Cerebellum A/P Flashcards

1
Q

Generally describe the structure and location of the cerebellum

A

The cerebellum is a “leafy” structure that is found behind (dorsal to) the pons and medulla. It’s found in between the cerebral cortex and the spinal cord.

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2
Q

Describe the function of the cerebellum.

A

Coordination of movement, planning and execution of movement, maintenance of posture and coordination of head and eye movement. Basically integrates sensory information from the spinal cord, motor information from the cerebral cortex and balance information from the vestibular system.

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3
Q

What are the two motor control centers of the CNS?

A

Cerebellum and the Basal Ganglia.

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4
Q

What is the midline of the cerebellum called?

A

It’s called the “Vermis,” which has the superior and inferior vermis component. Superior vermis in anterior lobe, inferior vermis in posterior

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5
Q

Describe the 3 sections of the cerebellum.

A

The vermis (superior and inferior) is the center of the cerebellum, adjacent to that in either side is called the paravermal or intermediate hemisphere, and lateral to that is the lateral hemisphere (which dominates most of the size of the cerebellum).

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6
Q

What is the “fluconodular lobe?”

A

It is the thin middle horizontal slice of the cerebellum that runs all the way through the lateral hemisphere, the intermediate hemisphere and the vermis.

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7
Q

What are the 3 lobes of the cerebellum?

A

Anterior, posterior and floculonodular lobes.

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8
Q

Where are both the cerebellum and pons derived from?

A

Derived from the “Metencephalon.”

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9
Q

What separates the cerebellum and the dorsal aspect of the pons?

A

The 4th ventricle.

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10
Q

What can be found inside the cerebellar cortex?

A

It has multiple parallel folds that has “maps” of the skeletal muscles of the body.

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11
Q

What is the function of the vermis?

A

Controls the axial (trunk) and proximal musculature of the limbs.

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12
Q

What is the function of the paravermal or intermediate hemisphere? (of cerebellum)

A

Control of the distal musculture.

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13
Q

What is the function of the lateral hemispheres of the cerebellum?

A

It is involved in motor planning, which mainly involves the distal musculature.

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14
Q

What is the function of the flocculonodular lobe?

A

It’s function is to control balance, smooth execution of movements, and eye movement.

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15
Q

Generally, what can we say that the vermis and the intermediate hemispheres of the cerebellum doing?

A

It is control ALL motor executions of the entire body regardless of being axial or limb located.

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16
Q

Major input TO the cerebellum comes from where?

A

It comes from the spinal cord inputs (from golgi tendons and muscle spindle) and then up to the middle and inferior cerebellar peduncle, which relays information into the cerebellum.

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17
Q

Major input FROM the cerebellum goes where?

A

It goes out through the superior cerebellar peduncle.

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18
Q

Where is the lateral hemisphere of the cerebellum getting its input from? What’s it involved with?

A

Since it is involved with motor planning and coordination, much of its input comes from the cerebral motor cortex (indirectly via the cortical spinal tract), and also the inferior olivary nucleus.

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19
Q

What is the inferior olivary nucleus’ role?

A

Acts as an “error detector,” meaning that it projects axons into the cerebellum and influences the cerebellar neurons to change how a movement is performed in the future (in a way to correct a previously “wrong” movement?)

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20
Q

Where is the input of the flocculonodular lobe coming from?

A

Since it is involved in balance and eye movements it makes sense that the input comes from the vestibular nuclei (CN 8).

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21
Q

Where are the inferior cerebellar peduncles coming from and what does it do?

A

It arises from the medulla and carries information from the spinal cord and olive into the cerebellum.

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22
Q

Where are the middle cerebellar peduncles coming from and what does it do?

A

Coming from the motor cortex into the cerebellum (thus, they are affarent pathways) and it simply relays the information from the motor cortex to the cerebellum.

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23
Q

What is the purpose of the superior cerebellar peduncle?

A

Takes information from the cerebellum out, this is the only way information from the cerebellum leaves, wheres the MCP and ICP delivers information TO the cerebellum.

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24
Q

What are the 3 layers of the cerebellar cortex?

A

Molecular layer, purkinje layer, and granule cell layer.

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25
Q

What is the outer most layer of the cerebellar cortex called and what does it do?

A

Outer most layer is called the “Molecular layer,” largely acellular with a lot of parallel fibers (axons of the granule cells). It also has baskets and stellate cells, and the dendric tree of the purkinje cells extend into this layer.

