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The Cerebellum 陽明大學醫學院 神經學系 陳昌明 醫師. Position Lies above and behind the medullar and pons and occupies posterior cranial fossa Cerebellum.

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Presentation on theme: "The Cerebellum 陽明大學醫學院 神經學系 陳昌明 醫師. Position Lies above and behind the medullar and pons and occupies posterior cranial fossa Cerebellum."— Presentation transcript:

1 The Cerebellum 陽明大學醫學院 神經學系 陳昌明 醫師

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3 Position Lies above and behind the medullar and pons and occupies posterior cranial fossa Cerebellum

4 Cerebellum External Configurations Cerebellum External Configurations Located in posterior cranial fossa Located in posterior cranial fossa Tentorium cerebelli (cerebrum), 4 th Tentorium cerebelli (cerebrum), 4 th ventricle (brain stem) ventricle (brain stem) Communicate with other structure via Communicate with other structure via superior, middle, and inferior cerebellar peduncle superior, middle, and inferior cerebellar peduncle

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6 External features Consists of two cerebellar hemisphere united in the midline by the vermis

7 External features Three peduncles Inferior cerebellar peduncle 下小腦脚 - connect with medulla and with spinal cord, contain both afferent and efferent fibers Middle cerebellar peduncle 中小腦脚- connect with pons, contain afferent fibers Superior cerebellar peduncle 上小腦脚- connect with midbrain, contain mostly efferent fibers

8 Cerebellum Longitudinal division  Vermis, Paravermal Region, Cerebellar Hemisphere Transverse division  Anterior Lobe  Posterior Lobe  Flocculonodular Lobe

9 Lobes Primary fissure Posterolateral fissure Flocculonodular lobe Anterior lobe Posterior lobe corpus of cerebellar

10 Lobes Two deep fissures  Primary fissure  Posterosuperior fissure Three lobs  Flocculonodular lobe 絨 球小結葉 flocculus and nodule  Anterior lobe  Posterior lobe Corpus of cerebellar

11 External features Tonsil of cerebellum 小腦扁桃体 two elevated masses on inferior surface of hemispheral portion just nearby foramen magnum Tonsil Superior surface View from below

12 Cbm unfold Functional divisions of cerebellar cortex

13 External features Cerebellum & Brainstem, Inferior Surface, Anterior View

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15 Subdivision of Flocculonodular Lobe Subdivision of Flocculonodular Lobe Nodulus Flocculus Nodulus Flocculus Subdivision of Anterior Lobe Subdivision of Anterior Lobe Vermis Hemisphere Vermis Hemisphere Lingula Lingula Central Lobule Ala Central Lobule postcentral fissure postcentral fissure Culmen Quadriangular Lobule Culmen Quadriangular Lobule Cerebellum External Configurations Cerebellum External Configurations

16 Subdivision of Posterior Lobe Subdivision of Posterior Lobe Vermis Hemisphere Vermis Hemisphere Declive Simple Lobule Declive Simple Lobule postcentral fissure postcentral fissure Folium Superior Semilunar Lobule Folium Superior Semilunar Lobule horizontal fissure horizontal fissure Inferior Semilunar Lobule Inferior Semilunar Lobule Tuber Tuber Gracile Lobule Gracile Lobule prepyramidal fissure prepyramidal fissure Pyramis Biventer Lobule Pyramis Biventer Lobule secondary fissure secondary fissure Uvula Tonsil Uvula Tonsil Cerebellum External Configurations Cerebellum External Configurations

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18 Cerebellar Cortex Molecular Layer Purkinje Cell Layer Granular Layer Corpus Medullare (Medullary Center) Deep Cerebellar Nuclei Fastigial Nuclei Nucleus Interpositus Emboliform Nucleus Globose Nucleus Dentate Nucleus Cerebellum Internal Configurations Cerebellum Internal Configurations

19 Internal structures Gray matter Cerebellar cortex Cerebellar nuclei  Dentate nucleus 齒狀核  Fastigial nucleus 頂核  Interposed nucleus 中間核 Emboliform nucleus 栓狀核 Globose nucleus 球狀核 White matter - medullary center 髓体

20 1. fastigial nucleus nucleus 2. globose nucleus nucleus 3. emboliform nucleus nucleus 4. dentate nucleus nucleus Deep Nuclei

21 Internal structures Cerebellar cortex Dentate nucleus Fastigial nucleus Globose nucleus Emboliform nucleus medullary center

