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SF2 - Test 3 > 3 - Cerebellum > Flashcards

3 - Cerebellum Flashcards

1
Q

How is the cerebellum connected to the thalamus?

Does the cerebellum connect directly to the psinal cord?

A

Deep Cerebellar Nuclei

No, cerebellum does not project directly to the spinal cord

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2
Q

Major cerebellar contributions to the motor system?

Clinical overview?

A

Balance, equilibrium, posture, muscle tone, coordination, adjustment (voluntary motor activity)

NO direct projections to the cortical spinal system

Clinical: Voluntary movement dirorders

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3
Q

Cerebellum attachment to pons and rostral medulla?

A

3x white matter peduncles

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4
Q

Most common malignant brain tumor of childhood?

A

Medulloblastomas

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5
Q

Lobes and Key Function of Cerebellum?

A

Anterior - Spinocerebellar

Posterior - Corticopontocerebellar

Flocculonodular - Flocculus and Nodulus (Vestibular system)

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6
Q

Clinical: Tonsillar Herniation

A

High ICP (bleeds, etc) can push tonsil into foramen magnum and compress the medulla

Impinge the medullary respiratory centers and reticular activating system

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7
Q

What is unique about the flocculonodular lobe?

A

Only cerebellar lobe which does not relay through a deep cerebellar nucleus

Key part of vestibular system

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8
Q

What do cerebellum have in place of gyri?

A

Folia (‘leaves’)

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9
Q

What are the three white matter peduncles of the cerebellum?

A

Superior (decussates)

Middle (Association Cortex, “where do I want to be”)

Inferior (priprioceptive, “where am I”)

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10
Q

What separates the posterior and flocculonodular lobe?

A

Posterolateral fissure

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11
Q

What is the major output from the cerebellum?

Target?

Unique feature?

A

Superior Cerebellar Peduncle or “Brachium Conjuntivum”

Target: Red Nucleus

Feature: Decussates

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12
Q

Clinical: What side will symptoms usually present with cerebellar lesions?

A

Ipsilateral

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13
Q

Middle Cerebellar Peduncle (Brachium Pontis)

Relative Size

Target

Function

A

Size: Largest Cerebellar Peduncle

Target: Pons

Function: Carries afferent pontocerebellar fibers to the cerebellum

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14
Q

Inforerior Cerebellar Peduncle (restiform body)

Targets

Divisions

Function

A

Target: Medulla/Rostral Pons

Divisions:

  1. Restiform Body - Afferent fiber system w/3 major tracts
  2. Juxtarestiform Body - Afferent/Efference fiber tracts

Function: Conveys some efferent information to the vestibular nuclei

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15
Q

Layers of the Foilia (“tree of life”):

Granule Cell Layer

Purkinje Cell Layer

Molecular Cell Layer

A
  1. Granule Cell Layer - Small/tight packed layer of excitatory interneurons
  2. Purkinje Cell Layer - Purkinje cell bodies
  3. Molecular Cell Layer - Majority of synapses; has:
    a. Unmyelinated granule axons
    b. Purkinje cell dendrites
    c. Interneurons
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16
Q

Neuronal Organization within Folia:

Inputs

Output

A

Input (2)

  1. Mossy Fibers - Excitatory
  2. Climbing Fibers (inferior olive only) - Excitatory

- - -

Output (1)

Purkinje Cells - Inhibitory; All output (except flocculonodular lobe) to Deep Cerebellar Nuclei

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17
Q

Neuronal Organization within the Folia:

Excitatory / Inhibitory Interneurons

A

Excitatory: Granule Cells - Granule Cell Layer

Inhibitory:

  1. Golgi Cells - Granule Cell layer; Feedback inhibition on granule cells
  2. Basket and Stellate Cells - Molecular layer; Provide Lateral inhibition of adjacent purkinje cells
18
Q

What is the target of inhibitory purkinje cells?

Exceptions?

A

Synapse with neurons in the Deep Cerebellar Nuclei

Exception: Those coming from the flocculonodular lobe

19
Q

Four Deep Cerebellar Nuclei?

Majority pass through?

A

D E G F

Destate Nuclei

Emoboliform Nuclei

Globose Nuclei

Fastigial Nuclei

E/G = Interposed Nuclei

Majority pass through superior cerebellar peduncle and relay in thalamus before projecting to cortex

20
Q

Where does the flocculonodular lobe send projections?

What is the nature of information flow?

A

Goes to Vestibular Nuclei; coordination of reflexive equilibrium and balance

**BYPASS DEEP CEREBELLAR NUCLEI**

Direct and reciprocal

21
Q

Cerebellar Afferents: Corticopontine Fibers

Connections

Inputs

Output

Entrance*

A

Connection: Frontal, Temporal, Parietal, Occipital Lobes

Input: Majority from sensory and motor cortex

Output: Project to ipsilateral pontine nuclei via Internal Capsule

Entrance: Middle Cerebellar Penducle (*exclusively afferent)

22
Q

Cerebellar Afferents: Spinocerebellar Fibers

  1. Dorsal Spinocerebellar tract (LLP)
  2. Cuneocerebellar Tract (ULP)
  3. Ventral Spinocerebellar Tract (LS)
  4. Rostral Spinocerebellar Tract (US)
A
  1. Dorsal Spinocerebellar tract (LLP) - Lower Limb motor, limb/proprioception
  2. Cuneocerebellar Tract (ULP) - Upper Limb motor, limb/proprioception
  3. Ventral Spinocerebellar Tract (LS) - Lower Limb sensory, spinal/interneurons
  4. Rostral Spinocerebellar Tract (US) - Upper Limb sensory, spinal/interneurons
23
Q