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26
Q

What is the middle layer of the cerebellar cortex called and what does it do?

A

Middle (and most important!) layer is called the “Purkinje layer,” and it has purkinje cells. Only axons of the purkinje cells leave the cerebellum cortex, and all inputs into the cerebellum is trying to modulate the firing of the purkinje cells.

27
Q

What is the inner most layer of the cerebellar cortex called and what is its function?

A

Innermost is called “Granule cell layer,” and it contains intrinsic granule cells, golgi cells and glomeruli. Granule cells are the only cells in the cerebellar cortex that is excitatory, whereas all other cells are inhibitory.

28
Q

What are “glomerulus” in the cerebral cortex?

A

A glomerulus contains a granule cell, axons from golgi cells, and is surrounded by glial capsule.

29
Q

What are the largest cells of the CNS?

A

The purkinje cells.

30
Q

What is the role of granule cells?

A

2 roles, 1. is to synapse into purkinje cells and 2. it is the only excitatory cell of cerebellar cortex.

31
Q

What are “golgi cells?”

A

Inhibitory interneurons that synapses into the dendrites of granule cells.

32
Q

How do all the inputs to the cerebellum contrast with all the neurons (except one type) within the cortex?

A

All neurons within the cerebellar cortex are inhibitory except the granule cells, whereas all the inputs to the cerebellum are excitatory.

33
Q

What are the 2 types of afferent fibers entering the cerebellum?

A

Excitatory mossy fibers and excitatory climbing fibers.

34
Q

Where do climbing fibers come from? What is the tract called? How do they enter the cerebellum?

A

Inferior olivary nucleus, the dominant feature of the upper medulla sections grossly. The tract is called the “Olivocerebellar tract,” enters through the inferior cerebellar peduncle. where it decussates.

35
Q

Where do climbing fibers go?

A

From the olivary nucleus to the cerebellum through the inferior cerebellar peduncle, where it will terminate on excitatory terminals of the purkinje cells.

36
Q

Where are mossy fibers coming from?

A

All inputs into the cerebellum not coming from the olivary nucleus uses the mossy fibers. This includes from the motor cortex (cortico or pontocerebellar tract), the spinocerebellar tract (from the spinal cord) and the vestibulocerebellar tract (from the vestibular nucleus).

37
Q

What is the excitatory neuron used by the CNS?

A

Glutamate.

38
Q

What do mossy fibers do?

A

Since they are affarent fibers into the cerebellum they are excitatory and thus their target is the excitatory terminals of the granule cells.

39
Q

Where do purkinje cells of the cerebellum synapse?

A

It synapses onto the deep cerebellar nuclei.

40
Q

How do climbing fibers differ in their excitation of Purkinje cells from Mossy fibers?

A

Climbing fibers provide both direct and indirect (through stimulation of the deep cerebellar nuclei) stimulus to the purkinje cells. Mossy fibers can only do so indirectly.

41
Q

How do mossy fibers stimulate the purkinje cells?

A

Regardless from where they come from, they all stimulate the granule cells, which sends its axons up to the molecular layer, bifurcates and through parallel fibers stimulate the purkinje fibers.

42
Q

How do the input and output from the cerebellum differ?

A

All input into cerebellum is excitatory, all output from cerebellum is inhibitory and mediated exclusively from the axons of the purkinje fibers, which happens to be the only axons leaving the cerebellum.

43
Q

Where do axons of the purkinje cells, stellate cells, golgi cells, basket cells and granule cells terminate? Which of these cells are excitatory and inhibitory?

A

Golgi cell axons terminate in granule cells, purkinje cell axons terminates in the deep cerebellar nuclei, and all others terminate in the purkinje cells. Everything but the granule cells area inhibitory, and granule cells are excitatory.

44
Q

What are the neurotransmitters used for excitatory and inhibitory fibers in the cerebellum?

A

Excitatory uses glutamate, inhibitory uses gamma amino buteryc acid (GABA).

45
Q

What are the 3 types of deep cerebellar nucleus?

A

Fastigal nucleus, the Interposed nucleus (composed of Emboliform and Globose nucleus) and the dentate nucleus.

46
Q

What are the deep cerebellar nucleus known as “interposed nucleus” composed of?

A

2 nucleus, the emboliform nucleus and the globose nucleus.