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26 Cerebellar Cortex Inputs Output Interneurons Climbing fibers from Inferior olive Mossy fibers Purkinje neurons Stellate neurons Granule neurons Basket neurons Golgi neurons Molecular Purkinje Granular NTA Fig

27 Cerebellar Cortex I. Molecular Layer Stellate Cell --- taurine (inhibitory) afferent: parallel fiber efferent: Purkinje cell dendrite Basket Cell ---- GABA (inhibitory) afferent: parallel fiber efferent: Purkinje cell soma Parallel Fiber granule cell axon Purkinje Cell Dendrite Cerebellum Internal Configurations Cerebellum Internal Configurations

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31 Cerebellar Cortex II. Purkinje Cell Layer Purkinje Cell -- 15,000,000 in number -- GABA (inhibitory) afferent from: parallel fiber climbing fiber stellate cell basket cell efferent to: deep cortical nuclei Bergman’s glial cell Cerebellum Internal Configurations Cerebellum Internal Configurations

32 Cerebellar Cortex III. Granular Layer Granular Cell Granular Cell -- 50,000,000,000 in number -- 50,000,000,000 in number -- glutamic acid (excitatory) -- glutamic acid (excitatory) afferent: mossy fiber afferent: mossy fiber efferent: Purkinje cell dendrite efferent: Purkinje cell dendrite basket cell, stellate cell basket cell, stellate cell Golgi cell Golgi cell Golgi Cell Golgi Cell -- GABA (inhibitory) -- GABA (inhibitory) afferent: parallel fiber, mossy fiber rosette afferent: parallel fiber, mossy fiber rosette efferent: granule cell dendrite efferent: granule cell dendrite Cerebellum Internal Configurations Cerebellum Internal Configurations

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34 1. Purkinje cell 2. granule cell 3. basket cell 4. Golgi cell 5. stellate cell 6. climbing fiber 7. mossy fiber 8. parallel fiber 9. inferior olivary nucleus 10. deep cerebellar nuclei

35 Synaptic Glomerulus Afferent terminals on granular layer Afferent terminals on granular layer  Mossy Fiber Rosette  Mossy Fiber Rosette -- afferent fibers except -- afferent fibers except inferior olivary input inferior olivary input -- 2/3 of medullary center -- 2/3 of medullary center  Granular Cell Dendrite  Granular Cell Dendrite -- main afferent input -- main afferent input  Golgi Cell Axon  Golgi Cell Axon -- synapse on granule cell dendrite -- synapse on granule cell dendrite -- GABA (inhibitory) -- GABA (inhibitory) - Surrounded by Astrocyte Foot Process - Surrounded by Astrocyte Foot Process Cerebellum Internal Configurations Cerebellum Internal Configurations

36 Synaptic Glomerulus

37 Classification by Phylogenetic and Ontogenic Development Archicerebellum Archicerebellum Paleocerebllum Paleocerebllum Neocerebellum Neocerebellum Classification by Afferent Connection Vestibulocerebellum Vestibulocerebellum Spinocerebellum Spinocerebellum Pontocerebellum Pontocerebellum Classification by Efferent Connection Vermis Vermis Paravermal Region Paravermal Region Cerebellar Hemisphere Cerebellar Hemisphere Cerebellum Classifications Cerebellum Classifications

38 Archicerebellum (nodulus) Archicerebellum (flocculus) Paleocerebellum Neocerebellum

39 Spinocerebellum Pontocerebellum Vestibulocerebellum

40 Afferent Connections (1): 1. Inferior Cerebellar Peduncle Restiform Body Restiform Body Posterior Spinocerebellar Tract Posterior Spinocerebellar Tract Olivocerebellar tract Olivocerebellar tract Cuneocerebellar Tract Cuneocerebellar Tract Reticulocerebellar Tract Reticulocerebellar Tract Juxtarestiform Body Juxtarestiform Body Vestibulocerebellar Tract Vestibulocerebellar Tract Primary Vestyibular Fiber Primary Vestyibular Fiber Cerebellum Connections Cerebellum Connections

