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The cerebellum
located at the posterior cranial
fossa
posterior to the fourth ventricle,
pons and medulla
It is connected to the posterior
brainstem by the three cerebellar
peduncles
superior cerebellar peduncle
connects it to the midbrain
middle cerebellar peduncle to the
pons
inferior cerebellar peduncle to the
medulla
INTRODUCTION
has two cerebellar
hemispheres which
are joined by the
vermis
divided into three
main lobes, the
anterior, middle and
the flocculonodular
lobes which are
separated from
each other by three
fissures.
INTRODUCTION
The cerebellar cortex, the
outer layer of the
cerebellum, is made up of
grey matter.
It has three layers:
the molecular cell layer
(external layer and is
composed mainly of stellate
and basket cells)
the middle purkinje cell layer
the internal granular layer.
INTRODUCTION
globose nucleus
fastigial nucleus
INTRODUCTION
FUNCTIONS OF CEREBELLUM:
control of posture and voluntary movement
has an unconscious influence on the coordination of the
actions and the smooth contraction of the skeletal
muscles
Receives information regarding balance from the
vestibular nerve.
INTRODUCTION
A lesion in one cerebellar hemisphere manifests its
signs and symptoms on the same side of the body
since the pathways by which is it connected are also
on the ipsilateral side.
In instances where cerebellar dysfunction is present,
the movements become uncoordinated and are
often much chaotic than the normal movement.
This overshoot of movement is called DYSMETRIA
and it often leads to ATAXIA.
INTRODUCTION
A number of tests for ataxia, dysmetria and
coordination may be done by a physician. These
tests include past pointing, finger-nose test, finger-
finger-nose test, counting, dysdiadochokinesia, the
knee-heel test, draw a circle test, performing of
everyday tasks such as dressing or undressing and
walking on a straight line.
PROCEDURE
Finger-nose test.
The subject is asked to extend his arm to the side and
then touch the tip of his nose with the tip of his index
finger, first with the eyes open followed by the eyes
closed. The opposite limb is tested similarly. A normal
subject is should be able to perform these actions
accurately, both slowly and rapidly.
PROCEDURE
Dysdiadochokinesia
The subject is asked to make fists, and then flex
theforearm to right angles, tuck the elbows into his
sides, and then alternately pronate and supinate
his forearms as rapidly as possible.
PROCEDURE
Heel-knee test.
The subject is asked to lie on his back, and then to
lift one foot high in the air, place its heel on the
opposite knee, and then to slide the heel down the
leg towards the ankle. The test is done first with the
eyes open and then with eyes closed, and it is
repeated on the other side.
PROCEDURE
Tandem Walking
The subject is asked to walk along a straight line and
then is observed by the examiner carefully as the
subject walks back to where he or she came from. The
subject may also be asked to walk along a line, placing
the heel of one footimmediately adjacent to the toes of
the foot behind. If incoordination is present, the subject
soon deviates to one or the other side and takes a
zigzag course like that of a drunk.
RESULTS AND DISCUSSION
To be able to identify or confirm the presence of
cerebellar lesions and diseases, it is necessary to
perform various tests for the motor functions.
gait
RESULTS AND DISCUSSION
MUSCLE TONE
continuously maintained state of slight tension or
tautness in the healthy muscles even when they appear
to be at rest
HYPERTONIA - An increase in tone is
known which occurs in lesions of upper
motor neurons and extrapyramidal
systems
HYPOTONIA - a decrease in tone which
is commonly seen in lower motor neuron
disease and cerebellar lesions
A spinal-reflex mechanism, although the
anterior cerebellum has a facilitatory
effect on it via the subcortical
structures.
RESULTS AND DISCUSSION
COORDINATION OF MUSCULAR
ACTIVITY OR MOVEMENTS
refersto the smooth interaction and cooperation of
groups of muscles to be able to perform motor tasks
evaluated by testing the patient's ability to perform
rapidly alternating and point-to-point movements
correctly (tests which involve the upper and lower limbs)
RESULTS AND DISCUSSION
GAIT
refersto the manner, style, or pattern of walking
dependent on the same vestibular, proprioceptive, and
integrative systems as stance and balance. However, it
requires direction from the central gait mechanism in
the frontal lobes, basal ganglia, brain stem, and
descending motor systems.
RESULTS AND DISCUSSION
four common forms of abnormal gait seen in
neurological conditions:
Spastic (hemiplegic) Gait
Knee cannot be flexed and
foot is not properly lifted off
the ground as patient is
instructed to walk on a narrow
base. As a result, patient
drags his/her foot on the
ground and tends to describe
a semicircle with the affected
leg.
RESULTS AND DISCUSSION
four common forms of abnormal gait seen in
neurological conditions:
Stamping Gait
- Patient raises each foot
suddenly and brings it
down on the ground
with a thump
-Seen in sensory ataxia
RESULTS AND DISCUSSION
four common forms of abnormal gait seen in
neurological conditions:
Drunken or reeling gait
Also an ataxic gait
Seen in cerebellar lesions
Characterized by a clumsy, and
zigzagging-like gait of a drunkard as
the patient is instructed to walk on a
broad base with his/her feet apart
Ataxia is equally severe whether
the eyes are closed or open
RESULTS AND DISCUSSION
four common forms of abnormal gait seen in
neurological conditions:
Festinant Gait
Seen in Parkinsons disease
Characterized by slow-paced
walking and short shuffling
steps, and uncontrolled
acceleration while walking
Inability to stop when patient
is pushed forward or pushed
back
RESULTS AND DISCUSSION
TESTS FOR UPPER RESULTS NORMAL ABNORMAL FINDINGS
LIMB FINDINGS
Slight tautness in the Hypertonia increased tone; patients
TONE NORMAL muscle. Resistance offered muscles resist the passive movements
to passive movements Hypotonia decreased tone; movements are
done by the examiner is free and the joints can be hyperextended
normal. *impaired check and rebound
b. Stamping gait. The patient raises each foot suddenly and brings it down on the
ground with a thump. It is seen in sensory ataxia (e.g. tabesdorsalis). He may be quite
steady as long as he can see the ground and the position of his feet.
c. Drunken or reeling gait. This ataxic gait is seen in cerebellar lesions, the patient walks
on a broad base, with the feet apart. The gait is clumsy and zigzagging like the gait of
a drunkard. The ataxia is equally severe whether the eyea are closed or open.
d. Festinant gait. This is seen in Parkinsons disease. Walking is usually slow and the
patient takes short, shuffling steps. Sometimes there is an uncontrolled acceleration while
walking, a process called festinant gait. When gently pushed forward, the patient may
be unable to stop as he chases his own center of gravity (propulsion). Similarly, when
pushed back, he is unable to stop (retropulsion)
REFERENCES
Ghai, CL. 2013. A textbook of practical physiology.
8th ed. JP Brothers Medical Publishers. New Delhi