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NSx Neuroanatomy > Cerebellum > Flashcards

Cerebellum Flashcards

1
Q

3 principle motor functions of cerebellum

A

Tone

Posture and balance

Co-ordination of movements

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2
Q

From which emrbyological precursor does cerebellum arise?

A

From metencerphalic portion of rhombencephalon

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3
Q

What are the three principle lobes of cerebellum

A

Anterior

Posterior

Flocullus

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4
Q

Function of flocculonodular lobe

A

Balance (most primitive) of head and eyes

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5
Q

Archicerebellum=

A

Floculonodular lobe

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6
Q

Paleocerebellum=

A

Anterior lobe

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7
Q

Function of anterior lobe of cerebellum?

A

Tone

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8
Q

Neocerebellum=

A

Posterior lobe

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9
Q

Function of posterior lobe

A

Co-ordination of movement

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10
Q

Which fissure divides anterior and posterior cerebellar lobes?

A

Primary fissure

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11
Q

Which fissure separates posterior lobe from floculonodular lobe

A

Posterolateral fissure

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12
Q

What is the name of the area of the cerebellum adjacent to the vermis?

A

Paravermal area/ Intermediate zone

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13
Q

What is the arrangement of the sensory homunculus of the cerebellum

A
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14
Q

In which portion of the cerebellum is the control of trunk and axial musculature found?

A

Vermal area

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15
Q

Where in the cerebellum is the control of the hands or feet?

A

Paravermal area

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16
Q

What are the two types of grey matter in the cerebellum?

A

Cerebellar cortex

Deep cerebellar nuclei

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17
Q

How can the afferent fibres to cerebellum be classified?

A

Those coming from alll portions of CNS - mossy fibres

Those coming from inferior olivary nucleus (olivocerebellar fibres- climbing fibres)

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18
Q

Spartans are climbing the olive tree to cerebellar cortex

A

Olivocerebellar fibres= climbing fibres

Spartans- contain aspartate

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19
Q

All fibres which enter cerebellum are

A

Exctitatory

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20
Q

Which neurotransmitters are released by mossy fibres?

A

Glutamate

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21
Q

Layers of cerebellar cortex

My

Personal

Garden

A

Molecular

Purkinje

Granular

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22
Q

With what must all fibres entering cerebllar cortex synapse before entering cortex?

A

Deep cerebellar nuclei

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23
Q

With what deeper structure do cells from the purkinje layer synapse?

Is this inhibitory or excitatory?

A

Deep cerebellar nuclei

Inhibitory (GABA)

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24
Q

With what do climbing fibres synape?

A

Dendrites of Purkinje cells in molecular layer of cerebellar cortex

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25
Q

Output from cerebellum is from which structures?

A

Deep cerebellar nuclei

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26
Q

With what layer of cortex do mossy fibres synapse?

A

Multiple dendrites with multiple granular cells

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27
Q

What happens to axons from the granular cell layer

A

Ascend to molecular layer and connects with millions of Purkinje cell dendrites as parallel fibres

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28
Q

Ratio of climbing fibre connections to Purkinje cells

A

1:1

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29
Q

Granular cells release which neurotransmitter?

A

Glutamate

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30
Q

What are the inhibitory cells of the granular layer of the cerebellar cortex?

What stimulates them?

A

Golgi cells (stimulated by parallel fibres of granular cells and directly by mossy cells)

Inhibitory to granular cells

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31
Q

What are the inhibitory cells of the molecular layer?

A

Basket and stellate cells

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32
Q

Function of stellate and basket cells

A

Inhibit Purkinje cells surrounding that activated by parallel fibres from the granular cell, dampens down background noise in effect.

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33
Q

Spinocerebellum=

A

Paleocerebellum

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34
Q

Archicerebellum=

A

Vestibulocerebellum

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35
Q

Neocerebelllum=

A

Cerebrocerebellum

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36
Q

What happens to fibres from vestibular system

A

Enters vestibular apparatus then cerebellum

Some enter cerebellum directly

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37
Q

Via which cerebellar peduncle do vestibulocerebellar fibres enter cerebellum?

