1. Clinical Case
A patient delays initiation of movement, displays an uneven trajectory in moving her hand from above her head to touch her nose, and is uneven in her attempts to demonstrate rapid alternation of pronating and supernating movements of the hand and forearm. Which regions of the brain is most likely contains the lesion?

2. Clinical Case
A 55-year-old male had been complaining about his having difficulty in coordinating the use of his arms in meaningful ways. For example, when examined by a neurologist, the patient was unable to move his finger accurately to his nose from his side when requested to do so but instead he would undershoot or overshoot the target. He also had difficulty in making Rapid alternating rotational movements of the hand. The neurologist believed that the patient was suffering from a disorder that resulted in a lesion of a region of the cerebellum or structures related to it. Which regions of the cerebellum is most likely contained this lesion

3. Cerebellum External features
located in posterior cranial fossa.
2. Communicate with brain stem by cerebellar peduncles.
Superior cerebellar peduncles( Brachium conjunctiva)
Middle cerebellar peduncles (Brachium pontis)
Inferior cerebellar peduncle (Restiform Body

4. Crebellum External features cont..
Anatomical sub divisions of Cerebellum
Longitudinal division
Vermis, Paravermal Region, Hemisphere
Transverse division
Anterior Lobe
---- primary fissure
Posterior Lobe
----posterolateral fissure
Flocculonodular Lobe

5. Cerebellum Classification
Archicerebellum (Equilibrium, Tone & Posture of trunk Muscles)
Paleocerebllum (Tone & Posture of limb Muscles)
Neocerebellum (Smooth performance of skilled act by coordination of move)
Classification by its Connections
Vestibulocerebellum
Spinocerebellum
cerebrocerebellum

7. Crebellum External features cont..
Subdivision of Flocculonodular Lobe
Nodulus Flocculus
Subdivision of Anterior Lobe
Vermis Hemisphere
Lingula
Central Lobule Ala Central Lobule
postcentral fissure
Culmen Quadrangular Lobule

8. Crebellum External features cont..
Subdivision of Posterior Lobe
Vermis crebellar Hemisphere
Declive Simple Lobule
postcentral fissure
Folium Superior Semilunar Lobule
horizontal fissure
Inferior Semilunar Lobule
Tuber
Gracile Lobule
prepyramidal fissure
Pyramid Biventer Lobule
secondary fissure
Uvula Tonsil

9. Crebellum Internal features cont..
Cerebellar Cortex
Molecular Layer
Purkinje Cell Layer
Granular Layer
Deep Cerebellar Nuclei
Fastigial Nuclei
(Nucleus Interpositus)
Emboliform Nucleus
Globose Nucleus
Dentate Nucleus

11. Crebellum Internal features cont..
Cerebellar Cortex
I. Molecular Layer
Stellate Cell (inhibitory)
afferent: parallel fiber
efferent: Purkinje cell dendrite
Basket Cell ---- GABA (inhibitory)
efferent: Purkinje cell soma
Parallel Fiber
granule cell axon
Purkinje Cell Dendrite

12. Cerebellum Internal features cont..
II. Purkinje Cell Layer
Purkinje Cell
-- 15,000,000 in number
-- GABA (inhibitory)
afferent: parallel fiber
climbing fiber
stellate cell
basket cell
efferent: deep cerebellar nuclei nuclei

13. Cerebellum Internal features cont..
III. Granular Layer
Granular Cell
-- 50,000,000,000 in number
-- glutamic acid (excitatory)
afferent: mossy fiber
efferent: Purkinje cell dendrite
basket cell, stellate cell
Golgi cell
Golgi Cell
-- GABA (inhibitory)
afferent: parallel fiber, mossy fiber rosette
efferent: granule cell dendrite

15. Cerebellum Internal features cont..
Synaptic Glomerulus
Afferent terminals on granular layer
 Mossy Fiber Rosette
-- afferent fibers except
inferior olivary input
-- 2/3 of medullary center
 Granular Cell Dendrite
-- main afferent input
 Golgi Cell Axon
-- synapse on granule cell dendrite
-- GABA (inhibitory)
- Surrounded by Astrocyte Foot Process

16. Cerebellum Connections
1. Inferior Cerebellar Peduncle
Restiform Body
Posterior Spinocerebellar Tract
Olivocerebellar tract
Cuneocerebellar Tract
Reticulocerebellar Tract
Juxtarestiform Body
Vestibulocerebellar Tract
Primary Vestyibular Fiber

17. Cerebellum Connections
Afferent Connections (2):
2. Middle Cerebellar Peduncle
Pontocerebellar fiber
Corticopontocerebellar Fiber
Reticulocerebellar Fiber
3. Superior Cerebellar Peduncle
Anterior Spinocerebellar Tract
Cerulocerebellar fiber
Raphecerebellar fiber
Rubrocerebellar fiber
Hypothalamocerebellar fiber

18. Cerebellum Connections
Efferent Connections:
1. Superior Cerebellar Peduncle
  Cerebellothalamic fiber
- From 3 deep nuclei to VPLo, VLc, CL
Cerebellorubral fiber
- From nucleus globusus
And dentate nucleus
2. Inferior Cerebellar Peduncle
  Fastigiovestibular fiber
Descending portion of
Uncinate fasciculus

20. Cerebellar Pathway

21. Main Connections of the Vestibulocerebellum
Vestibular
Organ
Floculonodular
Lobe
Vermis
VESTIBULAR NUCLEUS
vestibulospinal tract
MLF
FASTIGIAL
NUCLEUS
lower motor neuron
ARCHICEREBELLUM
LMN

22. Main Connections of the Paleocerebellum
RED NUCLEUS
NUCLEUS
INTERPOSITUS
rubrospinal
tract
Inferior
Olivry
Nucleus
ANTERIOR
LOBE
PARAVERMAL
ZONE
lower motor neuron
PALEOCEREBELLUM
SPINAL CORD
spinocerebellar tract

23. Main Connections of the Neocerebellum
CEREBRAL
CORTEX
THALAMUS
DENTATE
NUCLEUS
pyramidal
tract
Pontine
Nucleus
POSTERIOR
LOBE
CEREBELLAR
HEMISPHERE
lower motor neuron
NEOCEREBELLUM
LMN

24. Pyramidal Tract and Associated Circuits
upper motor neuron
UMN
Cerebellum
BASAL
GANGLIA
pyramidal tract
lower motor neuron
UMN

25. Cerebellum and Automatic Motor Control Lower Motor Neuron (LMN)
Motor Cortex
CEREBELLUM
Red Nucleus
Vestibular
Nucleus
Reticular
Formation
Lower Motor Neuron (LMN)
Proprioceptors

26. Functions Of Cerebellum
 Maintenance of Equilibrium
- balance, posture, eye movement
 Coordination of automatic movement of
walking and posture maintenance
- posture, gait
 Adjustment of Muscle Tone
 Motor Leaning – Motor Skills
 Cognitive Function

27. Cerebellum Disorders Ataxia: incoordination of movement
- decomposition of movement
- dysmetria, past-pointing
- dysdiadochokinesia(Adidydakokinesia)
- rebound phenomenon of Holmes
- gait ataxia, truncal ataxia, titubation
Intention Tremor
Hypotonia, Nystagmus

28. Cerebellum Disorders Archicerebellar Lesion: medulloblastoma
Paleocerebellar Lesion: gait disturbance
Neocerebellar Lesion: hypotonia, ataxia, tremor