CEREBELLUM

and its connections

FLOR MAE P. MENDOZA, MD, FPCR, FUSP, FCTMRISP
 CEREBELLUM
• Derived from the Metencephalon
• Located in the posterior cranial fossa
• Largest part of the hindbrain
• Connected to the posterior aspect of
the brainstem by the three cerebellar
peduncles
• Roof of upper 4th ventricle formed by
medial surfaces of the Superior
Cerebellar Peduncles
• Superior surface of the cerebellum
covered by Tentorium Cerebelli
• Joined by median vermis
CEREBELLUM
Receives sensory input from:
• Spinal cord
• Inferior Olivary nuclei
• Reticular formation
• Cuneate nucleus
• Pontine nucleus
• Vestibular nerves and nuclei
 Cerebellar Cortex
• Molecular Layer
- Contains outer stellate cell and
inner basket cell
• Purkinje Cell Layer
- Purkinje Cell -Large Golgi type I
neurons; flask-shaped and
arranged in a single layer
• Granular Layer
• Packed with small cells with
densely staining nuclei and scanty
cytoplasm
• Neuroglial cells and Golgi cells are
scattered throughout this layer
Functional organizations of the cerebellar
cortex
• Two main lines of input to the cortex and are
excitatory to the Purkinje cells
• Climbing and Mossy fibers
• Climbing – terminal fibers of the olivocerebellar
tracts; ascends like vine on a tree
• Mossy fiber – terminal fibers of all other cerebellar
afferent tracts; they have multiple branches and
exert a much more diffuse excitatory effect
• Purkinje cells form the center of a functional unit of
the cerebellar cortex
 Functional Areas of Cerebellar Cortex
• Vermis
• Long axis of the body
• Neck, shoulders, thorax, abdomen, hips
• Intermediate Zone
• Muscles of distal parts of limbs
• Hands and feet
• Lateral Zone
• Planning of sequential movements of
entire body
• Conscious assessment of movement
errors
Cerebellar Nuclei
• The cerebellum influences motor centers at various levels through the
cerebellar nuclei
• Fastigeal, Globose, Emboliform and Dentate Nuclei
• Fibers from the Fastigeal leave the
Cerebellum thru the Inferior
Cerebellar Peducle
• The rest of the three thru
Superior Cerebellar Peducnle
Anatomical
Subdivisions:
• Anterior lobe = Paleocerebellum or
Spinocerebellum

• Posterior lobe = Neocerebellum or

Cerebrocerebellum

• Flocculonodular lobe = Archicerebellum

or Vestibulocerebellum
Functional and Developmental Lobes:
A. Anterior lobe
- Paleocerebellum
- Rostral to primary fissures
- Concerned with regulation of muscle tone
- Maintains coordination of limb movements while the
movements are being executed
Functional and Developmental Lobes:
B. Posterior lobe
- Neocerebellum
- Largest lobe
- Located between the anterior lobe and the flocculonodular
lobe
- Concerned with muscle coordination
- Coordination of Voluntary movements
Functional and Developmental Lobes:
• C. Flocculonodular lobe
- Archicerebellum
- Oldest portion of the cerebellum
- Posterior to the posterolateral fissure
- Consists of the medial nodule and paired lateral flocculi
- Concerned with equilibrium
- Responsible for coordination of the paraxial muscles associated with
equilibrium
 ANATOMICAL PHYLOGENETIC FUNCTIONAL MAJOR AFFERENT
SOURCE

Anterior Lobe Paleocerebellum Spinal Cerebellum Spinocerebellar tracts

Posterior Lobe Neocerebellum Cerebral Cerebellum Corticopontocerebellar

tracts

Flocculonodular Lobe Archicerebellum Vestibular Cerebellum Vestibular System

Three cerebellar peduncles
Cerebellar Peduncle
- Three pairs that anchor cerebellum to brainstem
- Convey only all afferent and efferent cerebellar nerve fibers