A

Inferior cerebellar peduncle

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38
Q

What happens to fibres from the deep nucleus of floculonodular lobe?

A

Some return to vestibular apparatus (cerebellovestibular fibres)

Fibres from the vestibular apparatus descend as vestibulospinal tract

some interact with reticular nuclei and descend in reticulospinal tract

Some ascend from vestibular apparatus and influence CN3, 4, 6 as MLF

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39
Q

What is the function of the vestibulospinal tract

A

Extensor muscle tone

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40
Q

What is the deep nucleus of the floculonodular lobe?

A

Fastigial nucleus

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41
Q

Through which cerebellar peduncle does the dorsal spinocerebellar tract pass?

A

Ipsilateral inferior cerbellar peduncle

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42
Q

What is the nucleus of 2o spinocerebellar neurones?

A

Nucleus of Clark

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43
Q

How does proprioceptive information from upper limb enter cerbellum?

A

Cuneocerebellar pathway

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44
Q

How does ventral spinocerebellar pathway enter cerebellum?

A

Superior cerebellar peduncle then decussate again

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45
Q

Where do ventral spinocerebellar neurones decussate?

A

At level of spinal cord and again in the cerebellum

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46
Q

What additional information is carried by ventral spinocerebellar tract to cerebellum?

A

Carries information about descending corticospinal information

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47
Q

What is the most lateral deep cerebellar nuclei?

A

Dentate nucleus

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48
Q

What is the most medial deep cerebellar nuclei?

A

Fastigial

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49
Q

Deep cerebellar nuclei from lateral to medial

Don’t eat greasy food

A

Dentate

Emboliform

Globose

Fastigial

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50
Q

With which system is the fastigial nucleus intimately associated?

A

Vestibulocerebellar

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51
Q

With which system are the globose and emboliform nuclei associated?

A

Spinocerebellum

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52
Q

Dentate nucleus associated with which cerebellum

A

Cerebrocerebellum/neocerebellum

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53
Q

What are the interposed nuclei?

A

Globose and emboliform

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54
Q

What is the output of the interposed nuceli?

A

Spinocerebellar outflow:

Cerebellorubrothalamic fibres

Cerebellothalamic fibres

Cerrebellorubrospinal fibres

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55
Q

What is the output of neocerebellum?

A

Via dentate nucleus:

Dentorubrothalamic fibres

Dentothalamic fibres

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56
Q

What are the aminergic fibres of the cerebellum/

A

There are serotonin containing axons from the raphe nuclei of brainstem

Noradrenergive fibres from the locus coeruleus

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57
Q

What are the only excitatory cells in the cerebellar cortex?

A

Granule cells

58
Q

Describe the cerebellar circuit

A

Excitatory input is derived from mossy and climbing fibres which are received by Purkinje cells directly and indirectly.

These are responsible for the inhibitory output of the cerebellar cortex

The excitatory input to the Purkinje cells is. modified by modulating interneurons

59
Q

Deep cerebellar nuclei from medial to lateral

A

Fastigial

Globose

Emboliform

Dentate

FGED

60
Q

What are the sources of input to the deep cerebellar nuclei

A

Excitatory input derived from fibres originating in cells outside the cerebellum (ponotcerebellar, spinocerebellar, olivocerebellar fibres)

Inhibitory input from fibres that arise from the Purkinje cells of cortex

61
Q

Which of the deep cerebellar nuclei projects through the inferior cerebellar peduncle?

A

Fastigial nucleus-> brainstem

Remaining nuclei project to brainstem and cortex via thalamus through the superior peduncle

62
Q

What are the main cerebellar afferents

A

Cortex

Spinal cord

Vestibular nerve

63
Q

Describe corticocerebellar afferents

A

Cortical projections synapse with three structures prior to the cerebellum-

Pontine nuclei, inferior olivary nucleus, reticular formation

64
Q

Corticopontocerebellar pathway

A

Originates from a large area of the cerebral cortex descends through the corona radiata and IC and terminates in pontine nuclei

The pontine nuclei cells give rise to mossy fibres that decussate to reach the opposite cerebellar hemisphere via the middle cerebellar peduncle

65
Q

Cortico-olivocerebellar pathway

A

Large area of cerebral cortex descending to bilateral inferior olivary nuclei.

