COORDINATION

Adelina Yasmar Alfa

Bag/SMF Ilmu Panyakit Saraf

FK-Unpad / RS-Hasan Sadikin
Bandung 2001

Cerebellum as center of coordination

-Anatomy

-Physiology
-Its disorder

Anatomy

Occupies most of the posterior cranial fossa

Dorsal to the brainstem and attached to it by cerebellar

peduncles :
Superior cerebellar peduncle (Brachium conjunctivum) midbrain
Middle cerebellar peduncle (Brachium pontis) pons
Inferior cerebellar peduncle (restiform body) medulla oblongata

Other relationship :
The fourth ventricle
Tentorium cerebelli

Anatomy (ctnd)
Composition
Cerebellar hemispheres
Vermis : cortex and medulla (incl. Nuclei)

Lobes
Anterior lobe (palaocerebellum)
C/o most of the vermis and anterior aspect of hemispheres
Associated with proprioceptive (spinecerebellar) and exteroceptive input
Significant role in regulation of muscle tone (maintain posture)

Posterior lobe (neocerebellum)

The largest part; c/o main bulk of hemisphere and part of vermis
Receive connections of cerebrum through nuclei & brachium pontis
Role in muscular coordiantion of phasic movement

Flocculonodular lobe (archicerebellum)

C/o paired flocculi of hemispheres and unpaired nodulus
Cerebellar portion of vestibular system (somatic afferent collumn)
Significant role in muscle tone, equilibrium, and posture (trunk muscles)

Anatomy (ctnd)
Cerebellar cortex
Layers
Molecular layer :
Outer layer synaptic integrative layer
Input from granular layer and deep cerebellar nuclei
C/o nerve fibers and some basket cell

Purkinje cell layer

Middle cell layer Output layer to the intrinsic cerebellar nuclei

Granular layer
Innermost layer receive input from outside

Cell and Nerve types

Anatomy (ctnd)
Cerebellar cortex (ctnd)
Cell and Nerve types
Granule cells, Purkinje cells, Basket cells, Golgi cells
Mossy fibers
Primary cerebellar input from pontine nuclei and spinocerebellar pathways
Function : to excite the granule cell
Climbing fibers (Cf)
Its cell bodies located in the inferior olivary nucleus
Synapse with primary and secondary dendritic branches of Purkinje cells at many
sites
each action potential in Cf cause a giant EPSP

a burst of repetitive Purkinje cell firing

Anatomy (ctnd)
Subcortical cerebellar nuclei
Dentate nuclei
Emboliform nuclei*
Globose nuclei
Fastigial nuclei*
Relationship of cerebellar cortex and subcortical nuclei
Lateral areas of cortex to dentate nuclei
Paramedian areas to emboliform and globose nuclei
Median area (vermis) to globose and fastigial nuclei
* The emboliform and globose nuclei are collectively called the nucleus interpositus

Anatomy (ctnd)
Cerebellar connections
All fibers carrying information to and from cerebellum do
cerebellar peduncles

so by way of the

Incoming (afferent) fibers

Superior cerebellar peduncle : anterior spinocerebellar tract (paleo-), tectocerebellar

tract (midbrain tectum to neocerebellum), trigeminocerebellar tract

Medial cerebellar peduncle (entirely afferent!!) : corticopontocerebellar tract

!! Each cerebellar hemisphere monitors the activity of the opposite cerebral hemisphere

Inferior cerebellar peduncle : conveys unconscious exteroceptive and proprioceptive

fibers from the spinal cord and vestibular system :
Dosrsal spinocerebellar (to paleo-)
Vestibulocerebellar (to archi- of the same and opposte sides)

Anatomy (ctnd)
Cerebellar connections
Outgoing (efferent) fibers : No direct cerebellospinal pathways exist !!

Superior cerebellar peduncle : primarily c/o the efferent fibers from

dentate (-rubral, -thalamic,-reticular), emboliform and globose nuclei
(the last two project to red nucleus, inferior olive, reticular formation)

Medial cerebellar peduncle : No efferent fibers

Inferior cerebellar peduncle :

Through juxtarestiform body Fastigiobulbar tract (fastigial nuclei to
vestibular and reticular nuclei

Physiology
Normal cerebellar function
Responsible for muscle synergy (coordination) throughout the body
Coordinates the action od muscles and times their contraction movement
smoothly and accurately
As a monitor of other center of the brain (not the iniator!)
The modulator (regulator) of motor activities; integrated with :

Vestibular system (maintain muscle tone and equilibrium)

General proprioceptive and exteroceptive receptors

Auditory and visual system

Basically a somatic afferent organ !!

Cerebellar Disorder
Neocerebellum
Dysmetria inability to stop the movement at the desired point (overshoots or stops
before it is reached)

Intention tremor evident during purposeful movement, but absent/diminished with rest.
Titubation : rhytmic tremor iof the head, 3-4x/minute- lesion in the midline of cerebellum
Postural disturbance
A/dysdiadochokinesis - inability to stop a movement and follow it immediately by directly
opposite action
Hypotonia ipsilateral to the lesion site; loss of cerebellar facilitation to the stretch reflex
Eye disturbance : skew deviation and nystagmus (also occurred in vestibular lesion and its
connections)
Disturbance of articulation and phonation : scanning speech/stacatto
Gait disturbance : cerebellar ataxia (tend to fall to the lesion site)

Cerebellar Disorder
Paleocerebellum
Symptoms and signs of postural and muscle tone
disrturbance

Archicerebellum
Truncal ataxia (swaying while sitting)
Vertigo

Examination of coordination
Equilibratory coordination - maintanance of balance and the
coordination of the body as a whole; examination of station and gait
Truncal ataxia, titubation
Romberg sign, Walk tandem

Non-equilibratory coordination ability to carry out discrete,

relatively fine, intentional movement with extremities.
Dysmetria, Dysdiadochokinesia
Nose-to-finger test, finger-to-finger test, heel-to-knee-to-toe test
Rebound test, test pointing and past pointing
Functional test : button-unbuttoning, writing, picking coin at desk