CEREBELLUM

FUNCTIONS AND DYSORDERS

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 Cerebellum

• The cerebellum is a central organ for fine

motor control, responds for coordination of
voluntary movements.
• It processes information multiple sensory
channels (vestibular and proproiceptive)
together with motor impulses and modulates
the activity of motor nuclear areas in the brain
and spinal cord.
Anatomical position of cerebellum
• The cerebellum is located in the posterior
cranial fossa, at the back of the brain,
immediately inferior to the occipital
and temporal lobes. It is separated from these
lobes by the tentorium cerebelli, a tough layer
of dura mater.
• It lies at the same level of and posterior to
the pons, from which it is separated by the
fourth ventricle.
 Structure:
• There are 3 ways that the cerebellum can be
subdivided - anatomical lobes, zones,
functional divisions
 Anatomical zones
The cerebellum is made up:
• two hemisperes,
• Intermadiate zone
• the vermis
Hemisperes respond for coordination of limb
movements.
Vermis responds for coordination of movements
of a head, neck, and trunk muscles.
 White matter
located underneath the cerebellar cortex.
Embedded in the white matter are the
4 cerebellar nuclei:
1. Nucleus dentateus
2. Nucleus Emboliformis
3. Nucleus globosus
4. Nucleus Fastigii
The cerebellum consists of grey matter and white
matter:
Nuclei of cerebellum:
 Grey matter
located on the surface of the cerebellum. It is
tightly folded, forming the cerebellar cortex.
The gray matter of the cortex divides into three
layers:
an external - the molecular layer;
a middle - the Purkinje cell layer;
an internal - the granule cell layer.
The molecular layer contains two types of neurons:
the outer stellate cell and the inner basket cell.
1. Anatomical Lobes:
There are three anatomical lobes that can be
distinguished in the cerebellum. These lobes are divided
by two fissures – the primary fissure and posterolateral
fissure;
• The anterior lobe,
• The posterior lobe
• The flocculonodular lobe. It is the oldest part of the
brain in evolutionary terms (archicerebellum) and
participates mainly in balance and spatial orientation. Its
primary connections are with the vestibular nuclei,
although it also receives visual and other sensory input.
2. Zones

There are three cerebellar zones:

1. Vermis
2. Intermediate zone
3. Laretal hemisperes
In the midline of the cerebellum is the vermis. Either side
of the vermis is the intermediate zone. Lateral to the
intermediate zone are the lateral hemispheres. There is no
difference in gross structure between the lateral
hemispheres and intermediate zones
3. Functional Divisions
The cerebellum can also be divided by function.
There are three functional areas of the cerebellum –
1. cerebrocerebellum,
2. spinocerebellum and
3. vestibulocerebellum.

– Cerebrocerebellum – the largest division, formed by the lateral hemispheres.

It is involved in planning movements and motor learning. It receives inputs
from the cerebral cortex and pontine nuclei and sends outputs to the thalamus
and red nucleus. This area also regulates coordination of muscle activation
and is important in visually guided movements.

– Spinocerebellum – comprised of the vermis and intermediate zone of the

cerebellar hemispheres. It is involved in regulating body movements by
allowing for error correction. It also receives proprioceptive information.

– Vestibulocerebellum – the functional equivalent to the flocculonodular lobe. It

is involved in controlling balance and ocular reflexes, mainly fixation on a
target. It receives inputs from the vestibular system, and sends outputs back to
the vestibular nuclei.
3 paired pedunculus of cerebellum:
• The cerebellum attaches
to the brainstem by
three groups of nerve
fibers called
• the superior,
• middle and
• inferior cerebellar
peduncles,
through which efferent and
afferent fibers pass to
connect with the rest of
the nervous system.
• Essentially, the cerebellum is a coordination
center that maintains balance and controls
muscle tone through regulatory circuits and
complex feedback mechanisms and assures
the precise, temporally well-coordinated
execution of all directed motor processes.