Cells of the olivary nuclei give rise to climbing fibres that cross the midline to enter the opposite cerebellar hemisphere via the inferior cerebellar peduncle

66
Q

Cortico-reticulocerebellar pathway

A

Descends from cortex and terminates bilaterally in the reticular formation to give mossy fibres that enter the ipsilateral cerebellar hemisphere via the inferior and middle cerebellar peduncle

67
Q

Which of the afferent cerebellar pathways is not bilateral

A

Corticopontocerebellar

68
Q

Which of the afferent cerebellar pathways passes through the inferior cerebellar peduncle?

A

Cortico-olivocerebellar

Corticoreticulocerebellar

69
Q

Which of the afferent cerebellar pathways passes through the middle cerebellar peduncle?

A

Corticopontocerebllear

Corticoreticulocerebellar

70
Q

What are the three afferent spinocerebellar pathways?

A

Ventral spinocerebellar tract

Dorsal spinocerebellar

Cuneocerebellar

71
Q

Ventral spinocerebellar

A

Originates in the ventral and intermediate gray matter of the spinal cord

Most decussate to enter the contralateral ventral spinocerebellar tract on the other side but some ascend ipsilaterally.

After ascending, the ventral spinocerebellar tract enters that cerebellum via the superior cerebellar peduncle, crosses the midline for a second time and terminates as mossy fibres in the ipsilateral cerebellar cortex

Carries mainly proprioceptive fibres from the lower limbs to the ipsilateral cerebellum

72
Q

Ventral spinocerebellar tract function

A

Carries predominantly proprioceptive information from lower limbs to ipsilateral cerebellar hemisphere

73
Q

Dorsal spinocerebellar tract

A

Originates in nucleus dorsalis (Clarke’s column)

Most fibres uncrossed

Ascends bilaterally in the ventrolateral region of the lateral funiculus

Enters the cerebellum via the inferior cerebellar peduncle and terminates as mossy fibres

Functionally this tract carries sensory information from one side of the body (trunk and lower. limbs) to the ipsilateral cerebellum

74
Q

Dorsal spinocerebellar tract function

A

Carries sesnory (mainly proprioceptive) from one side of the body to the ipsilateral cerebellum.

75
Q

Cuneocerebellar tract

A

Afferent cerebellar connection

Originates in the accessory cuneate nucleus of the medulla

Upper limb equivalent of dorsal spinocerebellar tract

Enters ipsilateral cerebellar hemisphere via the inferior cerebellar peduncle.

Transmits mainly proprioceptive information from upper limb and upper thorax

76
Q

Cuneocerebellar tract function

A

Analagous to dorsal spinocerebellar tract

Proprioceptive information form upper limb and thorax

77
Q

Vestibular afferents

A

Vestibular nerve fibres terminate in vestibular nucleus then send mossy fibres to the ipsilateral flocculonodular lobe via the inferior cerebellar peduncle

78
Q

Efferent cerebellar connections

A

Entire output of the cerebellum is via the inhibitor Purkinje cells

Cells of the deep cerebellar nuclei constitute the entire efferent outflow syste,

These leave the cerebellum via the superior and inferior cerebellar peduncles to terminate in

Red nucleus

Thalamus

Vestibular complex

Reticular formation

79
Q

Efferent fibres transmitted by superior cerebellar peduncle

A

Fibres passing to red nucleus and thalamus

80
Q

Efferent fibres via inferior cerebellar peduncle

A

To vestibular and retiuclar formation

81
Q

Describe efferents to red nucleus

A

Globose and emboliform nuclei send fibres through the superior cerebellar peduncle to contralateral red nucleus.

