Cerebellar inflammation symptoms treatment. Problems with the cerebellum symptoms Cerebellum pathology is typical for what diseases

The cerebellum is involved in almost all movements, it helps a person throw a ball or walk around the room. Cerebellar problems are rare and are mainly associated with impaired movement and coordination.

Anatomy of the brain

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The brain consists of four lobes, each lobe performs its own function.

The frontal lobe is located at the front and top of the brain. She is responsible for high level human thinking and behavior such as planning, judgment, decision making, control and attention.

The parietal lobe is located at the top of the brain, behind the frontal lobe. It is responsible for receiving sensory information. The parietal lobe of the brain is responsible for understanding someone's position in their environment.

The temporal lobe is located in the lower front part of the brain. It is associated with visual memory, language and emotions.

Finally, the occipital lobe is located at the back of the brain and processes what a person sees.

Along with the lobes, the brain includes the cerebellum and the brainstem.

The brain stem controls vital important functions such as breathing, circulation, sleep, digestion and swallowing. These involuntary functions are under the control of the autonomic nervous system. The brain stem also controls reflexes.

The cerebellum is located in the lower back part of the brain, behind the brain stem.

Functions of the cerebellum:

Movement coordination. Most body movements require coordination of several muscle groups. The cerebellum allows the body to move smoothly.

Maintaining balance. The cerebellum detects changes in movement balance. It sends signals to the body to adjust to movement.

Eye coordination.

The cerebellum helps the body learn movements that require practice and fine tuning. For example, the cerebellum plays a role in learning the movements needed to ride a bicycle.

Researchers believe the cerebellum influences thinking and is linked to language and mood, but these functions are not yet well understood.

Symptoms of cerebellar damage

The most common sign of a cerebellar disorder is impaired muscle control. This is because the cerebellum is responsible for controlling balance and voluntary movements.

Symptoms and signs of cerebellar disorder include:

Lack of muscle control and coordination;

Difficulty walking;

Difficulties with speech;

Pathological eye movements;

Headache.

Cerebellar ataxia

Changes in the gait of a woman with cerebellar lesions

ICD-10:

G11.1 Early cerebellar ataxia

G11.2 Tardive cerebellar ataxia

G11.3 Cerebellar ataxia with DNA repair disorder

A disorder of the cerebellum is ataxia.Ataxiais a loss of muscle coordination and control due to a problem with the cerebellum. It can be caused by a virus or a brain tumor. Loss of coordination is often the initial sign of ataxia. Other symptoms include blurred vision, difficulty swallowing, fatigue, difficulty with precise muscle control, and changes in mood and thinking.

There are several diseases that cause symptoms of ataxia. These are heredity, poisons, stroke, tumors, head injuries, multiple sclerosis, cerebral paralysis, viral infections.

Genetic or hereditary ataxia is caused by a genetic mutation. There are several different mutations and types of hereditary ataxia. These disorders are rare; the most common type is Friedreich's ataxia, which affects 1 in 50,000 people. Symptoms of Friedreich's ataxia usually appear in childhood.

Idiopathic (sporadic) ataxia is a group of degenerative movement disorders in which there is no evidence of inheritance. Loss of coordination and speech are the first symptoms. Idiopathic ataxia usually progresses slowly and may be accompanied by fainting, irregular heartbeat, erectile dysfunction, and loss of bladder control.

There is currently no specific treatment to alleviate or eliminate the symptoms of the disease, except in cases of ataxia, where the cause is vitamin E deficiency.

Ataxia caused by toxins occurs. Poisons damage nerve cells brain - cerebellum, which leads to ataxia.

Toxins that cause cerebellar ataxia:

Alcohol;

Medicines, especially barbiturates and benzodiazepines;

Heavy metals such as mercury and lead;

Paint solvents.

Treatment and recovery depend on the toxin that caused the brain damage.

Ataxia viral etiology . This disorder is called acute cerebellar ataxia and most often affects children. Rare complication chickenpox is ataxia.

Acute cerebellar ataxia can also be caused by the Coxsackie virus, Epstein-Barr virus, and HIV. Lyme disease, caused by bacteria, is also associated with these conditions.

Ataxia usually resolves within a few months after the viral infection resolves.

Strokecan affect any area of the brain. The cerebellum is a less common site for stroke. A thrombus or hemorrhage in the cerebellum can cause ataxia, which occurs headache, dizziness, nausea and vomiting. Treatment for stroke may reduce symptoms of ataxia.

Brain tumorsThey are benign when they do not spread throughout the body, and malignant when the tumors metastasize.

Symptoms of a tumor in the cerebellum include:

Headache;

Vomiting without nausea;

Difficulty walking;

Diagnosis and treatment will vary depending on age, health status, disease progression, and other factors.

