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Neuroanatomy, Cerebellum
Sopiko Jimsheleishvili; Marine Dididze.
Author Information and Affiliations
Last Update: July 24, 2023.

Introduction
The cerebellum is a vital component in the human brain as it plays a role in motor movement
regulation and balance control. The cerebellum coordinates gait and maintains posture, controls
muscle tone and voluntary muscle activity but is unable to initiate muscle contraction. Damage
to this area in humans results in a loss in the ability to control fine movements, maintain posture,
and motor learning.[1][2][3]

Structure and Function

The cerebellum, which is the largest part of the hindbrain, is located in the posterior cranial
fossa, behind the fourth ventricle, the pons, and the medulla oblongata. Tentorium cerebelli, an
extension of the dura matter, separates the cerebellum from the cerebrum. It is composed of two
hemispheres joined by the vermis and is sub-divided into three lobes – anterior, posterior, and
flocculonodular, which are separated by two transverse fissures. The V-shaped primary fissure
separates the anterior and posterior lobe, while the posterolateral fissure separates the posterior
and flocculonodular lobes. A deep horizontal fissure found within the posterior lobe separates the
superior and inferior surfaces of the cerebellum. The cerebellum is neuron-rich, containing 80%
of the brain’s neurons organized in a dense cellular layer.[1][4]

The cerebellar cortex is a sheet-like structure, made of a single sheet less than 1mm thick, and
accordion-like folds fused at the midline (Essen 2018). Each fold is composed of an inner white
matter core that is covered by gray matter. The gray matter of the cortex divides into three layers:
an external - the molecular layer; a middle - the Purkinje cell layer; and an internal - the granular
layer. The molecular layer contains two types of neurons: the outer stellate cell and the inner
basket cell.[4][5]

The Purkinje layer consists of Purkinje cells, which are large Golgi type I neurons. Their
dendrites reach the molecular layer and have multiple branches. The axons are long, pass through
the granular layer, enter the white matter, acquire a myelin sheath, and terminate in the
intracerebellar nuclei. Their collateral branches make synaptic contacts with the basket and
stellate cells of the granular layer. Climbing and mossy fibers provide the primary input to the
cerebellar cortex. Mossy fibers use glutamate, while the climbing fibers use aspartate as their
main excitatory neurotransmitter to provide excitatory signals to the Purkinje cells. The climbing
fibers are named so because they travel in the cortex like vine branches on a tree. They represent
the terminal ending of the olivocerebellar tracts. The mossy fibers are the terminal branches of
all other cerebellar afferent tracts. Each mossy fiber may stimulate thousands of Purkinje cells
via multiple branching.[4][6]

Function: The cortex of the vermis coordinates the movements of the trunk, including the neck,
shoulders, thorax, abdomen, and hips. Control of the distal extremity muscles is by the
intermediate zone of the cerebellar hemispheres, located adjacent to the vermis. The remaining
lateral area of each cerebellar hemisphere provides the planning of sequential movements of the
entire body along with involvement in the conscious assessment of movement errors.[3][7]
Nuclei: The cerebellum consists of an outer layer of highly convoluted gray matter (cerebellar
cortex) surrounding a highly branched body of white matter known as the arbor vitae (Latin for
“tree of life”), which in turn surrounds the 3 pairs of deep cerebellar nuclei embedded in the
central cerebellar white matter (corpus medullaris). From medial to lateral, the deep nuclei are
the fastigial, interposed (consisting of globose and emboliform nuclei), and dentate nuclei, which
is the largest nuclei.[1] Fibers from the dentate, emboliform, and globose nuclei leave the
cerebellum through the superior cerebellar peduncle. Fibers from the fastigial nucleus exit
through the inferior cerebellar peduncle.[1][8]

Embryology
The cerebellum develops from the hindbrain vesicle that gives rise to the posterior part of the
alar plates of the metencephalon. The cerebellar hemisphere and vermis form by the 12th week.
Accordion-like folds gradually start developing from about the fourth month. Neurons of
cerebellar cortex form by the neuroblast derived from the matrix cells in the ventricular zone.
Other neuroblasts from the ventricular surface differentiate into cerebellar nuclei, which axons
grow towards the mesencephalon (midbrain) and create the superior cerebellar peduncle. Later,
projections of the axons of the corticopontine and the pontocerebellar fibers will develop the
middle cerebellar peduncle and connect the cerebral cortex with the cerebellum. The inferior
cerebellar peduncle will form mainly by the growth of sensory axons from the spinal cord, the
olivary and vestibular nuclei.[9]

Blood Supply and Lymphatics

The cerebellum receives vascular supply from three main arteries that originate from the
vertebrobasilar anterior system: the superior cerebellar artery (SCA), the anterior inferior
cerebellar artery (AICA), and the posterior inferior cerebellar artery (PICA).

