Updated: 5/17/2020

Cerebellum

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Overview
 

Introduction
  • Function
    • to smoothly coordinate movement
    • to play a role in motor planning and balance
  • Anatomy
    • the cerebellum is derived from the metencephalon and is found
      • dorsally to the pons and rostral medulla which are attached by cerebellar peduncles
        • between the cerebellum and this portion of the brainstem you will find the
          • fourth ventricle
    • the cerebellum contains
      • the vermis and flocculonodular lobes which play an important role in
        • proximal and truncal muscle control (vermis)
        • vestibulo-ocular control (flocculonodular lobes)
      • cerebellar hemisphere can be divided into
        • intermediate hemisphere which plays an important role in
          • distal appendicular muscle control
        • lateral hemisphere which plays an important role in
          • motor planning
      • cerebellar peduncles
        • superior cerebellar peduncles
          • mainly carries output signals
        • middle and inferior cerebellar peduncles
          • mainly carries input signals to the cerebellum
    • deep cerebellar nuclei can be arranged from lateral → medial as
      • Dendate nuclei
      • Eboliform
      • Globos
      • Fastigial
      • mnemonic: "Dont Eat Greasy Food"
  • Circuitry
    • input
      • brain (via the pontocerebellar and climbing fiber) to the cerebellum via the
        • middle cerebellar peduncle
      • spinal cord (via the spinocerebellar and climbing fibers) to the cerebellum via the
        • inferior cerebellar peduncle (there are exceptions)
      • vestibular system to the cerebellum via
        • juxtarestiform body (in the inferior cerebellar peduncle)
    • output
      • all cerebellar outputs are carried by Purkinje cells which synapse in the
        • deep cerebellar nuclei or vestibular nuclei
          • which deep cerebellar nuclei the Purkinje cell synapse with is dependent on where the Purkinje cell arose from
            • Purkinje cells from
              • lateral cerebellum synapse to the dendate nucleus which
                • exits the cerebellum via the superior cerebellar  peduncle → contralateral VL of the thalamus → motor cortex and supplementary motor areas to influence the corticospinal system for motor planning
              • intermediate cerebellum synapses to the eboliform and globose nucleus
                • exits the cerebellum via the superior cerebllar pendcuncle → contralateral VL of the thalamus motor cortex and supplementary motor areas to influence the lateral corticospinal tract
              • vermis synapses to the fastigial nucleus
                • eventually influencing the medial motor system
              • flocculonodular lobe synapses to the vestibular nucleus
                • eventually leading to vestibulo-ocular control
  • Clinical correlate
    • cerebellar disorders typically results in 
      • nausea, vomiting, and vertigo
      • slurred speech
      • uncoordinated limb movements
        • dysmetria (under- or over-shooting towards a target)
        • dysrhythmia
      • unsteadiness
    • lesion localization 
      • lesions to the vermis results in
        • truncal ataxia
      • lesions to the flocculonodular lobe results in
        • eye movement abnormalities
      • lesions to the cerebellar hemispheres results in
        • ipsilateral ataxia
  • Physical exam
    • physical exam maneuvers to test the cerebellum include
      • finger-to-nose and heel-to-shin test
      • finger tapping
      • rapid alternating movement
      • gait testing
        • truncal ataxia can present with
          • a wide-based and unsteady gait
      • testing for ocular dysmetria and nyastagmus
 

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