Anatomy of cerebellum


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Anatomy of cerebellum

  2. 2. GROSS ANATOMY OF CEREBELLUM<br />Location:<br /><ul><li>The term cerebellum is from “latin meaning” the little brain.It is a part of the hindbrain situated in the posterior cranial fossa.
  3. 3. It is also present behind the pons and medulla ablongata,seperated from two structures by the cavity of fourth ventricle.
  4. 4. It is covered by tentoriumcerebelli and is connected to brain stem by three cerebellar peduncles.
  5. 5. In adults the weight ratio between cerebellum and cerebrum is 1:10,Infants 1:20</li></li></ul><li>Anatomy of cerebellum......contd.<br />Horizontal fissure<br /><ul><li>Consists of two laterally, large hemisphere which are united by midline vermis.
  6. 6. Cerebellar surface is divided by numerous curve transverse fissures giving it a laminated appearance
  7. 7. One conspicious fissure “horizontal fissure”extends around dorsolateral border of each hemisphere from middle cerebellar peduncle to vallecula,seperating superior and inferior surface</li></ul>Hemisphere<br />Superior surface<br />Vermis<br />
  8. 8. External surface of cerebellum<br />Primary fissure<br /><ul><li>The deepest fissure in the vermis is primary fissure, which curves ventrolaterally in the superior surface of the cerebellum to meet horizontal fissure.
  9. 9. Primary fissure divides the cerebellum into anterior and posterior lobe.</li></ul>Anterior lobe<br />Primary fissure<br />Posterior lobe<br />
  10. 10. External surface of cerebellum<br />Horizontal fissure<br />Anterior lobe<br />Primary fissure<br />vermis<br />Posterior lobe<br />Hemisphere <br />
  11. 11. Arbor vitae cerebelli<br />Arbor vitae <br />•In latin “ tree of life” it is the white matter<br /> of the white matter of cerebellum.<br /> •It is so called because of the tree like<br /> appearance.<br />•It brings sensory and motor sensation to and from cerebellum.<br />Fourth ventricle<br />
  12. 12. The cerebellum is connected to<br />Brain stem by three peduncles<br />Superior cerebellar peduncle<br />Midbrain<br />Middle cerebellar peduncle<br />Pons<br />Inferior cerebellar peduncle<br />Medulla ablongata<br />
  13. 13. Peduncles of the cerebellum<br />
  14. 14. Parts of the cerebellum<br />Vermis<br />Hemisphere <br />
  15. 15. LOBES OF CEREBELLUM<br />Inferior surface<br />Anterior lobe<br /><ul><li>Divisions of lobes</li></ul>Anatomical<br /><ul><li>Flocculonodular lobe
  16. 16. Anterior lobe
  17. 17. Posterior lobe</li></ul>Posterior lobe<br />Flocculonodular lobe<br />Superior surface<br />Anterior lobe<br />Posterior lobe<br />
  18. 18. Division of lobes…..contd.<br />Functional(Evolutionary)<br /><ul><li>Paleocerebellum
  19. 19. Neocerebellum
  20. 20. Archicerebellum</li></li></ul><li>Archi-cerebellumposterior lobe(Vestibular part) •It is formed of the flocculo-nodular lobe + associated fastigial nuclei, lying on inf. Surface in front of postero-lateral fissure. <br />•Embryologically,it is the oldest part of cerebellum. •It receives afferentFibres. From vestibular apparatus of internal ear Via vestibulo-cerebellar tracts.•It is concerned with equlibrium<br />Neocerebellum<br />Archicerebellum<br />Paleocerebellum<br />
  21. 21. Archicerebellum …….contd.<br /><ul><li>It has connections with vestibular & reticular nuclei of brain stem through the inferior cerebellar peduncle.
  22. 22. Afferent vestibular Fibres. Pass from vestibular nuclei in pons & medulla to the cortex of ipsilateralflocculo-nodular lobe.
  23. 23. Efferent cortical (purkinje cell) Fibres. Project to fastigial nucleus, which projects to vestibular nuclei & reticular formation.
  24. 24. It affects the L.M.system bilaterally via descending vestibulo-spinal & reticulo-spinal tracts.</li></li></ul><li>Paleo-cerebellum (spinal part) : •it is formed of midline vermis + surrounding paravermis + globose & emboliform nuclei. •It receives afferentproprio-ceptive impulses from Ms.& tendons Via spino-cerebellar tracts (dorsal & ventral) mainly.•it sends efferentsto red nucleus of midbrain. •it is concerned withmuscle tone<br />Paleocerebellum<br />
  25. 25. <ul><li>It is concerned with muscle tone & posture.
  26. 26. . Afferents spinal Fibresconsist of dorsal & ventral spino-cerebellar tract from muscle, joint & cutaneous receptors to enter the cortex of ipsilateralvermis & paravermis Viainferior & superior cerebellar peduncles .
