Neuroanatomy

Lab
Exercise #7

CEREBELLU
M

The Case
A 37-year old man visited his physician because he had
noticed clumsiness of his right arm.
The symptoms had started 6 months previously and were
getting worse. He also noticed that his right hand had a
tremor when he attempted fine movements or tried to
insert a key in a lock. When he walked, he noticed that
now and again he tended to reel over to the right.
On physical examination, the face was tilted slightly to
the left, and the right shoulder was held lower than the
left. Passive movements of the arms and legs revealed
hypotonia and looseness on the right side. When asked to
walk heal to toe along a straight line on the floor, the
patient swayed over to the right side. When he was asked
to touch his nose with his right index finger, the right
hand displayed tremor and the finger tended to
overshoot the target. Speech was normal and nystagmus
was not present.

Important Points from the Case

37-year old man.
Clumsiness of his right arm.
Symptoms started 6 months ago and are getting

worse.
Right hand tremor when attempting fine movements.
Face was tilted slightly to the left, and the right
shoulder was held lower than the left.
Passive movements of the arms and legs revealed
hypotonia and looseness on the right side.
Sway to the right during heel to toe walking in a
straight line.
When he was asked to touch his nose with his right
index finger, the right hand displayed tremor and the
finger tended to overshoot the target.
Speech was normal and nystagmus was not present.

Diagnosis?
The hallmark of cerebellar
dysfunction is intension
tremor without paralysis or
paresis.
Symptoms are ipsilateral.
Unilateral lesions will result
in a patient falling toward the
side of the lesion.

Superior Cerebellar
Landmarks

Inferior Cerebellar
Landmarks

Other Cerebellar
Landmarks

Practice
Questions
Identify the item at the
pointer:

Postlunate
fissure

2
3
4

Horizontal
fissure

2
1

3
4
5

6
7
8
9
10
11

4
Cerebral5
aqueduct
6

7
8
9
10

2
3

11
12

Basal Ganglia
Quick Overview

1 Anterior column of fornix

2 Anterior horn of lateral
ventricle
3 Anterior limb of internal
capsule
4 Body of caudate nucleus
5 Body of fornix
6 Body of lateral ventricle
7 Bulb
8 Calcar avis
9 Choroid plexus
10 Claustrum
11 Corpus callosum
12 Forceps minor (corpus
callosum)
13 Genu of internal capsule
14 Head of caudate nucleus
15 Inferior horn of lateral
ventricle
16 Insula
17 Interventricular foramen
18 Lentiform nucleus: globus
pallidus
19 Lentiform nucleus:
putamen
20 Lunate sulcus
21 Optic radiation

End of Exercise #7
In order to be prepared
for the practical exams,
be sure to look at the
actual cerebellum
specimens.