Cerebellum Flashcards

1
Q

What are the outputs of the vermal cerebellum?

A
  • Through the fastigial nucleus sends information to the vestibular nucleus and pontine reticular formation (bilaterally)
    • From here information descends in medial descending system through lateral vestibulospinal tract and pontine reticulospinal tract
    • Some neurons of flocculo-nodular lobe send axons directly to cells of vestibular nuclei
    • Together the efferent vermal information suggests a role in equilibrium and posture
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2
Q

Describe the anatomic divisions of the cerebellum.

A

The cerebellum is anatomically divided into the two hemispheres, the midline vermis and the flocculonodulus.

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3
Q

What are the functions of each cerebellar “lobe”?

A

The hemispheres are involved in appendicular control, the vermis is involved in axial control, and the flocculonodular lobe is involved in vestibular balance.

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4
Q

What is the afferent fiber from the inferior olives? Through which peduncle does it reach the cerebellum?

A

The afferent fiber from the inferior olives is the climbing fiber. It enters the cerebellum through the inferior cerebellar peduncle.

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5
Q

What is Mollaret’s triangle?

A

Mollaret’s triangle is a physiologic connection between the red nucleus, inferior olives, and dentate nucleus of the cerebellum. A lesion in this pathway can cause palatal myoclonus.

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6
Q

What are the deep nuclei of the cerebellum (medial to lateral)?

A

Medial to lateral, the cerebellar deep nuclei are fastigial, globus, emboliform, and dentate.

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7
Q

What are the common abbreviations for axonal tracts within the cerebellum signaling pathways?

A
SCP, Superior cerebellar peduncle; 
MCP, middle cerebellar peduncle; 
ICP, inferior cerebellar peduncle; 
DRT, dentatorubrothalamic; 
VSC, ventral spinocerebellar; 
CPC, corticopontocerebellar; 
SC, spinocerebellar; 
VC, vestibulocerebellar; 
LVS, lateral vestibulospinal; 
MLF, medial longitudinal fasciculus.
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8
Q

What are the three cerebellar peduncles? Which carry efferent/afferent fibers? Where are they seen in cross section? What tracts course through them?

A
Superior (SCP)	Midbrain	DRT and VSC
Middle (MCP)	Pons	CPC
Inferior (ICP)	Medulla	All other tracts to/from the cerebellum (mostly inferior olive, all are climbing fibers)
*DRT, dentatorubrothalamic; 
*VSC - ventral spinocerebellar;
*CPC - corticopontocerebellar;
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9
Q

Where does information go from the paravermal cerebellum?

A
  • Through the interposed nuclei
    • To the contralateral red nucleus (primarily)
    • Directing motor output through the rubrospinal tract, part of the lateral descending system
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10
Q

Where does the lateral hemispheric cerebellum send it’s information

A
  • Through the dentate nucleus
    • To the contralateral ventrolateral thalamus (VL) primarily
    • Influences wide areas of the cortex, particularly primary motor and associated motor cortex
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11
Q

Where does vestibular input to the cerebellum occur?

A
  • Arrives in the flocculo-nodular lobe

* Limited extent nearby regions of the posterior lobe

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12
Q

Information from the spinal cord enters the cerebellum where?

A
  • Distributed to the vermal and paramerval portions
    • Double somatotopic distribution is found (anterior and posterior lobe both)
    • Axial body surface found medially, distal limbs projecting laterally
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13
Q

What information is contained in the lateral zone of the cerebellum?

A

• Lateral zone does not receive any direct primary afferent input
• Vast amounts of information come to cerebellum from the cortex by way of pontine nuclei to end in the lateral zone
• Arises from primary motor cortex and associated motor cortex
• Contains collaterals of corticospinal and corticobulbar fibers
○ Corticobulbar has fibers that terminate in the medulla
• Cortical input is from contralateral cortex (at the level of the lateral zone of cerebellum)
○ From a synapse with ipsilateral neurons in the basal pons and pontine neurons send axons contralaterally to cerebellar hemispheres

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14
Q

What are the 4 functional regions of the cerebellum given in class?

A
• Vestibulocerebellum
	• Spinocerebellum
		○ Two subdivisions
		○ Vermis and paravermal contributions
	• Cerebrocerebellum
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15
Q

What are the principal inputs of the 4 functional regions?

A
• Vestibulocerebellum
		○ Vestibular sensory cells
	• Spinocerebellum (vermis)
		○ Visual, auditory, vestibular, somatosensory
	• Spinocerebellum (paravermis)
		○ Spinal afferents
	• Cerebrocerebellum
		○ Cortical afferents
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16
Q

What are the functions of the 4 functional areas of the cerebellum?