The SCA branching varies based on embryology; it can branch either from the junction point of
the basilar artery and posterior cerebral artery and pass below the oculomotor nerve, or directly
from the posterior cerebral artery and pass above the oculomotor nerve. In the majority of
subjects, the SCA encircles the brainstem below the oculomotor nerve and above the trigeminal
nerve. The SCA splits into two branches: medial and lateral. The medial branch of the SCA
further splits into two branches; one supplies the mesencephalon and inferior and superior
colliculi while the second supplies the superior portion of the vermis and the superomedial
cerebellar cortex. The lateral branch of the SCA supplies the superolateral cerebellar cortex.
Blood vessels have deeper penetration in the vermis that makes it more echogenic on fetal
ultrasound.[10][11]

The AICA branches off the basilar trunk in almost all subjects. It passes the abducens nerve and
meets with the facial and vestibulocochlear nerves at the cerebellopontine angle. It then divides
into two branches: one supplies the anterior inferior cerebellum while the other supplies the
flocculus, choroid plexus, and the middle cerebellar peduncle.[10][11]

PICA is the largest vertebral artery branch. It passes between the cerebellum and the medulla and
supplies the cerebellar nuclei, inferior surface of the vermis, and the undersurface area of the
cerebellar hemisphere. Medulla oblongata and the choroid plexus of the fourth ventricle are
supplied by PICA, which may give rise to posterior spinal arteries in some anatomical variations.
The cerebellum is drained by veins that empty into the great cerebral vein or adjacent venous
sinuses.[10]

Nerves
The cerebellum attaches to the brainstem by three groups of nerve fibers called the superior,
middle, and inferior cerebellar peduncles, through which efferent and afferent fibers pass to
connect with the rest of the nervous system. The following tables summarize how the cerebellum
connects with the cerebrum (Table 1), the brainstem (Table 2), and the spinal cord (Table 3).[1]
[3]

Table 1: Connection of cerebellum with the cerebrum

Table 2: Connection of cerebellum with the brainstem

Table 3: Connection of cerebellum with the spinal cord

Surgical Considerations
Cerebellum and its nuclei are eloquent parts of the brain and maximum effort must be put to
avoid damage to these areas during surgeries in and around these structures.

Clinical Significance
The cerebellum receives afferent information about voluntary muscle movements from the
cerebral cortex and from the muscles, tendons, and joints. It also receives information concerning
balance from the vestibular nuclei. Each cerebellar hemisphere controls the same side of the
body, thus if damaged the symptoms will occur ipsilaterally. Several signs and symptoms arise as
a consequence of cerebellar dysfunction: During hypotonia, the muscles lose resistance to
palpation due to diminished influence of the cerebellum on gamma motor neurons. The patient
walks with a broad-based gait and leans toward the affected side. Disturbances of voluntary
movements, called ataxia, involve tremors with fine movements, such as writing or buttoning
the clothes. Finger to nose test is performed to examine the coordination of the muscle
movements. When a patient is asked to touch the tip of the nose with the index finger, the
movements are not properly coordinated, and tremor is observed at the end of the movement,
called intention tremor. A similar test can be performed on the lower limbs by asking the patient
to place the heel of one foot against the shin of the opposite leg. Ataxia of ocular muscles results
in nystagmus, a rhythmical oscillation of the eyes. To provoke nystagmus, the patient should
rotate eyes horizontally. Similarly, ataxia of the larynx muscles results in dysarthria. Speech is
slurred and syllables are separated from one another. Dysdiadochokinesia is the lack of ability
to perform rapidly alternating movements. One can ask the patient to quickly supinate and
pronate both forearms simultaneously. Movements will be slow and incomplete on the side of the
cerebellar lesion.[12][13][14]

Cerebellar syndromes involve vermis and hemispheres. In vermis syndrome, muscle

incoordination involves the head and trunk. Patients cannot maintain a straight posture and may
fall. The most common cause of vermis syndrome is a medulloblastoma of the vermis in
children. The cerebellar syndrome involves the incoordination of muscles of the limbs
unilateral to the hemisphere lesion. Dysarthria and nystagmus are also common findings.
Disorders of the lateral part of the cerebellar hemispheres produce delays in initiating
movements. The most common cause of cerebellar dysfunction is alcohol poisoning, but also
trauma, multiple sclerosis, tumors, thrombosis of the cerebellar arteries may occur.[12][14]

Occlusion of PICA cause Wallenberg syndrome, which includes the following signs and
symptoms: dysphagia and dysarthria resulting from paralysis of the ipsilateral palatal and
laryngeal muscles; analgesia of the ipsilateral side of the face; vertigo, nausea, vomiting, and
nystagmus; ipsilateral Horner syndrome; ipsilateral limb ataxia and contralateral loss of
sensations of pain and temperature.[14]
Some data indicate that cerebellum dysfunction may correlate with disorders like autism and
schizophrenia.[15]

Review Questions
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Comment on this article.

Figure

The Hind-Brain or Rhombencephalon, Upper surface of the

cerebellum. Contributed by Gray's Anatomy Plates

Figure

The Hind-Brain or Rhombencephalon, Bottom Surface of the

Cerebellum, Post Nodular fissure, Flocculus. Contributed by
Gray's Anatomy Plates

Figure

The Hind-Brain or Rhombencephalon, Sagittal section of the

cerebellum; near the junction of the vermis with the
hemisphere. Contributed by Gray's Anatomy Plates

Figure

Cerebellum Tables. Contributed by Marina Dididze, MD,

PhD

Figure

Functional zones of the cerebellum. Contributed by Mahmut

Unverdi, MD

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Disclosure: Sopiko Jimsheleishvili declares no relevant financial relationships with ineligible companies.

Disclosure: Marine Dididze declares no relevant financial relationships with ineligible companies.

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