Which then projects fibres as the crossed rubrospinal tract

82
Q

The function of rubrospinal tract

A

Infleunces flexor activity of the extremities

83
Q

Which cerebellar nuclei send fibres to which red nucleus

A

Globose and emboliform to the contralateral red nucleus

84
Q

Fibres from left emboliform/globose nuclei exert influence via rubrospinal tract on which side of body

A

Left

Contralateral red nucleus

Then crossed rubrospinal tract

85
Q

Efferents from which cerebellar nuclei project to the thalamus

A

Dentate

(and some from globose and emboliform)

Via superior cerebellar peduncle

Contralateral thalamus

86
Q

Coordination of which side of the body is influenced by the dentate nucleus?

A

Ipsilateral

Sends fibres via the thalamus to the contralateral primary motor cortex, the corticospinal tract of which projects to the same side as the dentate.

87
Q

Which cerebellar nucleus sends efferent fibres to the vestibular complex

A

Fastigial nucleus

88
Q

Descirbe efferent cerebellar fibres to the vestibular complex

A

Axons from the fastigial nucleus pass through inferior cerebellar peduncle to terminate on the lateral vestibular nucleus on both sides

Some Purkinje axons project directly onto the lateral vestibular nucleus.

Neurones of the lateral vestibular nucleus form the uncrossed descending vestibulospinal tract

Thus neurones from fastigial. nucleus facilitates ipsilateral extensor muscle tone.

89
Q

Cerebellar efferents to the reticular formation

A

Fastigial nucleus axons pass through the inferior cerebellar peduncle to synapse with cells in the reticular formation on both sides.

The reticular formation descends as the reticulospinal tract which projects bilaterally to the spinal gray matter.

90
Q

Fibres in superior cerebellar peduncle

A

Efferent fibres from globose, emboliform and dentate nuclei

Ventral spinocerebellar tract

91
Q

Middle cerebellar peduncle fibres

A

Afferent pontocerebellar fibres from contralateralside

92
Q

Inferior cerebellar peduncle fibres

A

Afferent fibres:

Dorsal spinocerebellar tract

Cuneocerebellar tract

Olivocerebellear tract

Vestibulocerebelar tract

Reticulocerebellar tract

Fastigial effernts to lateral vestibular nucleus and reticular formation

93
Q

What is the general function of the cerebellum

A

Receives cortical proprioceptive input, spinal proprioceptive input and vestibular input vai mossy and climbing fibres which excite Purkinje cells

Purkinje cells inhibit deep cerebellar nuclei influence of descending motor pathways

To modulate motor output based on information about joint position

94
Q

Vestibulocerebellum

A

Floculonodular lobe

Receives mossy fibres from ipsilateral vestibular nuclei and vestibular ganglion via inferior cerebellar peduncles

Also receives information from LGN, superior colliculi and striate cortex

Sends efferents via Fastigial nucleus-> inferior cerebellar peduncle-> vestibular nuclei

95
Q

Function of vestibulocerebellum

A

Influences primary motor activity through its contacts with the vestibulospinal tract

Concerned with adjustment of axial muscle tone and maintenance of equilibrium

Role in eye movements, control and coordination of head and eye movements

96
Q

Spinocerebellum

A

Vermis and intermediate part of cerebellar hemisphere

Somatosensory information from the dosral and ventral spinocerebellar tracts and auditory/visual/vestibular systems.

Two parts are composed of two separate output pathways

Vermis purkinje cells

Intermediate cerebellar hemispheric cells

Conrtols execution of movement and regulates muscle tone.

97
Q

Function of vermis Purkinje cells in spinocerebellum

A

Vermis Purkinje cells-> Fastigial-> reticular formation, lateral vestibular nucleus and 1o motor cortex via relays in ventorlateral thalamus-> control of medial descending systems controlling axial and proximal musculature

98
Q

Function of intermediate Purkinje cells in spinocerebellum

A

Sends axons to interposed nuclei (globose and emboliform) which project to rubrospinal and lateral corticospinal tracts

Responsible for control of the lateral descending systems which regulate appendicular muscles.