A
• Vestibulocerebellum
	○ axial control, vestibular reflex
	Balance, eye movement
• Spinocerebellum (vermis)
	○ axial motor control, posture, locomotion, gaze
• Spinocerebellum (paravermis)
	○ distal motor control
• Cerebrocerebellum
	○ initiation, planning, timing
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17
Q

What are the principal destinations of the 4 functional areas of the cerebellum?

A
•  Vestibulocerebellum
		○ axial motoneurons
	• Spinocerebellum (vermis)
		○medial systems
	• Spinocerebellum (paravermis)
		○ lateral system
		Red nucleus
	• Cerebrocerebellum
		○ integration areas (thalamus)
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18
Q

What are the main characteristics of cerebellar deficits?

A
  • Disturbances of synergy, equilibrium or tone
    • Always ipsilateral
    • Cerebellum communicates with ipsilateral side of body, contralateral motor cortex
    • Cerebellar lesions result in a loss of coordination (including equilibrium)
    • NO loss of muscle strength or sensation
    • Lesions of modest amounts of cerebellar cortex have little obvious motor effect and to do so must involve large regions of cortex or lesions of the underlying deep nuclei
19
Q

What is ataxia?

A

• Loss of synergy and loss of coordination or timing of the involved muscles
• Looks like past-pointing (dysmetria)
• Inability to bring a limb to a required or desired point in space
• Decomposition of movement or (dysdiadochokinesia)
• Often intention tremors perpendicular to the direction of the limb motion
○ Inappropriate coordination of antagonist muscles
• Extraocular problems
○ Inappropriate nystagmus
○ Slurred speech

20
Q

What is the helpful pneumonic for recognizing cerebellar deficits?

A
• HANDS Tremor
	• H - hypotonia
		○ Anterior lobe injury
	• A - ataxia
		○ Dysdiadochokinesia (impaired rapid alternating movements)
		○ Decomposition of movement
		○ Dysmetria (past-pointing)
	• N - Nystagmus
	• D - Dysarthria
	• S - stance and gait problems
	• Tremor - intention tremor, oscillation as limb approaches a target
21
Q

What types of cells are located in each of the cerebellar layers?

A

The molecular layer contains (1) stellate cells, (2) basket cells, (3) dendrites of Purkinje cells, (4) dendrites of Golgi type II cells, and (5) axons of granule cells.
The Purkinje layer contains the cell bodies of Purkinje cells.
The granular layer contains (6) granule cells, (7) Golgi type II cells, and (8) glomeruli (synaptic complexes that contain mossy fibers, axons and dendrites of Golgi type II cells, and dendrites of granule cells).

22
Q

What are the three layers of the cerebellar cortex?

A
  • Outermost molecular cell layer
  • Middle Purkinje cell layer
  • Innermost granular cell layer
23
Q

What type of fiber originating in the cerebellar cortex is inhibitory on the deep cerebellar nuclei?

A

Purkinje fibers originate in the cerebellar cortex and synapse on the deep nuclei as an inhibitory neuron

24
Q

Where does the dentatorubrothalamic tract synapse?

A

These fibers synapse in the ventrolateral (VL) nucleus of the thalamus before ascending to the cortex.

  • dentate nucleus
  • red nucleus
  • thalamus
25
Q

What are mossy fibers?

A
  • All information not from inferior olive are mossy fibers
    • Input to the cortex, form synaptic glomeruli with granule cells
    • Terminate in the granular layer and make excitatory synaptic contacts mainly with granule cells
    • Also with golgi cells
26
Q

All cerebellar cortical neurons make inhibitory synaptic connections with their targets EXCEPT…?

A

• Granule cells
• Ascending axons of granule cells branch in a T-shaped manner to form the parallel fibers
• They make excitatory synaptic contacts with purkinje cells and molecular layer interneurons
*mossy fibers generally synapse with granule cells

27
Q

Describe the relationship between a climbing fiber and a purkinje cell

A

• Climbing fibers have a more discrete distribution, each one contacting as few as one dozen purkinje cells
• Each purkinje cell si contacted by one climbing fiber
• This contact is extensive, with thousands of relese sites distributed over the soma and dendrites of the purkinje cell
• Single climbing fiber AP gives rise to burst of Purkinje fiber spikes
○ Complex spike, opposed to the parallel fiber’s simple spike

28
Q

Describe the resting function of purkinje cells

A
  • Like the globus pallidus (basal ganglia)
    • High rate of spontaneous activity
    • Generate AP at 50-100 Hz without excitatory input, thus are continuously suppressing activity of the deep cerebellar neurons
    • It takes inhibition of purkinje cells by basket and stellate cells to release the deep cerebellar neurons from inhibition
29
Q

What is the vestibular-ocular reflex?