Cerebellar Pathways: Inferior Olivary Nuclear Complex

A

Arise from contralateral inferior olivary nucleus in medulla

Decussate then enter inferior cerebellar peducle

Large excitatory input onto purkinje neurons

24
Q

Deep Cerebellar Nuclei and Efferents:

Dentate Nuclei

Input

A

Input from lateral cerebellar hemisphere

Largest deep cerebellar nuclei

25
Q

Deep Cerebellar Nuclei and Efferents:

Interposed Nuclei

Input

A

Input: Intermediate part of cerebellum

26
Q

Deep Cerebellar Nuclei and Efferents:

Fastigial Nuclei

Input

A
  1. From Vermis/Medial part of cerebellum
  2. Small input from flocculobodular lobe
27
Q

Deep Cerebellar Nuclei and Efferents:

Vestibular Nuclei (medulla)

Input

A

Input: Inferior Vermis and flocculonodular love

28
Q

Lateral vs Intermediate Hemispheres of Cerebellum

Function

Nuclei

Output

A

Lateral Hemisphere:

Function: Skilled motor activity

Nuclei: Dentate Nuclei

Output: Red Nucleus, VL Thalamus, Inferior Olive

Intermediate Hemisphere:

Function: Muscle tone, posture, coordination; moment to moment corrections

Nuclei: Interposed Nuclei

Output: Red Nucleus, VL Thalamus

29
Q

Deep Cerebellar Nuclei and Functional Divisions:

Vermis vs Vestibulocerebellum

Function

Nuclei

Peduncle

Output

A

Vermis:

Function: Mx and adjustment of trunk posture

Nuclei: Fastigial Nucleus

Peduncle: Superior

Output: Vestibular nuclues, Reticular Formation, VL Thalamus

Vestibulocerebellum:

Function: Posture, balance, and coordination of eye movements

Nuclei: Vestibular

Peduncle: Inferior (input and output)

30
Q

Most common infarcts of cerebellum?

A

PICA / SCA

Vertigo, nausea, vomiting, horizontal nystagmus, lumb ataxia, unsteady gait, headache

31
Q

Clinical: General ipsilateral signs of cerebellar dysfunction?

A

Hypotonia - reduced muscle tone

Ataxia

Dysmetria - over/under shooting intended movement

Vertigo

Falling toward ipsilateral side

32
Q

Clinical: Cerebellar Dysfunction - Midline (Vermis) Lesion

A

Bilateral deficits (midline.. duh)

Symptoms: Truncal Ataxia - Fall/sway toward lesion

Cerebellar Dysarthria (scanning speech)

Nystagmus (especialli if flocculonodular lobe is involved)

33
Q

Clinical: Nystagmus sympton in cerebellar lesion–what is likely involved?

A

Flocculonodular Lobe

34
Q

Clinical: Cerebellar Dysfunction - Hemisphere Lesion

A

Hypotonia (reduced muslce tone)

Intention Tremor (under voluntary movement)

Dysmetria (finger to nose)

Adiadochokinesis (rapid alternating movements)

35
Q

Clinical: Cerebellar Dysfunction - Cerebellar Hemorrhage

A

Cause: Chronic Hypertension, trauma

Symptoms: Headache, nausea, comiting, ataxia, nystagmus

Large Hemorrhage: Sixth-Nerve palsies; impaired consciousness

Severe swelling can compomise respiration

36
Q

Clinical: Cerebellar Dysfunction - Friedreiche’s Ataxia

A

Autosomal Recessive Neurodegenerative disorder

Targets dorsal and lateral column

Cerebellar: Peduncle, Dorsal / Ventral Spinocerebellar tracts, Purkinje Nuerons, Clark’s Nucleus

Symptoms: (around 5-15)

Ataxia

Areflexia

Impaired fine touch

Vibration

Progressive weakness, Babinksi

37
Q

Clinical: Cerebellar Dysfunction - Wernick’e Encephalopathy

A

Cause: Cerebellum sensitive to alcohol and malnourishment, particularly Vitamin B1

Can affect cerebellum

Symptom Triad:

  1. Confusion
  2. Gait Ataxia
  3. Nystagmus

Wernicke-Korsakoff Syndrome – Severe Amnesia and Confabulation

“…ALCOHOLIC” stem, think this

38
Q

Clinical: Cerebellar Dysfunction - Medulloblastoma

A

20% of all intracranial tumors in young children

Malignant invasive cancer that begins in posterior fossa, involves vermis

Symptoms:

Truncal Ataxia, Poor coordination, Headache, Nausea, Vomiting, Tiredness, Dizziness, Diplopia, Nystagmus, Tinnitis

39
Q

Cerebellar Afferents:

Dorsal Spinocerebellar vs Cuneocerebellar

A

Dorsal: Lower Body

Enters dorsal root (C8 - L2)

Gracile Fasciculus

Inferior Cerebellar Peduncle

Ipsilateral

Cuneo: Upper body

Enters dorsal root

Cuneate Fasciculus

Inferiore Cerebellar Peduncle

Ipsilateral

40
Q

Cerebellar Afferents:

Ventral Spinocerebellar vs Rostral Spinocerebellar

A

Ventral:

Ventral Commissure - crossing

Superior Cerebellar Peduncle - crossing

Double Cross = Ipsilateral

Rostral:

Inferior Cerebellar Peduncle

Ipsilateral

41
Q
A

SF2 - Test 3 (25 decks)

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