1. Cerebellar system and diseases
Balance & Equilibrium

2. Cerebellum Coordination of movement
Control of gait, posture (Balance )
Control of muscle tone (Motor control )
Cognitive functions
Attention
Emotions
Language

3. Motor coordination Cerebellum does not initiate movement
It contributes to coordination, precision, and accurate timing.
It receives input from sensory systems and from other parts of the brain and spinal cord,
It integrates these inputs to tune fine motor activity.
Because of this fine-tuning function,
Cerebellar lesions produce disorders in fine movement, equilibrium, posture, and motor learning.

4. 4 Cerebellar nuclei& neurons
Basket cells-inhibitory
Stellate cells-inhibitory
Golgi cells-inhibitory
Granule cells-excitatory (Glutamate)
Purkinje cells; inhibitory (GABA)
Dentate nucleus emboliform
İnterpositus nucleus
Fastigius nucleus globose
molecular
granular

5. Intrinsic Fibers Mossy fibers
These fibers carry impulses from the inferior peduncle from spinocerebellar pathways, olivocerebellar pathways.
Climbing fibers
They carry impulses from the middle cerebellary peduncle. They carry impulses from the cortex and projects to the cortex.

6. Phylogenetically..
Flocculo-nodulus ARCHICEREBELLUM – related with vestibular nuclei
Anterior lobes-PALEOCEREBELLUM- spinocerebellar pathways
Posterior lobes- NEOCEREBELLUM – cerebello-pontin pathways

7. Vestibulo-cerebellum
Flocculo-nodulus receives special proprioceptive impulses from the vestibular nuclei (located in pons and the bulb)
Equilibrium and balance , spatial orientation.
Any lesion will cause ataxia , gait disturbance,
Walking difficulty

8. Spinocerebellum Vermis, The medial zone of the anterior lobes
It receives proprioceptive input from the spinocerebellar tract and from visual and auditory systems.
It sends fibres to deep cerebellar nuclei that, in turn, project to both the cerebral cortex and the brain stem, thus providing modulation of descending motor systems; POSTURE, MUSCLE TONE.

9. Neocerebellum
Posterior lobes receive afferents from cortex through corticopontine pathways.
It projects to the cortex via the dentate nucleus. Its projections are to the cerebral cortex through nucleus ruber, thalamus.
In association with the differentiation of skeletal muscle this part is the largest in humans.It coordinates skilled movements.

10. Many projections (mainly the purkinje cell) relay on deep cerebellary nuclei (mainly dentate nuclei) and then projects.
Contrary, Floculo-nodulus directly projects to vestibular nuclei.

11. Clinical manifestations of cerebellar dysfunction
Muscular coordination
Equilibrium
Locomotion
No weakness
Initiation of movement delays.
Relaxing delays.
Contractions are irregular, intermittent.
Speech disturbances

12. Features with regard to lobes
Posterior lobe
(neocortex)
Anterior lobe
(paleocortex)
Flocculo-nodulus
(archicortex)
Ataxia + ++
Nystagmus -
+/_
Intentional tremor _
Hyptonia
Rebound
Dysmetria..

13. Dysmetria Loss of ability to gauge the distance Speed
Power of movement
The act may be carried out with too little or too much power.
The act may stop before the goal is reached
or overshoot.

14. dysdiadokokinesia
Disturbance of reciprocal innervation-coordination of agonist-antagonist muscles.
İmpairment of rapid alternating muscles.

15. Hypotonia
The body parts may be extended or flexed to extreme positions as the muscle tonus is decreased (flask).

16. Intentional tremor
Tremor is not observed at rest, but during reaching a target tremor becomes established.
Diferential diagnosis
Resting tremor (parkinsonian)
Postural tremor (essential , drugs)

17. Speech in cerebellar diseases
Explosive
Slurred
As if drunken

18. Disease Hereditary cerebellar diseases Friedrich ataxia
Spinocerebellar ataxia’s
Acquired cerebellar diseases
Vascular (Wallenberg syndrome, SCA infarct)
Degenerative (multisystem atrophies)
Demyelinating (Multipl Sclerosis)
Toxic-metabolic (Alchohol abuse, diphenyl hidantion chronic use)
Neoplastic, paraneoplastic (cerebellar neoplasms)