A
  • VOR - vestibular ocular relfex
    • Involves the influence of the semi-circular canals upon the extraocular muscles of the eye to preserve constancy of visual field during head movements
    • Can be manipulated if you mess with the visual field (put prism glasses on animals)
    • VOR will adapt over time, according to changes in the visual field (if an image is reveresed than the VOR changes to reverse as well)
    • Adaptation of VOR is very dependent on the cerebellom and in particular the flocculo-nodular lobe
30
Q

What spikes in purkinje cell population seem to be associated with motor task learning?

A
  • Monkey and stabilizing a bar example
    • Monkey knew how to stabilize a bar and had only simple spikes (mossy fibers)
    • When the deflection force of the bar changed (the motor program to keep the bar steady changed) there was an increase in complex spikes (climbing fibers)
    • So the climbing fibers and complex spikes seem to be associated with motor learning
31
Q

What’s the interpretation of the monkey and bar experiement? (cerebellar function)

A

• Normal operation of the cerebellum directs or tunes the planned motor output in accordance with expectation
○ Somehow programmed through the inferior olive
• It also tunes with respect to actual motor performance (rehearsed action)
• When the inferior olive detects a discrepancy between planned and actual motor performance it generates climbing fiber activity (an error signal)
○ Modulates cerebellar function, including long-term depression of sensitivity to mossy fiber input

32
Q

What needs to happen to cause Long Term Depression?

A
  • LTD - long term depression
    • Both the AMPA - glutamate parallel fiber activation and the climbing fiber PKC/intracellular Calcium activation
    • The end result is attenuated post-synaptic response AMPA-channel opening
33
Q

Parallel fibers in the cerebellum release what NT and cause what response?

A
  • Glutamate, binds AMPA and metabotropic receptors
    • AMPA is depolarizaiton and AP
    • Metabotropic will lead to IP3 production, calcium release and PKC activation
    • Climbing fibers preferentially act through the increased intracellular calcium mechanism
34
Q

What are extrapyramidal signs?

A
  • Abnormal movement, posture or muscular tone

* NOT paresis or sensory loss

35
Q

What are the general signs of basal ganglia disorders?

A
• Increased tone
	• Tremor (resting)
	• Hypokinesis
		○ Rigidity
		○ Bradykinesia
	• Hyperkinesis
		○ Chorea
		○ Athetosis
		○ Akathisia
36
Q

What are the general signs of cerebellar disorders?

A
• Synergy
		○ Dysmetria
		○ Dysdiadochokinesia
		○ Decomposition of movement
	• Dysequilibrium
	• Tone (hypotonia)
	• Tremor (action or intention)
	• Nystagmus
37
Q

What is ataxia?

A
  • General term, meaning without order
    • Problems with synergistic movement
    • Involves disruption of the smooth trajectories of movements
38
Q

What is dysmetria?

A
  • Past pointing or overshoot
    • One subtype of ataxia
    • Finger-nose-finger testing
    • Most revealed if finger is at extreme of patient’s reach and occasionally moved suddenly to a different location
    • Intention tremor will be revealed with this as finger approaches the target or returns to nose
39
Q

What is dysdiadocholinesia?

A

• Impairment in rapid alternating movements
• Evaluated by having the patient place his or her palm flat on their knee and pronate and supinate as rapdily as possible
• (another test) Tapping the palm up and down as fast as possible and
*(another test) - testing rapid precision hand movements by tapping finger and thub together as quickly as possible or tapping thumb to each of the four other digits in sequence as quickly as possible
• Tests reveal ataxia or bradykinesia

40
Q

What is the pronator drift test?

A
  • Patient stands with eyes closed and arms extended in front with palms facing upward
    • Positive result is the affected limb pronating and drifting downward
    • Seen in pyramidal tract dysfunction, parietal lobe dysfunction or cerebellar disease
41
Q

How can you use speech to test coordination?

A
  • Lalalalalala
    • Kakakakakaka
    • Papapapapapapa
    • Mix that up: lakapa, lakapa, lakapa
    • Coordination involved in rapidly switching between the different sounds
42
Q

What is the Romberg Test and what does it examine?

A
  • Tests station and gait
    • Patient stands with feet together, eyes closed and examiner behind him or her (safety)
    • Romberg is subjective and deemed positive if the patient shows unsteadiness
    • Assessment of vestibular, cerebellar, and proprioceptive contributions to balance all with with the contribution of vision removed
    • Can add the pull-test, which is posive if the patient steps backwards with a pull on the shoulder
43
Q

What kind of gait test can you use to see if a patient has a vermal or paravermal deficit?

A

• Paravermal is distal limbs (trick question)
• But vermal dysfucntion can be tested by having the patient do a tandem gait, or heel-toe gait walking on a straight line
○ People with vermal dysfunction would have trouble coordinating these midline movments and usually compensate with widely spaced limbs

44
Q

What are the 8 categories of gait disorders?

A
  • Hemiparetic
    • Diplegic/paraparetic
    • Neuropathic
    • Myopathic
    • Bradykinetic
    • Choreiform
    • Ataxic
    • sensory