Pons – only division of the brainstem wherein three pairs of peduncles

anchor the cerebellum to only one division of the brainstem therefore,
all afferent and efferent cerebellar fibers pass through the pons and
through one of the peduncles.
A. Superior Cerebellar Peduncle or
Brachium Conjunctivum
• Connects the cerebellum to the midbrain
• Principal efferent pathway
• Fibers originating from the dentate, emboliform, and globose
nuclei enter this
• Distributed to the red nucleus, Reticular Formation, and
thalamus
• 2/3 of afferent in Anterior Spinocerebellar tract pass through
this
B. Middle Cerebellar Peduncle or
Brachium Pontis
• Connects the cerebellum with the pons
• Carries fibers arising from the contralateral pontine nuclei to
the cerebellum, the corticopontocerebellar fibers
C. Inferior Cerebellar Peduncle or
Brachium Restiformis
• Connects cerebellum to the medulla
• Carries predominantly afferent fibers to the cerebellum
• 1/3 of Anterior spinocerebellar tract
• Posterior spinocerebellar tract
• Cuneocerebellar tract
• Olivocerebellar tract
• Reticulocerebellar fibers
• Vestibulocerebellar fibers
• In addition, a small efferent pathway carries output from the
Fastigeal Nuclei, the Fastigiobulbar tract
Cerebellar Afferent
Fibers
• Connection between cerebrum
and cerebellum is important
• Control of voluntary movement
• Sends information to the
cerebellum by three pathways
namely:
• Corticopontocerebellar
• Cerebro-olivocerebellar
• Cerebroreticulocerebellar
 Cerebellar Afferent Fibers
The spinal cord sends information
to the cerebellum from
somatosensory receptors in
three pathways:
• Anterior Spinocerebellar tract
• Posterior Spinocerebellar tract
• Cuneocerebelar tract
 Cerebellar Afferent Fibers
From the Vestibular Nerve
o Sends many afferent fibers
directly to the cerebellum
through inferior Cerebellar
Peduncle on same side
o All afferent fibers from the
inner ear terminate as mossy
fibers in the Flocculonodular
Lobe
 Cerebellar Efferent Fibers
• Entire output of the cerebellar cortex is
through the axons of the Purkinje cells
• The efferent fibers from the cerebellum
connect with the red nucleus, thalamus,
vestibular complex and reticular formation
• Efferent Cerebellar Pathways:
• Globose-Emboliform-Rubral Pathway
• Dentatothalamic Pathway
• Fastigial Vestibular Pathway
• Fastigial Reticular Pathway
 Important Roles of Cerebellum
• It controls posture and voluntary movements
• It unconsciously influences the smooth contraction of voluntary
muscles and carefully coordinates their actions
• It coordinates, by synergistic action, all reflex and voluntary
muscular activity
• It graduates and harmonizes muscle tone and maintains normal
body posture
• It permits voluntary movements to take place smoothly with
precision and economy of effort
Function of Cerebellum or what Does It Do
• Adjusts the Rate, Regularity and Force of
Willed Muscular Contractions
• Coordinates Willful muscular contractions
• Coordinator of precise movements
• Requires “proprioceptive” input
What the Cerebellum Does Not Do
- Mental Processes - Consciousness
- Emotions - Homeostasis
- Autonomic Functions - Sensations

The cerebellum is not able to initiate muscle movement.

Influences of Cerebellum on muscle activity is not directly, but
indirectly, through vestibular nuclei, reticular formation, red nucleus,
tectum and corpus striatum and cerebral cortex.
 Major Clinical Signs of Cerebellar
Syndrome
A. Ataxia/ Dystaxia/ Intention D. Hypotonia
tremor - Floppiness of the extremities
- Incoordination of intentional - Muscles lose resilience to palpation
movements E. Dysmetria
- Key cerebellar dysfunction - Overshoots or undershoots when
B. Dysarthria attempting to touch a target
- Slurred speech - Error in metering distance
- Neurogenic disturbance of voice F. Dysdiadochokinesia
articulation - Inability to perform rapid alternating
C. Nystagmus movements regularly
- Oscillating eye movements - Dystaxia-dysmetria
Clinical Tests
• For Dystaxia of Stance/ Gait
• Free walking for broad-based gait
• Inspect for swaying when • For Leg Dystaxia
standing • Heel-to-shin test
• Tandem gait walking • Heel tapping test