  27. 27. Efferents cortical fibrespass to globose & emboliform nuclei, then Via sup. C. peduncle to contra-lateral red nucleus of midbrain to give rise descending rubro-spinal tract. </li></li></ul><li>Neo-cerebellum (cerebral part) <br />•It is the remaining largest part of cerebellum. •It includes the most 2-cerebellar hemispheres + dendate nuclei.•It receives afferent impulses from the cerebral cortex+pons Via cerebro-ponto- cerebellar pathway. •it sends efferents to Ventro lateral nucleus of thalamus.•it controls voluntary movements (muscle coordination).<br />Neocerebellum<br />
  28. 28. <ul><li>It is concerned withmuscular coordination.
  29. 29. It receives afferents from cerebral cortex involved in planning of movement- to pontine nuclei ,cross to opposite side Via middle Cerebellar peduncle to end in lateral parts of cerebellum (cerebro-ponto-cerebellar tract).
  30. 30. Neo-cerebellarefferentsproject to dendatenucleus,which in turn projects to contra-lateral red nucleus & ventral lateral nucleus of thalamus ,then to motor cortex of frontal lobe, giving rise descending cortico-spinal & cortico-bulbar pathways. Efferents of dentate nucleus form a major part of superior C. peduncle.</li></li></ul><li>Other types of Divisions<br /><ul><li>Afferent regions</li></ul>— Spinocerebellum<br /> — Pontocerebellum<br /><ul><li>Efferent regions</li></ul> — Vestibulocerebellum<br /> — Lateral Hemisphere<br />
  31. 31. Summary of classification<br />Archicerebellum<br />Nodulus<br />Classification by phylogenetic<br />Ontogenic development<br />Archicerebellum<br />Paleocerebllum<br />Neocerebellum<br />Classification by Afferent Connection<br />Vestibulocerebellum<br />Spinocerebellum<br />Pontocerebellum<br />Classification by Efferent Connection<br />Vermis<br />Paravermal Region<br />Cerebellar Hemisphere<br />Archicerebellum<br />flocculus<br />Palaeocerebellum<br />Neocerebellum<br />Spinocerebellum<br />Pontocerebellum<br />Vestibulocerebellum<br />
  32. 32. Structure of the cerebellum<br />Cortex <br />Medulla <br />
  33. 33. Subdivision of lobes<br />Subdivision of Flocculonodular lobe <br />Flocculus<br />Nodulus<br />Subdivision of Anterior lobe<br />Lingula<br />Ala of central lobule<br />Central lobue<br />l<br />
  34. 34. Posterior lobe<br />Simple lobule<br />Postcentral fissure<br />Declive<br />Superior semilunar lobule<br />folium<br />Horizontal fissure<br />uvula<br />Inferior seminular lobule<br />Tuber <br />
  35. 35.
  36. 36.
  37. 37.
  38. 38. Superior surface<br />Ant lobe<br />Post lobe<br />Inferior surface<br />Post lobe<br />Ant lobe<br />
  39. 39. Structure<br /><ul><li>Cerbellum consists of outer layer of grey matter known as cortex and inner layer of white matter known as medulla.
  40. 40. The medullary core is composed of incoming and outgoing fibres projecting to and from the cerebellar cortex.
  41. 41. Medullary core also contain the nucleuses of the cerebellum which are four in number.</li></li></ul><li>Medulla <br />Structure of cerebellum <br />Cortex <br />
  42. 42. Structure of cerebellar……contd.<br />Cerebellar Cortex<br />Molecular Layer<br /> Purkinje Cell Layer<br /> Granular Layer<br />Corpus Medullare (Medullary Center)<br />Deep Cerebellar Nuclei<br />Fastigial Nuclei<br />Nucleus Interpositus<br />Emboliform Nucleus<br />Globose Nucleus<br /> Dentate Nucleus<br />
  43. 43. CEREBELLUMcortex<br />Cerebellar Cortex<br />I. Molecular Layer<br />Stellate Cell --- taurine (inhibitory)<br />afferent:parallel fiber <br />efferent:Purkinje cell dendrite<br />Basket Cell ---- GABA (inhibitory)<br />afferent:parallel fiber<br />efferent:Purkinje cell soma<br />Parallel Fiber<br />granule cell axon<br />Purkinje Cell Dendrite<br />
  44. 44. Cerebellum layers……contd.<br />II. Purkinje Cell Layer<br />Purkinje Cell <br /> -- 15,000,000 in number<br />-- GABA (inhibitory)<br /> afferent: parallel fiber <br /> climbing fiber<br />stellate cell<br /> basket cell <br /> efferent: deep cortical nuclei<br />Bergman’s glial cell<br />
