Damage to the cerebellum, what is the cerebellum and how does rehabilitation work for damage to the cerebellum?

The cerebellum of the human brain is responsible for the normal functioning of muscle fibers, their tone, coordination of movements, balance and adaptation in space. It is divided into a middle part (represented by a worm) and two hemispheres, which are located on the sides. On the ventral side, a small formation is adjacent to the hemisphere - a shred.

The cerebellum contains the processes of neurons, and the cortex is located on its surface. The cerebellar cortex is a superficial layer that has 3 layers: molecular, ganglionic and granular. Under the cortex is white matter formed by myelinated nerve fibers: some fibers (afferent) go to the cerebellar cortex from the spinal cord and medulla oblongata, others (climbing) - from the cortex to the subcortical nuclei.

We will try to understand the structural features of the organ, as well as its functional responsibilities, in more detail.

Where is the cerebellum located?

Many people are interested in what the cerebellum is. So it consists of almost 50% of the neurons of the entire central nervous system, despite this it is small in size and weight (up to 150 g). Located in the cranial cavity between the temporal lobes. Due to this localization, the small brain communicates with other parts of the central nervous system, which are responsible for the functioning of the entire organism.

The cerebellum is located under the cerebral hemispheres behind the brain stem and pons. Due to this arrangement, it manages to perform its functions.

Anatomy of the cerebellum

The structure of the cerebellum resembles the structure of the cerebral hemispheres. Let us consider each of the structural units and functions of the cerebellum in more detail.

Worm

The worm is a narrow strip. A small element runs along the side, called the amygdala, and is responsible for motor activity and balance. The amygdala is divided into upper and lower parts, grooves are located on the sides, they are assigned the function of separating the worm from the hemispheres.

The outer surface of the worm is covered with gray matter, which controls body posture, muscle fiber activity, and balance. A disorder in its functioning causes problems with walking and standing.

Shares

The lobes of the cerebellum are separated by large grooves, one of which is in contact with the surface of the hemispheres. Their totality is considered part of the small brain.

The vermis and lobes of the hemispheres are located at the same level. They are distinguished: tongue, central particle, apex, slope, letter, tubercle, pyramid, sleeve, nodule.

Yu.V. Zueva, N.K. Korsakova, L.A. Kalashnikov

Moscow, Russia

For many years, the cerebellum was considered as a structure responsible solely for the coordination and static movement of movements. And although clinical studies have long accumulated material on the connection between cerebellar pathology and diseases such as autism, schizophrenia, senile dementia, due to the lack of instrumental and technical base, these data remained at the phenomenological level (Sehmahmann, 1991; Snider, 1982; Weinberger et al ., 1980; Cole et al.., 1989). With the development of neuroimaging research methods, such as positron emission tomography, single-photon emission tomography and high-resolution magnetic resonance imaging, as well as the accumulation of a huge amount of data in the framework of anatomical, laboratory, and clinical studies, the role of the cerebellum in the organization of mental functions was shown (Akshoomoff & Courchersne , 1992; Botez-Marquard & Botez, 1993; Berquin et al., 1998; Kim et al., 1994; Leiner et al., 1986; Orioli & Stick, 1989; Paradiso et al., 1997; Paulesu et al., 1995; Petersen & Fiez, 1993; Sehmahmann, 1996, 1997, 1998; Sehmahmann & Handya, 1987; Silvery et al., 1994). The concept of the influence of the cerebellum on cognitive processes was formed relatively recently, but already in 1997 in the USA, under the editorship of Sehmahmann, the world's first monograph “Cerebellum and Cognition” was published, summarizing the currently available clinical, anatomical, physiological and neuroimaging data (Sehmahmann, 1997 ). The anatomical basis for the participation of the cerebellum in mental functions is its bilateral connections with the associative zones of the cortex of the predominantly contralateral cerebral hemispheres and the limbicoreticular complex. At the same time, the isolated existence of pathways going to the motor cortex and prefrontal parts of the brain was noted, which in turn determines the possibility of isolated occurrence of cognitive and motor disorders with damage to the cerebellum (Hook, 1997; Kim et al., 1994; Leiner et al. 1986 , 1993; Middleton & Stick, 1994; Orioli & Strick, 1989; Sehmahmann, 1997; Sehmahmann & Handya, 1987). It has also been shown that cerebellar pathology of various origins (tumors, degenerations, hypoplasia, vascular changes) leads to a wide range of mental dysfunctions in the form of disorders of planning, abstract thinking, working memory, deficits of spatial functions, speech, emotional and personal changes (Botez-Marquard & Botez, 1993; Berquin et al., 1998; Canavan et al., 1994; Cole, 1994; Grafman et al., 1992; Malm et al., 1998; Sehmahmann, 1998; Silvery et al., 1994).

