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CEREBELLUM

Largest part of hind brain. LOCATION: Posterior cranial fossa behind pons & medulla. ANATOMY: Covered above by meninges (Tentorium Cerebelli). Has 2 hemispheres joined by Vermis.

LOBES: 3 1) anterior lobe 2) posterior / middle lobe 3) flocculo nodular lobe FISSURES: 2 1) Primary fissure (v shaped). Part of cerebellum above this fissure is anterior lobe. 2) Uvulo-nodular fissure (separates posterior lobe from flocculo nodular lobe)

Topographical representation: Vermis & Intermediate zone of cerebellar hemisphere. Each cerebellar hemisphere has 2 zones, intermediate zone & lateral zone. Axial parts of body represented in Vermis. Limbs & facial region Intermediate zone.

AFFERENTS TO TOPOGRAPHICAL REPRESENTATION: Corresponding areas of motor cortex. Corresponding parts of the body & Brain stem EFFERENTS: Cerebral cortex Red nucleus Reticular formation

VERMIS: 10 Primary lobules.

I II III IV V VI

LINGULA CENTRAL LOBULE CENTRAL LOBULE CULMEN DECLIVE SIMPLE LOBULE

VII FOLIUM TUBER.


VIII PYRAMID IX X UVULA NODULE

Cerebellum has: 1) cortex cerebellar (grey matter on periphery)


2) white matter core (having deep cerebellar nuclei, 4 on each side, from lateral to medial side: DENTATE, EMBOLIFORM, GLOBASE & FESTIGEAL. (Lateral medial) BUT DEGF! (dont eat greasy food) EMBOLIFORM + GLOBASE = NUCLEUS INTERPOSITUS.

MOTOR OUTPUT FROM CEREBELLUM:


Axons of neurons in deep cerebellar nuclei motor output. From dentate + interpositus leave via SUPERIOR CEREBELLAR PEDUNCLE.

From fastigial nucleus leave via INFERIOR CEREBELLAR PEDUNCLE.

SUPERIOR CEREBELLAR PEDUNCLE

G E ( N.I)

INFERIOR CEREBELLAR PEDUNCLE

CEREBELLAR CORTEX:
3 LAYERS:
DENDRITES

Outermost molecular layer 2nd layer purkinje cells layer 3rd later granular layer

PURKINJE CELL AXONS

MOLECULAR LAYER:
STELLATE CELLS BASKET CELLS Large no. of dendrites & nerve fibers from deeper layers.

PURKINJE CELL LAYER:


Single layer. Flask shaped cells. From top of cells arise dendrites 1, 2 (without dendritic spines, i.e., smooth) & 3 branches (with dendrite spines).

From base of cells axons white matter acquires myelin sheath.


Most nerve fibers from purkinje cells synapse onto deep nuclear cells. Only few fibers bypass deep nuclear cells go to vestibular nuclei.

GRANULAR LAYER:
Granule cells having Multiple dendrites synapse with incoming Mossy fibers. Their axons pass into molecular layer end into a T termination. These fibers also synapse with golgi cells, basket cells & stallate cells.

WHITE MATTER OF CEREBELLUM:


3 TYPES OF FIBERS: INTRINSIC FIBERS AFFERENT FIBERS EFFERENT FIBERS

INTRINSIC FIBERS:
Pass between cerebellar cortex & vermis. Also pass from 1 cerebellar hemisphere to other. They remain in the cerebellum.

AFFERENT FIBERS:
2 TYPES: CLIMBING FIBERS (come from inferior olivary nucleus) MOSSY FIBERS (all the other afferent fibers except the climbing are called Mossy fibers).

EFFERENT FIBERS:
Start as axons of purkinje cells.

Most of these axons synapse onto deep nuclear cells. From deep nuclear cells, efferent fibers arise go to different parts of CNS . Only few purkinje fibers bypass deep nuclear cells go to vestibular nuclei (these are from vermis & flocculo-nodular lobe).

There is a neuronal circuit in cerebellum. Millions of functional units.


Each functional unit consist of a purkinje cell & a deep nuclear cell. Climbing fibers give collaterals, which synapse with deep nuclear cells. collaterals from climbing fibers excite deep nuclear cells. Climbing fibers pass to molecular layer synapse with dendrites of purkinje cells.

Mossy fibers collaterals synapse with deep nuclear cells. Mossy fibers granular layer synapse with dendrites of granule cell. 1 climbing fiber can synapse with about 10 purkinje cells. 1 mossy fiber can synapse with 100s of granule cells.

Excitatory: deep nuclear cells Granule cells Inhibitory: Purkinje cells Basket cells Golgi cells Stellate cells

When deep nuclear cells are to be excited, its through COLLATERALS from climbing & mossy fibers.
When inhibited, its through purkinje cells. Purkinje cells & deep nuclear cells discharge continuously (50-100 impulses/sec). This is the neuronal circuit in the cerebellum.

BASIC FUNCTION OF CEREBELLUM:


To control timing of turn-on signals to agonists & turn-off signals to antagonists at the onset of a movement & then To control timing of turn-off signal to agonists & turn-on signals to antagonists at the end of a movement.

Basic disturbance in cerebellar disease ATAXIA / INCOORDINATION OF MOVEMENT.