41 Afferent Connections (2): 2. Middle Cerebellar Peduncle Pontocerebellar fiber Pontocerebellar fiber Corticopontocerebellar Fiber Corticopontocerebellar Fiber Reticulocerebellar Fiber Reticulocerebellar Fiber 3. Superior Cerebellar Peduncle Anterior Spinocerebellar Tract Anterior Spinocerebellar Tract Cerulocerebellar fiber Cerulocerebellar fiber Raphecerebellar fiber Raphecerebellar fiber Rubrocerebellar fiber Rubrocerebellar fiber Hypothalamocerebellar fiber Hypothalamocerebellar fiber Cerebellum Connections Cerebellum Connections

42 Efferent Connections : 1. Superior Cerebellar Peduncle Cerebellothalamic fiber - from 3 deep nuclei to VPLo, VLc, CL Cerebellorubral fiber - from nucleus interpositus and dentate nucleus ascending portion of uncinate fasciculus of Russell 2. Inferior Cerebellar Peduncle Fastigiovestibular fiber descending portion of uncinate fasciculus of Russell Cerebellum Connections Cerebellum Connections

43 Three functional divisions Vestibulocerebellum 前 庭小腦  Archicerebellum 原小 腦  Flocculonodular lobe Spinocerebellum 脊 髓小腦  Paleocerebellum 舊小 腦  Vermis and intermediate zone Cerebrocerebellum 大 腦小腦  Neocerebellum 新小 腦  Lateral zone Flocculonodular lobe Vermis Intermediate zone Lateral zone

44 IV th vent Vermis Intermediate hem. Spinocerebellum: Vermis Intermediate hem. Spinocerebellum (Vermis + Intermed. Hem) Control of limbs and trunk Lateral hem. Cerebrocerebellum: Lateral hem. Cerebrocerebellum (Lateral hemisphere) Planning of movement+ Floculo-nodular lobe Vestibulo-cerebellum (Floculo-nodular lobe) Control of eye & head movements Balance Cerebellar divisions NTA Fig. 13-1

45 Connections and function of cerebellum Vestibulocerebellum Connections  Afferents: receive input from vestibular nuclei and primary vestibular  Efferents: projects to the vestibular nucleus → (1) vestibulospinal tract → motor neurons of anterior horn for reflexively control of equilibrium (2) vestibulo-ocular tract → medial longitudinal fasciculus → CN nucleus 3, 4, 6 for EOM control. Function: involved in eye movements and maintain balance

46 MLF Main Connections of the Vestibulocerebellum lower motor neuron lower motor neuron LMN LMN vestibulospinal tract FASTIGIAL NUCLEUS NUCLEUS Vestibular Organ Organ Floculonodular Lobe Lobe Vermis Vermis ARCHICEREBELLUM VESTIBULAR NUCLEUS

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48 Main Connections of the Paleocerebellum lower motor neuron lower motor neuron SPINAL CORD rubrospinal tract tract NUCLEUS NUCLEUSINTERPOSITUS Inferior Inferior Olivry OlivryNucleus ANTERIOR ANTERIOR LOBE LOBEPARAVERMAL ZONE ZONE PALEOCEREBELLUM RED NUCLEUS RED NUCLEUS spinocerebellar tract

49 Spinocerebellar tracts End mainly in the anterior lobe, the paramedian lobule, and the pyramis of the posterior lobe

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51 Connections and function of cerebellum Cerebrocerebellum Connection  Afferents: receives input from the cerebral cortex via a relay in pontine nuclei  Efferents: projects to dentate nucleus → VI → primary motor cortex → corticospinal tract → motor neurons of anterior horn Function: participates in planning movements

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56 CEREBRAL CORTEX CORTEXCEREBRAL DENTATENUCLEUSDENTATENUCLEUS Main Connections of the Neocerebellum lower motor neuron lower motor neuron LMN LMN pyramidal tract tract POSTERIORLOBECEREBELLAR HEMISPHERE HEMISPHEREPOSTERIORLOBECEREBELLAR THALAMUSTHALAMUS NEOCEREBELLUM PontineNucleusPontineNucleus

57 upper motor neuron UMN UMN BASALGANGLIABASALGANGLIA Pyramidal Tract and Associated Circuits lower motor neuron UMN UMN pyramidal tract CerebellumCerebellum

58 Reticular Formation Reticular Formation CEREBELLUM Cerebellum and Automatic Motor Control Lower Motor Neuron (LMN) Motor Cortex Red Nucleus Vestibular Nucleus Vestibular Nucleus ProprioceptorsProprioceptors