However, most studies are limited to the consideration of either individual mental functions and their components, or the study of clinical syndromes, which prevents the possibility of finding general mechanisms for the formation of very diverse and numerous cognitive symptoms. It seems adequate to solve this problem by applying complex syndromic analysis to impaired mental functions. At the school of A.R. Luria for more than 20 years, T.V. Melnikova (1974) conducted a study of patients with subtentorial tumors (including a cerebellar tumor) and obtained data on the presence of neuropsychological syndromes of the frontal and temporoscopic type. parieto-occipital. At the same time, a relationship was shown between neuropsychological disorders and dysfunction of these particular parts of the cerebral cortex using EEG. However, the identified changes were explained by transient vascular disorders associated with a specific tumor location. The role of the cerebellum in cognitive deficits has not been identified and has not been developed in further studies.

Based on the experience of Western researchers and applying the methodology of syndromic analysis developed at the school of A.R. Luria (2000), we formulated the task of conducting a comprehensive study of disorders of higher mental functions (HMF) in cerebellar infarctions and identifying clinical parameters that influence the degree of cognitive decline in this form of pathology. Isolated infarctions, compared with other types of diseases (cerebellar degenerations, tumors, congenital anomalies), are the most adequate and correct clinical model, since they develop in patients without concomitant signs of damage to the cerebral hemispheres, which cannot be completely excluded in the case of degenerative diseases or tumors of the cerebellum, often accompanied hydrocephalus. However, isolated infarctions are a very rare clinical model (Malm et al., 1998: Schmahmann. 1998; Schmalimann & Handya. 1987) and the present study of 25 patients with this pathology is the first to be conducted on such a large sample.

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A. R. Luria and psychology of the 21st century. Content

Functions of the organ and what it is responsible for

The small brain plays the role of evaluator when making decisions. The functions of the cerebellum of the human brain are the reception and storage of information about the results of this action and possible consequences.

The cerebellum performs the following functions:

  • maintaining the tone of muscle fibers and control over body posture;
  • adjustment of slow movements and their coordination in relation to body position;
  • control of the process of performing movements that require quick reactions.

To study as best as possible the characteristics of this organ and why it is needed, scientists conducted a number of studies on animals. The cerebellums were removed, and as a result, the following development was observed:

  • astasia - the animal felt unsure in space, it spread its limbs wide and swayed;
  • atony - disruption of the ability of normal functioning of muscle fibers, loss of the ability to flex and straighten limbs;
  • asthenia - loss of the ability to exercise control over one’s movements;
  • ataxia - sudden movements.

Symptoms of cerebellar damage

When the functioning of the small brain is disrupted, asthenia, ataxia and atony are more often observed. A variant of the norm is considered to be a situation where a person’s movements are coordinated, and in the process of their execution various groups of muscle fibers are actively involved, their contraction and relaxation occurs with a certain force at the right time. When the cerebellum is damaged, this process is disrupted.

Pathologies

Let us consider in more detail the characteristics of the pathologies that occur in disorders of the functioning of the cerebellum.

Ataxia

The characteristic symptom of the pathology is the patient’s unsteady gait. It seems to him that he is losing support under his feet, as a result he spreads his legs so as not to fall. When performing the Romberg test (consists of standing on your legs closed together), a positive result will be observed.

Dystonia

The tone of muscle fibers, mainly flexors and extensors, is disrupted. Performing any exercise leads to rapid muscle fatigue.

Dysarthria

This condition is characterized by impaired pronunciation, speech becomes slow, incomprehensible and slurred. It can also become chanted and fragmentary.

