Functions – influences ipislateral motor activity (mainly flexors).

 Pathway:
 Globose , emboliform
 Superior cerebellar peduncle (decussate)
 Red nucleus (midbrain)
 Rubrospinal tract
 Decussate
 Spinal cord
DENTO-THALAMIC
PATHWAY
 Axons from the neurons of the dentate nucleus travel through the
superior cerebellar peduncle & cross the midline in the decussation of
the superior cerebellar peduncle
 From here, the fibers end in the ventrolateral nucleus of the thalamus,
which again reach to the primary motor cortex of the cereberum via
internal capsule & corona radiate
 By this pathway, the dentate nucleus can influence motor activity of the
opposite
 cerebral cortex. The impulses from the motor cortex are transitted to the
spinal cord through the cortico-spinal tract after decussation in the
pyramid
 Hence, the dentate nucleus is able to coordinate muscle activity on the
same side
Origin – dentate nucleus
destination – contralateral ventrolateral (VL) nucleus of
thalamus. Primary motor area of cerebral cortex.
Functions – influences ipislateral motor activity.

 Pathway:
 Dentate nucleus
 Superior cerebellar peduncle
 Decussate
 Ventrolateral nucleus of thalamus
 Cerebral cortex
 Corticospinal tract (decussate at pyramids)
 Spinal cord
FASTIGIAL-VESTIBULAR
PATHWAY
 Origin:Axons from the fastigial nucleus travel through the
inferior cerebellar peduncle and end on the neurons of the
lateral vestibular nucleus on both sides
 The neurons from the vestibular nucleus form the
vestibulospinal tract
 Function:This nucleus influences mainly on the ipsilateral
extensor muscle tone
PATHWAY
 Fastigial nucleus
 Inferior cerebellar peduncle
 Vestibular nucleus
FASTIGIAL-RETICULAR
PATHWAY
 The axons from the fastigial nucleus travel through the
inferior cerebellar peduncle and synapse with the neurons of
the reticular formation
 Hence, this nucleus influences spinal motor activity
through the reticulospinal tract
Origin – fastigial nucleus
destination – neurons of reticular formation.
Function – influences ipsilateral muscle tone.

 Pathway:
 Fastigial nucleus
 Inferior cerebellar peduncle
 Reticular formation
 Reticulospinal tract
 Spinal cord
FUNCTIONS OF
CEREBELLUM
 To coordinate, by synergistic action, all reflex and
voluntary muscular activity
 It harmonizes muscle tone & maintains normal
body posture
 It permits voluntary movements, such as walking,
to take place smoothly with precision & economy
of effort
 It is NOT able to initiate muscle movement
CLINICAL NOTES
 Lesions in one cerebellar hemisphere give rise to signs & symptoms that
are limited to the same side of the body. The causes may
 include:
 1. Acute alcohol poisoning
 2. Congenital agenesis or hypoplasia
 3. Trauma
 4. Infections
 5. Tumors
 6. Multiple sclerosis
 7. Vascular disorders e.g. thrombosis
 8. Poisoning with heavy metals
SIGNS & SYMPTOMS OF
CEREBELLAR
DISORDERS
 1. Hypotonia
 2. Postural changes & alteration of gait
 3. Disturbances of voluntary movements (Ataxia)
 4. Dysdiadochokinesia
 5. Disturbances of reflexes
 6. Disturbances of ocular movement
 7. Disorders of speech e.g. dysarthria
 8. Cerebellar syndromes e.g.
 a) Vermis syndrome b) cerebellar hemisphere syndrome
 • HYPOTONIA
 The muscles lose resilience to palpation
 Diminished resistance to passive movements of
joints
 shaking the limb produces excessive movements at
the terminal joints
• POSTURAL CHANGES & ALTERATION OF
GAIT

 Head is often rotated & flexed

 Shoulder on the side of the lesion is lower on the
normal side
 The patient assumes a wide base when stands
 The patients stands on stiff legs to compensate loss
of muscle tone
 While walking, the patient lurches and staggers
toward the affected side
 • ATAXIA
 The muscles contract irregularly & weakly
 Tremor occurs while fine movements are
attempted, such as buttoning clothes, writing,
shaving
 Muscle groups fail to work harmoniously
 There is decomposition of movement e.g. past-
pointing or hitting the nose and putting the heel on
the shin of opposite leg
 DYSDIADOCHOKINESIA
 It is the inability to perform alternating movements
regularly and rapidly
 Example: Ask the patient to pronate & supinate the
forearm rapidly. On the side of the cerebellar
lesion, the movements are slow, jerky & incomplete
 • DYSORDERS OF
REFLEXES
  Pendular knee jerk
DISTURBANCES OF OCULAR
MOVEMENT
 Nystagmus:
 1. Pendular nystagmus: rythmic oscillation of the
eyes may be of the same rate in both directions
 2. Jerk nystagmus: oscillation of the eyes quicker in
one direction than the other
 DISORDERS OF SPEECH
 Dysarthria: occurs due to ataxia of the muscles of
larynx
 • VERMIS SYNDROME
(MEDULLOBLASTOMA)

 The vermis is unpaired and influences midline

structures. Hence in its lesions:
 The patient may fall forward or backward
 Difficulty in holding the head steady and in an
upright position
 • CEREBELLAR
HEMISPHERE
SYNDROME
 May occur due to the tumors of the cerebellar
hemisphere
 So it involves the muscles of the same side
 Swaying & falling to the side of the lesion
 Dysarthria & nystagmus
COMMON DISEASES
INVOLVING THE CEREBELLUM
 One of the most common diseases affecting cerebellar
function is acute alcohol poisoning. This occurs as the result
of alcohol acting on GABA receptors on the cerebellar
neurons.
 The following frequently involve the cerebellum: congenital
agenesis or hypoplasia, trauma, infections, tumors, multiple
sclerosis, vascular disorders such as thrombosis of the
cerebellar arteries, and poisoning with heavy metals.
 The many manifestations of cerebellar disease can be
reduced to two basic defects: hypotonia and loss of
influence of the cerebellum on the activities of the cerebral
cortex.
QUIZ 1
 Which of the following is largest intracerebellar nucleus?
 A.Emboliform
 B. Fastigial
 C. Dentate
 D. Globose
QUIZ 2
 In dentothalamic pathway, destination is
 A,Ventrolateral nucleus of thalamus
 B. Contalateral ventrolateral nucleus of thalamus
 C.Dorsolateral nucleus of thalamus
 D. Contralateral dorsal nucleus of thalamus
QUIZ 3
 Flocconodular lobe is also called
 A. Cerebrocerebellum
 B. Vestibulocerebellum
 C.Spinocerebellum
 D. All of the above
ANSWERS:
 1:c
 2:b
 3:b
THANK YOU