CONNECTIONS OF CEREBELLUM THROUGH 3 PEDUNCLES: AFFERENT EFFERENT Superior peduncle midbrain Middle peduncle pons Inferior peduncle medulla

INFERIOR CEREBELLAR PEDUNCLE CONNECTIONS:


AFFERENTS: Posterior spino-cerebellar tract.

Cuneo-cerebellar tract (from cuneate nucleus). Vestibulo-cerebellar fibers (from vestibular nuclei). Reticulo cerebellar (from reticular formation). Olivo-cerebellar (from inferior olivary nucleus).

EFFERENTS: Cerebello-vestibular Cerebello-reticular

MIDDLE PEDUNCLE:
Mainly AFFERENTS (Ponto-cerebellar fibers). These fibers arise from pontine nuclei & cross over to opposite side middle cerebellar peduncle. These fibers are part of cortico-pontocerebellar pathway.

SUPERIOR PEDUNCLE:
AFFERENTS: Anterior spinocerebellar tract. Rubro-cerebellar tract (from red nucleus).

Tecto-cerebellar (from tectum of midbrain).

EFFERENTS: To Red nucleus, then to thalamic nuclei then to Cerebral cortex. Other fibers go directly ventrolateral & ventro anterior thalamic nuclei cerebral cortex . Some basal ganglia.

CEREBELLUM HAS RECIPROCAL CONNECTIONS


1) CEREBRAL CORTEX 2) RETICULAR FORMATION 3) VESTIBULAR NUCLEI 4) RED NUCLEUS AFFERENTS EFFERENTS

FUNCTIONS OF CEREBELLUM:
Functionally divided into 3 parts: 1) lateral zone 2) intermediate zone 3) flocculo-nodular lobe & vermis.

LATERAL ZONE: FUNCTION


No body representation. Also called cerebro-cerebellum (extensive connections with cerebral cortex). Program & plan movement. Plans sequence & timing of each component of movement. Smooth progress of movement, e-g, eating the curry & bread (bread curry mouth).

*cerebellum does not INITIATE movement BUT COORDINATES it.

In cerebellar disease loss of smooth progression of movements. Extra motor predictive function.
Helps to access timing of movement.

INTERMEDIATE ZONE: FUNCTION


Also called spino-cerebellum, due to connection with spinal cord. Face & limbs are represented. Coordination of movements (distal part of limbs). Acts as a comparator. Compares intended plan of movement with actually performed movement. In case of discrepancy, corrective signals are sent.

Cerebellum gets intended plan of movement from motor cortex & also from red nucleus.

Fig shows cerebral & cerebellar control of voluntary movements involving especially intermediate zone & its associated nucleus interpositus.

It recieves information actually performed movements from PROPRIOCEPTORS through spino-cerebellar tracts. Compared & corrected via signals through red nucleus & thalamic nuclei to motor cortex.

Also controls: rate, range & direction of movement. Damping function. Prevents pendular movements & tremors (pendular knee jerk in case of disease)

Also controls very rapid movements like typing (ballistic movements). Also controls very rapid eye movement (reading & when a person in a moving vehicle, fixate the outside scene).

FUNCTION OF FLOCCOLONODULAR LOBE & VERMIS:


Controls posture & equilibrium. Also concerned with motion sickness. Controls stretch reflex & muscle tone. Normal influence is facilitatory on stretch reflex & muscle tone. From here purkinje nerve fibers vest nuclei (bypass deep nuclear cells) Also called vestibulo-cerebellum due to connection with vestibular nuclei.

CEREBELLAR DISEASE:
Involvement of cerebellar cortex & 1 or more of deep cerebellar nuclei. *No muscle paralysis & no sensory loss occurs. (MCQ)

FEATURES: 1) ATAXIA:
Incoordinate movements due to defect in control of RANGE, DIRECTION, RATE & TIMING of movement. Asynergia (no synergism between agonists & antagonists; normal synergism = when agonists contract, antagonists relax).

2) DYSMETRIA & PAST POINTING:


Inability to control range or extent of movement. Dysmetria also manifest as past pointing. When patient tries to touch an object hand overshoots (past pointing).

3) ADIADOCOKINESIA / DYSDIADOCOKINESIA:
Inability to perform RAPID, ALTERNATE, OPPOSITE movement (rapid supination & pronation of arm).

4) DRUNKEN GATE / STAGGERING GATE:


Patient walks on a broad base. SPECIFIC POSTURE: Head is rotated & flexed towards the side of lesion.

5) SLURRED SPEECH:
Due to dysarthria ( disordered articulation). Incoordination of muscles of articulation. Some words or syllables are spoken loud & others are spoken in weak tone. Some are held for long period & some are spoken short.

6) INTENTION TREMORS / ACTION TREMORS:


Absent at rest. Appear when patient performs some voluntary action. Example of drinking water from a cup.

7) REBOUND PHENOMENON:
Patient cannot stop a movement abruptly. Example of flexion of elbow may hit his face.

8) DECOMPOSITION OF MOVEMENTS:
Patient is not able to perform actions involving simultaneous movement at more than 1 joint. Movements are broken into components. Loss of smooth progression of 1 movement to other.

9) NYSTAGMUS:
Rhythmic rapid movement of eyeballs when eyes are focused on 1 side. Cerebellum has a damping function, which is disturbed.

10) PENDULAR KNEE JERK:


Due to loss of damping function of intermediate zone of cerebellum.

11) HYPOTONIA:
Due to loss of excitatory action of cerebellum on stretch reflex & muscle tone.