Adiadochokinesis

Damage to the cerebellum causes loss of the ability to analyze and process information received about the speed and strength of movements. There is a loss of the ability to perform them smoothly. The patient is asked to stretch his arms in front of him and return them. One of the upper limbs will lag behind (movements become asymmetrical).

Dysmetria

Characterized by loss of ability to perform operations related to precision. This deviation is explained by a violation of the coordination of muscle fibers - antagonists.

realizing them through the entire structure of the central nervous system.

The cerebellum takes part in various activities of the body:

  • motor,
  • somatic,
  • vegetative,
  • sensory,
  • integrative, etc.

The cerebellum consists of two hemispheres and has a cortex of gray matter. The cortex contains cells with numerous dendrites that receive impulses from many sources associated with muscle activity: proprioceptors of tendons, joints and muscles, as well as from the motor centers of the cortex. Therefore, the cerebellum integrates information and coordinates the work of all muscles involved in movement or maintaining a posture. The cerebellum is absolutely necessary for coordinating fast movements such as running, typing on a keyboard, and talking.

The cerebellum is anatomically and functionally divided into archi-, paleo- and neocerebellum.

  • Archicerebellum
    (ancient cerebellum) - the flocculomedullary lobe belongs to it, has the most pronounced connections with the vestibular system, which explains the importance of the cerebellum in the regulation of balance.
  • Paleocerebellum (old cerebellum) - consists of sections of the cerebellar vermis, pyramid, tongue, parafloccular section and receives information mainly from the pro-prioreceptive systems of muscles, tendons, periosteum, and joint membranes.
  • Neocerebellum (new cerebellum) - includes the cortex of the cerebellar hemispheres and parts of the vermis; it receives information from the cortex, mainly along the fronto-pontine-cerebellar pathway, from the visual and auditory rehearsal systems. This indicates its participation in the analysis of visual and auditory signals and in the organization of appropriate reactions.

The cerebellar cortex creates the conditions for rapid information processing

Diagnosis of organ problems

Identifying the problem, in the case of vermiform aplasia, using ultrasound examination is possible even during intrauterine development. Children are born with a large number of neurological disorders. They require mandatory treatment and a recovery course.

Identification of disorders of small brain structures occurs in a neurological office, through special exercises. If one of the hemispheres is damaged, a finger-nose test is performed, it allows you to determine the area that is damaged, and it is in that direction that the finger will deviate. If the ancient cerebellum or archicerebellum is damaged, there will be a loss of the ability to navigate in space.

To identify cerebellar ataxia caused by tumors, a comprehensive examination by specialized specialists is carried out. Examination of the cerebellum can be carried out using:

  • performing a spinal tap;
  • computed tomography;
  • magnetic resonance imaging;
  • Dopplerography;
  • electronystagmography;
  • DNA diagnostics.

Adenomas and cysts at the initial stage of development are detected using MRI of the brain.

The influence of the cerebellum on autonomic functions

The small brain is endowed with the ability to influence the functioning of all body systems. Damage to the cerebellum leads to a decrease in blood pressure and the development of bradypnea. The tone of the respiratory muscles on the affected side will be decreased, while on the opposite side there will be an increase.

The tone of the intestinal muscle fibers changes, it will be reduced, and this causes a disruption in the removal of the contents of the intestines and stomach. There is a suppression of the absorption of nutrients. Metabolic processes accelerate, the level of glucose in the blood increases, which persists for a long period of time compared to the norm. Appetite worsens, the patient loses weight, and the process of tissue regeneration is suppressed.

In drawing a conclusion, I would like to focus on the fact that the cerebellum, despite its small size, plays a very important role in the functioning of the entire organism. Its defeat can cause severe disorders; in the absence of adequate therapy, this is fraught with irreversible consequences.

Diseases

Diseases that affect the cerebellum - cyst, malignant tumor, malformations and anomalies, abscess, olivopontocerebellar degenerative processes, cerebellar ataxia caused by hereditary factors, known as Pierre Marie's ataxia. Pathologies of the cerebellum cause disorders in the functioning of the musculoskeletal system. Violations affect:

  • coordination of movements (dynamic ataxia);
  • maintaining balance (static ataxia);
  • muscle tone.

The defeat of a specific lobe is reflected in symptoms. For example, damage to the tissue of the flocculo-nodular area leads to atony of the muscles running along the spinal column.

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