Cross twice so ipsilateral

99
Q

Pontocerebellum

A

Large lateral regions of the cerebellar hemispheres

Input is from latera areas of contralateral cerebral cortex, especially parietal and frontal lobes via corticopontine fibres that enter the cerebellum through the middle cerebellar peduncle

Effernts project via dentate nuelcus to the ventrolateral nucleus of the thalamus to the primary motor cortex completing the corticopontinethalamocortical loop

Decussates in both cerebellar peduncle and corticospinal tract so it is ipsilateral.

Involved in precision in the conrtol of rapid limb movements and with tasks requiring fine dexterity.

100
Q

Destructive lesions in the pontocerebellum

A

Can lead to movement disorders e.g. delay in initiation or termination of movement or involuntary tremor at the end of a movement.

101
Q

Symptoms of cerebellar disease

A

HA

N+V

Gait disturbance

Vertigo

102
Q

Midline structures in cerebellum

A

Anterior and posterior vermis

Flocculonodular lobe

Fastigial nuclei

Involved in equilibrium required during ambulation, maintenance of truncal posture and control of extra-ocular eye movements

103
Q

Signs of midline cerebellar disease

A

Gait difficulty

Truncal ataxia

Abnormal head postures

Oculomotor dysfunction

104
Q

Features of truncal instability 2o to cerbellar disease

A

May be manifested during walking by a tendency to fall towards the side of the lesion

While sitting patient may lean or fall to one side

105
Q

Falling to left in cerebellar pathology

A

?Left sided lesions

106
Q

Gait disturbance in cerebellar disease

A

Wider than normal base

Unsteadiness

Irregularity of steps

Lateral veering

Lateral lesions tend to cause the patient to veer towards the side of the lesion

Mild gait disturbance may be exacerbated by asking the patient to tandem walk.

107
Q

Abnormal head postures in cerebellar disease

A

May be due to midline or lateral lesions

Can present as a head tilt or rotation

108
Q

Primary disorders of gaze with cerbellar pathoology

A

Nystagmus

Ocular dysmetria

109
Q

Nystagmus associated with midline cerebellar pathology

A

Gaze-evoked

Rebound

Optokinetic

110
Q

Gaze evoked nystagmus

A

Fast saccade to laterally located target with slow movement back to mid-position

111
Q

Rebound nystagmus

A

Type of gaze-evoked nystagmus that changes direction after sustained lateral gaze or refixation to the primary position

https://collections.lib.utah.edu/ark:/87278/s6089dz6

112
Q

Optokinetic nystagmus

A

Non-pathological nystagmus which develops normally when an individual attempts to count the stripes on a rotating drum or moving cloth strip

In the presence of cerebellar disease, optokinetic nystagmus may become exaggerated, producing unusually large amplitudes of both the fast and slow components.

113
Q

Ocular dysmetria

A

Conjugate overshoot of a target with voluntary saccades

Eyes appear to jerk back and forth because of repeated inaccuracies in saccadic movements intended to bring the target to the fovea.

114
Q

Signs of lateral cerebellar disease

A

Involves lateral hemisphere, dentate and interposed nuclei

Hypotonia

Dysarthria

Limb ataxia

Intention tremor

Impaired check

Oculomotor disorders

115
Q

Hypotonia in cerebellar disease

A

Seen in lateral cerebellar disease

Decreased resistance to passive movement of the limbs

May find an increased duration and amplitude of swing in patellar reflex (pendular cerebellar reflex), slower rate than clonus

116
Q

Pendular cerebellar reflex

https://www.youtube.com/watch?v=_ff4FN8mGbc

A

Seen in the hypotonic lower limb in the context of cerebellar disorder

Should be distinguished from clonus which at occurs at a more rapid rate.

117
Q

Dysarthria

A

Dysarthria of cerebellar disease is characterised by slow, laboured, slurred or garbled speech

Intact comprehension and grammar

118
Q

Limb ataxia

A

Dysmetria and decomposition of movement

Dysmetria- error in trajectory and speed of movement, most easily demonstrated in the UE using a finger to nose test. Frequently patients with cerebellar disease will have past-pointing with over or undershoot when approaching the nose

Decomposition of movement involves errors in the sequence and speed of the component parts of the movement e.g. dysdiadochokinesia

119
Q

Intention tremor

A

Irregular rhythmic interruption of voluntary movement that begins and increases as the patient approaches a target

Distinguished from rest tremor as it occurs on movement and from action tremor which is seen from beginning to end of the movement.