59 Cerebellum---- connection Corticonuclear Connections A zone fastigial nucleus medial vestibular nucleus B zone lateral vestibular nucleus C1, C3 zone --- emboliform nucleus C globose nucleus D parvocellular portion of dentate nucleus D magnocellular portion of dentate nucleus

60 1. vermis 2. paravermal region 3. cerebella hemisphere 4. nodulus 5. flocculus 6. fastigial nucleus 7. globose nucleus 8. emboliform nucleus 9. dentate nucleus 10. medial vestibular nucleus 11. lateral vestibular nucleus

61 Olivocerebellar Connections (1) Caudal portion of medial and dorsal accessory olivary nucleus vermis of cerebellar cortex (A and B) fastigial nucleus vestibular nucleus (2) Rostral portion of medial and dorsal accessory olivary nucleus paravermal region (C1, C2, C3) nucleus interpositus (3) Principal Inferior Olivary Nucleus cerebellar hemisphere (D1, D2) dentate nucleus Cerebellum Connections Cerebellum Connections

62 Olivo-cerebellar system The inferior olivary complex  Principal olive, medial and dorsal accessory olive, and medial lamina. 1.5 million cells  Send climbing fibers to all cerebellar cortex in a specific topographic manner A Small area in the inferior olive is linked to a definite area of the cerebellar output

63 The inferior olivary complex  Receives projections from The spinal cord  crossed ventral and dorsal spino-olivary tracts The brainstem (esp. red nuclei) Cerebellar nuclei  Interpositus & dentate nuclei exert an inhibitory effect Pretectal nuclei  Relaying optokinetic information Cerebrum  Motor cortex (area 4), premotor cortex (area 6)  Visual and Vestibular areas  Zona incerta of the thalamus  Relay for the projections from the motor cortex, prefrontal, cingulate, parietal and temporal area

64 medial and dorsal accessory olivary nucleus caudal portion rostral portion Principal Inferior Olivary Nucleus

65 Functional divisions of cerebellar cortex Vermis Intermediate hem Cerebrocerebellum Lateral hemisphere Spinocerebellum Vestibulo- cerebellum Floculo-nodular lobe

66 Functional divisions of cerebellar cortex --> Deep nuclei Cerebrocerebellum Lateral hemisphere Dentate Intermediate hemisphere Inter posed To lateral sysetms Spinocerebellum Vermis Fastigial To medial sysetms To frontal motor areas Motor Planning +++ Motor execution Vestibulo- cerebellum To vestibular nuclei Eye mvt & balance

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68 Reticular nuclei Lateral reticular nuclei (lateral to inferior olive)  Sent mossy fibers to bilateral cerebellum (ipsilateral dominant) via superior cerebellar peduncle.  Receive excitatory reciprocal input from the cerebellar nuclei  Receive collaterals from propiospinal neurons Relay motor information to cerebellum

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70 Organization of Motor Subsystems

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78 Cerebellum Function Cerebellum Function  Maintenance of Equilibrium - balance, posture, eye movement  Coordination of half-automatic movement of walking and posture maintenance - posture, gait  Adjustment of Muscle Tone  Motor Leaning – Motor Skills  Cognitive Function

79 Balance

80 Motor Skill Pablo Casals

81 Cerebellum Clinical Syndromes Cerebellum Clinical Syndromes Ataxia: incoordination of movement - decomposition of movement - dysmetria, past-pointing - dysdiadochokinesia - rebound phenomenon of Holmes - gait ataxia, truncal ataxia, titubation Intention Tremor Hypotonia, Nystagmus Archicerebellar Lesion: medulloblastoma Paleocerebellar Lesion: gait disturbance Neocerebellar Lesion: hypotonia, ataxia, tremor

82 Posture Gait – Ataxia Tremor

83 CerebellarAtaxia Ataxic gait and position: Left cerebellar tumor Left cerebellar tumor a. Sways to the right in a. Sways to the right in standing position standing position b. Steady on the b. Steady on the right leg right leg c. Unsteady on the c. Unsteady on the left leg left leg d. ataxic gait d. ataxic gait abc d

84 Cerebellar tumors on vermis - Truncal Ataxia - Truncal Ataxia - Frequent Falling - Frequent Falling The child in this picture: - would not try to stand - would not try to stand unsupported unsupported - would not let go of the bed rail - would not let go of the bed rail if she was stood on the floor. if she was stood on the floor. Cerebellar Medulloblastoma

85 Thank you for your attention


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