• Cerebellar coordination of movements occurs

unconsciously.
SPINOCEREBELLAR
PATHWAYS
Spinocerebellar pathways
 Examination of cerebellum function
1. Examination of gait
2. Examination of stance and posture (equilibrium) -
Romber`s test
3. Finger-nose test
4. Heel-knee test
5. Babinski test – examination of asynergya
6. Examination of diadochokinesias
7. Examination of speech
8. Eamination of handwriting
 Gait examination

• Ask the patient make some steps with open

eyes, and eyes closed, to turn the body
quickly, to stop, to walk straightly on line.
• Pay attention to an position of feet during
walking, on stability of patient, on deviation
aside, on presence accompanied movements
of hands and feet. It is necessary to note a
kind of pathological gaits (ataxic, spastic gait,
tabetic gait, doll (shuffling gait), steppage gait)
• Romberg` test - in standing position, feet together, having extended
hands before itself. In the presence of static ataxia, imbalance or
falling down are observed.
• Finger - nose test – ask patient to close eyes, to take a hand aside
and to get with index finger to a tip of the nose.
• Heel-knee test – ask patient laying on a back to lift a foot, to touch
by a heel other foot knee and to slice downwards.
• At all tests pay attention to acurateness of performance, to
dysmetria, and intention tremor.
• Asynergya Babinski test - Patient laying in spine position with the
crossed on chest hands should sit down. If asynergya is present
patient legs’ll be lifted.
• Dysdiadochokinesis - ask patient to pronate and supinate his
stretched hands. If the test is positive one hand will be behind.
• During the examination definitе the type of ataxia (static,dynamic).
 Symptoms and sings of cerebellar
dysfunction
• The cerebellum receives afferent information
about voluntary muscle movements from the
cerebral cortex and from the muscles, tendons,
and joints. It also receives information concerning
balance from the vestibular nuclei. Each cerebellar
hemisphere controls the same side of the body,
thus if damaged the symptoms will occur
ipsilaterally.[1]
• Dysfunction of the cerebellum can produce a wide
range of symptoms and signs.
 Symptoms and sings of cerebellar
dysfunction
1. Ataxia: unsteadiness or incoordination of limbs, posture, and gait.
A disorder of the control of force and timing of movements leading
to abnormalities of speed, range, rhythm, starting, and stopping.
2. Hypotonia: normal resting muscle tension is reduced, leading to
decreased muscle tone and abnormal positions of parts of the
body.
3. Intention Tremor: an intention tremor of the hand on purposive
movement is the most common, with coarse, rapid, side-to-side
oscillations that increase as the movement goal is approached.
Resting tremors of the limbs, head, and trunk can occur. At times,
paroxysms of these tremors are severe enough to shake the entire
bed and delude the unwary physician into suspecting seizure
activity.
4. Gait: the station or manner of standing is abnormal; the legs are
apart and there is swaying of the body. "The patient staggers,
reels, and lurches on walking.
5. Nystagmus Ocularmotor abnormalities.
6. Dysdiadochokinesia - the lack of ability to perform rapidly
alternating movements. Ask the patient to quickly supinate and
pronate both forearms simultaneously. Movements will be slow
and incomplete on the side of the cerebellar lesion.
7. Dysarthria/Scanning speech - ataxia of the larynx muscles,
speech is slurred and syllables are separated from one another.
8. Micrography – handwriting with small letters
9. Dysmertia
• The clinical picture depends on the functional area of the
cerebellum that is affected.
• Damage to the flocculonodular lobe (vestibulocerebellum):
loss of equilibrium causing an altered walking gait
• Lateral zone damage: problems with skilled voluntary and
planned movements leading to errors in intended movements
(eg., dysdiadochokinesia, the inability to perform rapid
alternating movements).
• Damage to the midline portion: disruption of whole-body
movements
• Damage to the upper part of the cerebellum: gait
impairments and other problems with leg coordination (ie,
ataxia).
• A wide variety of manifestations are possible