  45. 45. Purkinje cells<br />flaskshaped cell, single layered Dendrites <br /><ul><li>Molecular layer - profuse branching - dendritic spines Axon - synapse with deep cerebellar nucleus - basket & stellate cells - vestibular nuclei</li></li></ul><li>Cerebellum layers……..contd.<br />III. Granular Layer<br />Granular Cell <br /> -- 50,000,000,000 in number<br /> -- glutamic acid (excitatory)<br /> afferent: mossy fiber<br /> efferent: Purkinje cell axon<br />basket cell, stellate cell<br /> Golgi cell<br />Golgi Cell<br />-- GABA (inhibitory)<br /> afferent: parallel fiber, mossy fiber rosette<br /> efferent: granule cell dendrite<br />
  46. 46. Climbing fibres<br />- from inferior olivary complex<br />- direct action on individual Purkinje cell<br />- powerful , sharply localised<br />- Basket cells, stellate cells, Golgi cells act as inhibitory interneurons.<br />Mossy fibres<br />-from spinal cord / brain stem centres<br />-indirect action on Purkinje cells via granule cells<br />-diffuse<br />( thousands of Punkinje cells may be excited )<br />
  47. 47. White matter of the cerebellum<br /><ul><li>Consists of three types of nerve fibres in the white matter</li></ul>Axons of purkinje cells<br /> The only axons to leave cerebellar cortex to end in deep <br />cerebellar nuclei specially dendate nucleus.<br />Mossy fibres<br /> They end in the granular layer.<br />Climbing fibres<br /> They end in the molecular layer<br />
  48. 48. White matter of cerebellum<br /><ul><li>The internal circuity of cerebellum
  49. 49. Donot leave the cerebellum,interconnect</li></ul> different regions of cerebellum.<br /><ul><li> Some connect the same side.
  50. 50. Some connect the two cerebellar hemisphere
  51. 51. The cerebellar efferent via middle cerebellar</li></ul> peduncle(MCP) and inferior cerebellar peduncle<br /> (ICP)<br /><ul><li>The cerebellar afferent via superior cerebellar</li></ul> peduncle(SCP) and from fastigial from inferior <br />cerebellar peduncle(ICP)<br />
  52. 52. Intrinsic pathway<br />Afferent pathways to cerebellar cortex excite Purkinje cells. <br />Basket, stellate and Golgi cells regulate Purkinje cell activity<br />Efferent pathways from the cerebellar cortex originate from Purkinje cells - <br />
  53. 53. Intrinsic pathway<br />
  54. 54.
  55. 55. Cerebellar AFFERENT pathway<br />From cerebral cortex<br />cortico-ponto-cerebellarfibres<br />cerebro-olivo-cerebellarfibres<br />cerebro- reticulo- cerebellarfibres<br />From spinal cord<br />anterior spinocerebellar tract<br />posterior spinocerebellar tract<br />cuneocerebellar tract <br />From vestibular nucleus<br />vestibulocerebellar tract [ flocculonodular lobe ]<br />From other areas<br />red nucleus, tectum<br />
  56. 56.
  57. 57. Cerebellar EFFERENT pathways<br /><ul><li>Axons of Purkinje cells </li></ul> synapse with the cerebellar nuclei.<br /><ul><li> Axons of the neurones form the efferent pathways</li></ul>Connect with<br /><ul><li>Red nucleus
  58. 58. Thalamus
  59. 59. Vestibular nuclei
  60. 60. Reticular formation</li></li></ul><li>Histological structure of cerebellum<br />
  61. 61. Histology of the cerebellum…..contd<br />Molecular layer<br />Purkinje layer<br />Granular layer<br />
  62. 62. Cerebellar cortex…..contd.<br />Synaptic Glomerulus<br />Afferent terminals on granular layer<br /> Mossy Fiber Rosette <br /> -- afferent fibers except<br /> inferior olivary input<br /> -- 2/3 of medullary center<br /> Granular Cell Dendrite <br /> -- main afferent input <br /> Golgi Cell Axon <br /> -- synapse on granule cell dendrite<br /> -- GABA (inhibitory)<br /> - Surrounded by Astrocyte Foot Process<br />
  63. 63. Cerebellar structure……Deep nuclei<br />1. fastigial<br /> nucleus<br />2. globose<br /> nucleus<br />3. emboliform<br /> nucleus<br />4. dentate <br /> nucleus<br />
  64. 64. Deep nucleuses of cerebellum<br />Dentate nucleus<br />Emboliform nucleus<br />Globose nucleus<br />Fastigial nucleus<br />Nucleus interpositus<br />