• For Arm Dystaxia

• Finger-to-nose test
• Pronation-supination test
• Thigh-slapping test
Clinical Tests
• For Hypotonia
• Inspect a hypotonic patient
- Assumes a “floppy” posture
- Rag doll or dumped-in-a-heap
postures
• Pendular quadriceps reflexes
• Test for “overshooting”
• Wrist-slapping test
• Arm-pulling test
• Test for Nystagmus
• Inspect and have the patient
follow your finger through the
fields of gaze
Intention tremor
• The ataxic patient is unable
to direct the limb to a target
without its progression
being interrupted by a
swaying to and fro that is
perpendicular to the
direction of the movement
Dystaxia Truncal Ataxia
- Loss of coordination - Disturbances of balance
chiefly in the lower limbs manifested chiefly by a
- Marked gait instability lack of coordination of the
paraxial muscles
- Sliding the heel of one
foot smoothly down the - Attempts to walk on a
shin of the other leg is wide base with the trunk
extremely difficult for constantly reeling and
the patent to do swaying
 Cerebellar Syndromes:
1. Cerebellar Hemisphere Syndrome
- Mainly posterior lobe involvement,
variably anterior lobe
- Lateralized cerebellar signs limited to
one half of the body
- From an acute destructive lesion
- Infarct
- Hemorrhage
- Neoplasm
- Abscess
- Trauma
 Cerebellar Syndromes:
2. Rostral Vermis Syndrome
- Mainly anterior lobe involvement
- Dystaxia is predominant in the legs,
sparing the cranial nerve
musculature
- Results from Alcoholism –
nutritional deficiency
 Cerebellar Syndromes:
3. Caudal Vermis Syndrome
- Mainly flocculonodular lobe and/or posterior
lobe
- Dystaxia or disequilibrium of stance and gait
- Axial dystaxia with little or no extremity
dystaxia
- Implies a midline cerebellar neoplasm
- Medulloblastoma
- Ependymoma
- Astrocytoma
 Cerebellar Syndromes:
4. Pancerebellar Syndrome
- All lobes
- Cerebellar signs are bilateral in all
musculature, cranial, axial and
Appendicular
- Lesion affects the whole cerebellum
- Toxic-metabolic
- Demyelinating
- Heredofamilial degenerative diseases
• Acute lesion - resulting from Thrombosis of Cerebellar
artery or a rapidly growing tumor, produce rapid
withdrawal of influence of cerebellum on muscular activity.
• Chronic lesion - the signs and symptoms are much less
severe, and these is enough time to allow other areas of
the CNS to compensate for loss of Cerebellar Function

• A person who has unilateral lesion involving one cerebellar

hemisphere demonstrates absence of coordination between
different groups of muscles on the same side of the body.
It affects not only agonists and antagonists in a single joint
movement but also associated muscle activity.
Etiologies of Cerebellar Dysfunction
- Developmental - Arnold-Chiari malformation
- Demyelinative – Multiple Sclerosis
- Degenerative
- Neoplastic – Medulloblastoma
- Infectious – Abscess formation
- Vascular – Hemorrhage, Infarction
- Drugs/ toxins – Alcohol, Phenytoin
- Metabolic – Inborn disorders of metabolism
Cerebellar Examination
CEREBELLUM
QUIZ
TRUE or FALSE
TRUE OR FALSE?
1. The cerebellum is separated from the occipital lobes of the cerebral
hemisphere by the tentorium cerebelli.
2. The important Purkinje cells are Golgi type II neurons.
3. The intracerebellar nuclei are deeply embedded in the white matter.
4. The climbing and mossy fibers of the cerebellum constitute the two
main lines of input to the cerebellar cortex.
5. The middle cerebellar peduncle is formed of fibers that arise from
the pontine nuclei.
TRUE OR FALSE?
6. The anterior lobe is separated from the middle (posterior) lobe by
the primary fissure.
7. Rest tremor is a sign of cerebellar disease.
8. The gray matter of the cerebellum is found in the cortex and in the
four masses forming the intracerebellar nuclei.
9. The inferior cerebellar peduncle contains afferent fibers of the
olivocerebellar tract.
10. From medial to lateral, the nuclei are named as follows: fastigial,
globose, emboliform, and dentate.
THANK YOU!