120
Q

Impaired check

A

Wide excursion of a limb following the involuntary displacement of lib.

121
Q

Oculomotor disorders with lateral hemispheric disease

A

Opsoclonus

Ocular flutter

Ocular bobbing

Ocular myoclonus

122
Q

Opsoclonus

A

Constant, random, conjugate saccades of unequal amplitudes in all directions.

Frequently they are most marked immediately before and after a fixation

https://youtu.be/r1LQwWkaY9s?t=62

123
Q

Constant, random, conjugate saccades of unequal amplitudes in all directions.

Frequently they are most marked immediately before and after a fixation

https://youtu.be/r1LQwWkaY9s?t=62

A

Opsoclonus

124
Q

Ocular flutter

A

Rapid to and fro oscillations of the eyes

Abrupt in onset lasting only for seconds and disturbing vision for duration of episode

https://youtu.be/JV2z8bmTLHg?t=71

125
Q

Rapid to and fro oscillations of the eyes

Abrupt in onset lasting only for seconds and disturbing vision for duration of episode

https://youtu.be/JV2z8bmTLHg?t=71

A

Ocular flutter

126
Q

Ocular bobbing

A

Intermittent abrupt downward displacement of the eyes followed by a slow and synchronous return to primary position.

Relatively quick downward displacement is slower than the fast phase of nystagmus

Should be distinguished from downbeat nystagmus which is associated with cervicomedullary lesions.

Horizontal eye movements are typically paralysed

https://www.youtube.com/watch?v=YAUT15d1YBU

127
Q

Intermittent abrupt downward displacement of the eyes followed by a slow and synchronous return to primary position.

Relatively quick downward displacement is slower than the fast phase of nystagmus

Should be distinguished from downbeat nystagmus which is associated with cervicomedullary lesions.

Horizontal eye movements are typically paralysed

A

Ocular bobbing

https://www.youtube.com/watch?v=YAUT15d1YBU

128
Q

Ocular myoclonus

A

Rhythmic pendular oscillation of the eyes associated with synchronous oscillations of the palate

https://www.youtube.com/watch?v=OqZk5eeaL-U

129
Q

Rhythmic pendular oscillation of the eyes associated with synchronous oscillations of the palate

https://www.youtube.com/watch?v=OqZk5eeaL-U

A

Oculopalatal myoclonus

This is a , usually vertical, pendular nystagmus associated with a synchronous rhythmic movement of the palate, developing months after a severe brain stem stroke. The stroke involves the dentato0rubro-olivary tract (Mollaret’s triangle). MRI can show hypertrophy of the inferior olivary nucleus in the medulla.

130
Q
A

Hypertrophic olivary degeneration (HOD) is a rare condition characterized by a unique pattern of trans-synaptic degeneration. It is caused by a lesion in the triangle of Guillain and Mollaret, resulting in hypertrophy of the inferior olivary nucleus.

Palatal myoclonus, rhythmic involuntary movement of the soft palate, uvula, pharynx, larynx and upper extremity are classically described clinical features

131
Q
A
132
Q

Constituents of floculonodular lobe

A

Nodule

Inferior medullary velum

Flocullus

133
Q

9 lobules of the vermis

LCCDFTPUN

A

Lingula
Central lobule
Culmen
Decline
Folium
Tuber
Pyramid
Uvula Nodule

134
Q
A

Lingula (tongue)
Light blue- SCP.

135
Q
A

Central lobule

136
Q
A

Culmen (i.e. highest point)

137
Q
A

Declive

138
Q
A

Folium

139
Q
A

Tuber

140
Q
A

Pyramid

141
Q
A

Uvula

142
Q
A

Nodule

NSx Neuroanatomy (25 decks)

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