To avoid damage to the cerebellum, it is necessary to maintain general state brain health. Reducing your risk of stroke, traumatic brain injury, and exposure to poisons will help avoid some forms of ataxia.

Used Books:

De Smet, Hyo Jung, et al. " The cerebellum: its role in language and related cognitive and affective functions" Brain and language 127.3 (2013): 334-342.
Lippard, Jim. " The Skeptics Society & Skeptic magazine.»

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Coordination motor disorder caused by cerebellar pathology. Its main manifestations include gait disorder, disproportionality and asynergy of movements, dysdiadochokinesis, and changes in handwriting such as sweeping macrography. Typically, cerebellar ataxia is accompanied by scanned speech, intention tremor, postural tremor of the head and torso, and muscle hypotonia. Diagnosis is carried out using MRI, CT, MSCT, MAG of the brain, Dopplerography, cerebrospinal fluid analysis; if necessary, genetic research. Treatment and prognosis depend on the causative disease that caused the development of cerebellar symptoms.

General information

Chronically progressive cerebellar ataxia is often a consequence of alcoholism and other chronic intoxications (including substance abuse and polydrug addiction), slowly growing cerebellar tumors, genetically determined cerebral degenerative and atrophic processes with damage to the cerebellar tissue or its pathways, and a severe form of Chiari malformation. Among the genetically determined progressive ataxias of the cerebellar type, the most famous are Friedreich's ataxia, non-Friedreich's spinocerebellar ataxia, Pierre-Marie's ataxia, Holmes cerebellar atrophy, and olivopontocerebellar degeneration (OPCD).

Cerebellar ataxia with a paroxysmal course can be hereditary or acquired. Among the causes of the latter are TIA, multiple sclerosis, intermittent obstruction of the cerebrospinal fluid pathways, and transient compression in the foramen magnum.

Symptoms of cerebellar ataxia

Cerebellar ataxia is manifested by sweeping, uncertain, asynergic movements and characteristic unsteady gait, during which the patient spreads his legs wide for greater stability. When trying to walk along one line, there is a significant swaying to the sides. Ataxic disorders increase with a sharp change in the direction of movement or a rapid start of walking after getting up from a chair. Sweeping movements are a consequence of a violation of their proportionality (dysmetria). It is possible to have both an involuntary stop of a motor act before its goal is achieved (hypometry) and an excessive range of movements (hypermetry). Dysdiadochokinesis is observed - the patient’s inability to quickly perform opposite motor acts (for example, supination and pronation). Due to impaired coordination and dysmetria, a change in handwriting that is pathognomonic for cerebellar ataxia occurs: macrography, unevenness and sweep.

Static ataxia is most obvious when the patient tries to get into the Romberg position. For pathology of the cerebellar hemisphere, a deviation, and even a fall, in the direction of the lesion is typical; with changes in its median structures (the vermis), a fall is possible in any direction or backward. Carrying out a finger-nose test reveals not only missingness, but also the intention tremor accompanying ataxia - trembling of the fingertip, which intensifies as it approaches the nose. Testing the patient in the Romberg position with open and eyes closed, shows that visual control does not particularly affect the test results. This feature of cerebellar ataxia helps differentiate it from sensory and vestibular ataxia, in which the lack of visual control leads to a significant worsening of coordination problems.

As a rule, cerebellar ataxia is accompanied by nystagmus and dysarthria. Speech has a specific “cerebellar” character: it loses its smoothness, slows down and becomes intermittent, stress is placed on each syllable, making speech resemble a chant. Often, cerebellar ataxia is observed against the background of muscle hypotonia and decreased deep reflexes. When tendon reflexes are evoked, pendulum-like movements of the limb are possible. In some cases, titubation occurs - low-frequency postural tremor of the torso and head.

Diagnosis of cerebellar ataxia

Since cerebellar pathology can have a wide variety of etiologies, specialists from various fields are involved in its diagnosis: traumatologists, neurosurgeons, oncologists, geneticists, endocrinologists. A thorough examination of the neurological status by a neurologist makes it possible to determine not only the cerebellar nature of the ataxia, but also the approximate area of the lesion. Thus, pathology in the cerebellar hemisphere is indicated by hemiataxia, the unilateral nature of coordination disorders and decreased muscle tone; about the pathological process in the cerebellar vermis - the predominance of walking and balance disorders, their combination with cerebellar dysarthria and nystagmus.

In order to exclude vestibular disorders, a vestibular analyzer is examined: stabilography, vestibulometry, electronystagmography. If an infectious lesion of the brain is suspected, a blood test is performed for sterility and PCR tests are performed. Lumbar puncture with examination of the obtained cerebrospinal fluid can reveal signs of hemorrhage, intracranial hypertension, inflammatory or tumor processes.

