1. Cerebellum and Basal Ganglia David Roman Renner, MD Suzanne Stensaas, PhD 2009 Kenya Curriculum

2. BG CBLM Courtesy of Stephen C. Voron, MD

3. BG CBLM Courtesy of Stephen C. Voron, MD

4. BG CBLM pyramidal cell in the motor homunculus of the frontal lobe Courtesy of Stephen C. Voron, MD

5. BG CBLM corticospinal tract Courtesy of Stephen C. Voron, MD

6. BG CBLM decusation at the pyramids (spino- medullary junction Courtesy of Stephen C. Voron, MD

7. BG CBLM thalamus: AKA the “gate keeper” prevents unwanted movements Courtesy of Stephen C. Voron, MD T

8. BG CBLM BASAL GANGLIA consultant on automatic movements provides input into the thalamus Courtesy of Stephen C. Voron, MD T

9. Cerebellum: consultant on rapid movements provides input into the thalamus BG CBLM

10. Basal Ganglia resting tremor postural instability festination rigidity masked facies bradykinesia dyskinesia torticollis chorea athetosis hemiballismus akathisia Cerebellum intention tremor dysmetria dysdiadochokinesia hypotonia heal to shin finger to nose rebound ataxic gait titubation nystagmus dysmetric saccades

11. Basal ganglia lesions produce contralateral signs. Cerebellar lesions produce ipsilateral signs.

12. Most movement disorders produced by cerebellar and basal ganglia pathology disappear during sleep. Cerebellar and basal ganglia signs are usually not present if the corticospinal tract is damaged.

13. The cerebellum is the great comparator: 1. It compares cortical willful command with muscle tension, joint position, & tone (via ipsilateral spinocerebellar tracts) 2. Advises the cortex on how much, how many, how fast 3. The motor cortex sends the revised command down the corticospinal tract

14. The BASAL GANGLIA are the autopilot for procedural movements. The CEREBELLUM is the refiner of finely controlled movements (particularly of fingers).

15. COMPARISON OF MOTOR SYSTEMS http://library.med.utah.edu/neurologicexam/html/home_exam.html http://library.med.utah.edu/neurologicexam/html/home_exam.html

16. Courtesy of Stephen C. Voron, MD