  65. 65. Fibres entering and leaving through cerebellar peduncles<br />Superior cerebellar peduncle<br />Fibres entering the cerebellum<br />1. Ventral spino-cerebellar tract<br /> 2. Rostralspino-cerebellar tract<br /> 3. Tecto-cerebellarfibres<br /> 4. Rubro-cerebellarfibres<br /> 5. Trigemino-cerebellarfibres<br /> 6. Hypothalamo-cerebellarfibres<br /> 7. Coerulo-cerebellarfibres<br />Fibres leaving the cerebellum<br />1. Cerebello-rubralfibres<br /> 2. Cerebello-thalamic fibres<br /> 3. Cerebello-reticular fibres<br /> 4. Cerebello-olivaryfibres<br /> 5. Cerebello-nuclear fibres<br /> 6. Some fibres to hypothalamus <br /> and thalamus<br />Superior cerebellar peduncle<br />
  66. 66. Middle cerebellar peduncle<br /><ul><li>Pontocerebellarfibres</li></ul>Inferior cerebellar peduncle<br />Fibres entering cerebellum<br /> 1. Posterior spinocerebellar tract<br /> 2. Cuneo-cerebellar tract<br /> 3. Olivo-cerebellarfibres<br /> 4. Reticulo-cerebellarfibres<br /> 5. Vestibulo-cerebellarfibres<br /> 6. Anterior external arcuatefibres<br /> 7. Fibres of striaemedullaries<br /> 8. Trigemino-cerebellarfibres<br />Fibres Leaving the cerebellum<br /> 1. Cerebello-olivaryfibres<br /> 2. Cerebello-vestibular fibres<br /> 3. Cerebello spinal and cerebello reticular<br />fibres<br />Middle cerebellar peduncle<br />Inferior cerebellar peduncle<br />
  67. 67. Classification of cerebellum<br />Classification by phylogenetic and <br />Ontogenic development<br />Archicerebellum<br />Paleocerebllum<br />Neocerebellum<br />Classification by Afferent Connection<br />Vestibulocerebellum<br />Spinocerebellum<br />Pontocerebellum<br />Classification by Efferent Connection<br />Vermis<br />Paravermal Region<br />Cerebellar Hemisphere<br />Archicerebellum<br />Nodulus<br />Archicerebellum<br />flocculus<br />Palaeocerebellum<br />Neocerebellum<br />Spinocerebellum<br />Pontocerebellum<br />Vestibulocerebellum<br />
  70. 70. Functions of cerebellum<br />Maintenance of Equilibrium<br />- balance, posture, eye movement <br />Coordination of half-automatic movement of<br /> walking and posture maintenace<br /> - posture, gait <br />Adjustment of Muscle Tone<br />Motor Leaning – Motor Skills<br />Cognitive Function<br />
  71. 71. Balance<br />
  72. 72. Motor skills<br />
  73. 73. Syndromes<br />Ataxia:incoordination of movement<br />- decomposition of movement<br /> - dysmetria, past-pointing<br /> - dysdiadochokinesia<br /> - rebound phenomenon of Holmes<br /> - gait ataxia, truncal ataxia, titubation<br />Intention Tremor<br />Hypotonia,Nystagmus<br />Archicerebellar Lesion: medulloblastoma<br />Paleocerebellar Lesion: gait disturbance<br />Neocerebellar Lesion: hypotonia, ataxia, tremor<br />
  74. 74. Cerebellar Ataxia <br />Ataxic gait and position: <br /> Left cerebellar tumor<br /> a. Sways to the right in<br /> standing position<br /> b. Steady on the <br /> right leg<br /> c. Unsteady on the <br /> left leg<br /> d. ataxic gait<br />
  75. 75. CerebellarMedulloblastoma<br />Cerebellar tumors on vermis<br />- Truncal Ataxia<br /> - Frequent Falling<br />The child in this picture:<br /> - would not try to stand <br /> unsupported<br /> - would not let go of the bed rail<br /> if she was stood on the floor.<br />
  76. 76. Cerebellar lesions<br />Are usually vascular, may be traumatic or tumour.<br />Manifestations of unilateral cerebellar lesions :1-ipsilateral incoordination of (U.L) arm= intention tremors : it is a terminal tremors at the end of movement as in touching nose or button the shirt. 2-Or ipsilateralcerebellar ataxia affects (L.L.) leg, causing wide-based unsteady gait.<br />Manifestations of bilateral cerebellar lesions (caused by alcoholic intoxication, hypothyrodism, cerebellar degeneration & multiple sclerosis) 1-dysarthria : slowness & slurring of speech. <br />2-Incoordination of both arms.=intention tremors.<br />3-Cerebellar ataxia : intermittent jerky movements or staggering ,wide-based, unsteady gait 4-Nystagmus : is a very common feature of multiple sclerosis. It is due to impairment coordination of eye movements /so, incoordination of eye movements occurs and eyes exhibit a to-and-fro motion.<br />Combination of nystagmus+ dysarthria+ intension tremors constitutes Charcot’triad, which is highly diagnostic of the disease. <br />
  77. 77. THANK YOU<br />