47
Q

The purkinje cells from the cerebellum are all linked to different deep cerebellar nucleus based on their locations. To which nucleus are the purkinje cells from the vermis, the intermediate (or paravermal) hemispheres and the lateral hemispheres linked to?

A

Pkje cells from vermis synapse onto the fastigial nucleus, from the intermediate hemispheres to the interposed nuclei, and the lateral hemispheres to the dentate nucleus.

48
Q

Where do purkinje cells from the floculonodular lobe go to?

A

Into the lateral vestibular nucleus.

49
Q

What is the goal of cerebellar outflow (via the deep cerebellar nuclei)?

A

The firing of the upper motor neurons, and thereby also modulate the lower motor neurons indirectly.

50
Q

In an overarching view, what is the general function of the cerebellum?

A

Smoothes out the contractions and relaxation of all striated muscles by comparing the actual vs intended movement.

51
Q

What is the function of the anterior lobe of the cerebellum?

A

Anti-gravity muscles regulation to modulate posture.

52
Q

Function of the posterior love of the cerebellum?

A

It deals with fine motor coordination.

53
Q

What is “Anterior Vermis Syndrome?”

A

Most commonly caused by alcohol abuse, it leads to trunk, leg, and gait ataxia. Involves the anterior lobe of the cerebellum.

54
Q

What is “Posterior Vermis Syndrome?”

A

Is usually secondary to brain tumors in children (i.e. medulloblastomas and ependymomas), this involves the flocculonodular lobe and leads to truncal ataxia.

55
Q

Through what tract does the outflow of cerebellar information travel?

A

The “Dentatothalamic tract” through the superior cerebellar peduncle, which goes to the VL/VA nucleus of the thalamus. SCP also receives input from the ventral spinocerebellar tract affarents.

56
Q

Where does the MCP receive inputs from to send to the cerebellum?

A

From the pontocerebellar tract.

57
Q

Where does the ICP receive input to send to the cerebellum?

A

From olivocerebellar tract (from inferior olivary nucleus from contralateral medulla), the cuneocerebellar tract, and the dorsal spinocerebellar tract.

58
Q

Where do clinical manifestations of cerebral lesions present?

A

It presents in the ipsilateral side of cerebral lesions due to double decussations.

59
Q

What’s the “double decussation” in the cerebellar outflow fibers?

A

The deep cerebral nucleus fibers would leave the SCP and then cross over at the midbrain, and from there axons will travel down to:

  1. The red nucleus, and the 2nd decussation occurs in the midbrain, axons descend down the rubrospinal tract ipsilateral to original side of the cerebellum that initiated the impulse.
  2. VL/VA nucleus of the thalamus –> precentral gyrus –> axons descends down the corticospinal tract and second decussation in medulla (pyrimidal decussation) and then fibers descend down the CST again.
60
Q

What are the clinical symptoms of cerebellar damage?

A

Mnemonic is VANISHEDD: Vertigo, Ataxia, Nystagmus, Intention tremor, Slurred/Staccato speech, Hypotonic reflexes, Exaggurated broad-based gait, Dysdiadochokinesia (inability to do rapid alternating movements) and Dysmetria (inability to use voluntary movement to point to a place in 3D space, as presented by the finger-to-nose movements).

61
Q

Trace the axons coming out of the Dentate nucleus.

A

Crosses midline in the midbrain (1st decussation) and synapses in the motor nuclei of the thalamus (Ventral Lateral (VL) and Ventral Anterior (VA) nuclei of thalamus). These nuclei project to the motor cortex and influence the firing of Upper Motor Neurons (UMN) at their cellular locations and go down the CST.
** Note, the CST neurons would decussate a second time to influence the lower motor neurons.**

62
Q

What is the hallmark of cerebellar dysfunction?

A

Tremor with intended movement without weakness or paralysis.

63
Q

How do patients with a vermal lesion present and how does one differentiate between a lesion in the cerebellum vs a lesion in the dorsal column?

A

Presents with difficulty maintaining posture, gait or balance (an ataxic gait). In cerebellar lesion a pt will fall with their eyes open, meaning neg Romberg sign, but in a dorsal column lesion a patient will fall with their eyes closed + Romberg sign. (Motor vs sensory ataxia).

64
Q

How would a patient present with posterior vermal lesion?

A

This affects the truncal muscles so patient will have difficulty sitting up, thus truncal ataxia.