The main methods for diagnosing diseases underlying cerebellar pathology are neuroimaging methods: CT, MSCT and MRI of the brain. They can detect cerebellar tumors, post-traumatic hematomas, congenital anomalies And degenerative changes cerebellum, its prolapse into the foramen magnum and compression when adjacent anatomical structures are displaced. In the diagnosis of ataxia of a vascular nature, MRA and Dopplerography of cerebral vessels are used.

Hereditary cerebellar ataxia is established based on the results of DNA diagnostics and genetic analysis. The risk of having a child with a pathology in a family where there have been cases of this disease can also be calculated.

Treatment of cerebellar ataxia

Treatment of the causative disease is fundamental. If cerebellar ataxia has an infectious-inflammatory origin, it is necessary to prescribe antibacterial or antiviral therapy. If the cause lies in vascular disorders, then measures are taken to normalize blood circulation or stop cerebral bleeding. For this purpose, angioprotectors, thrombolytics, antiplatelet agents, vasodilators, and anticoagulants are used in accordance with indications. For ataxia of toxic origin, detoxification is performed: intensive infusion therapy in combination with the prescription of diuretics; in severe cases - hemosorption.

Ataxia is not yet hereditary radical treatment. Metabolic therapy is mainly carried out: vitamins B12, B6 and B1, ATP, meldonium, ginko biloba preparations, piracetam, etc. To improve metabolism in skeletal muscles, increase its tone and strength, patients are recommended to massage.

Tumors of the cerebellum and posterior cranial fossa often require surgical treatment. Removal of the tumor should be as radical as possible. If the malignant nature of the tumor is established, a course of chemotherapy or radiotherapy treatment is additionally prescribed. For cerebellar ataxia caused by occlusion of the cerebrospinal fluid pathways and hydrocephalus, shunt operations are used.

Prognosis and prevention

The prognosis depends entirely on the cause of cerebellar ataxia. Acute and subacute ataxia caused by vascular disorders, intoxication, inflammatory processes, with timely elimination causative factor(vessel occlusion, toxic effects, infection) and adequate treatment can completely regress or partially persist in the form residual effects. Chronically progressive hereditary ataxias are characterized by an increasing aggravation of symptoms, leading to disability of the patient. The most unfavorable prognosis is for ataxia associated with tumor processes.

The prevention of injuries, the development of vascular disorders (atherosclerosis, hypertension) and infection is of a preventive nature; compensation of endocrine and metabolic disorders; genetic counseling when planning pregnancy; timely treatment pathologies of the cerebrospinal fluid system, chronic cerebral ischemia, Chiari syndrome, processes of the posterior cranial fossa.

Among various diseases of the nervous system, cerebellar atrophy is considered one of the most dangerous and common. The disease manifests itself as a pronounced pathological process in tissues, usually caused by trophic disorders.

The human brain has a complex structure and consists of several sections. One of them is the cerebellum, which is also called the small brain. This department performs a wide range of functions necessary to maintain the performance of the entire body.

The main function of the described part of the brain is motor coordination and maintaining skeletal muscle tone. Due to the work of the cerebellum, it is possible to coordinate the work of individual muscle groups, which is necessary for performing any everyday movements.

In addition, the cerebellum is directly involved in reflex activity body. Through nerve connections, it is connected to receptors in different parts of the human body. When exposed to a certain stimulus, a nerve impulse is transmitted to the cerebellum, after which a response is formed in the cerebral cortex.

The ability to conduct nerve signals is possible due to the presence of special nerve fibers in the cerebellum. The development of atrophy has a direct impact on these tissues, as a result of which the disease is accompanied by various movement disorders.

The cerebellum is supplied with blood through three groups of arteries: anterior, superior and posterior. Their function is to provide an uninterrupted supply of oxygen and nutrients. In addition, certain components in the blood provide local immunity.

The cerebellum is one of the main parts of the brain responsible for motor coordination and many reflex movements.

Causes of atrophy

In general, atrophic processes in the brain, and in particular in the cerebellum, can be triggered by a large number of reasons. These include various diseases, impact pathogenic factors, genetic predisposition.

With atrophy, the affected organ does not receive the required amount nutrients and oxygen. Because of this, irreversible processes develop associated with the cessation of the normal functioning of the organ, a decrease in its size, and general exhaustion.

In number possible reasons Cerebellar atrophy includes the following:

Meningitis. With this disease, it develops inflammatory process in various parts of the brain. Meningitis is infection, which, depending on the form, is caused by bacteria or viruses. Cerebellar atrophy due to the disease can develop due to prolonged exposure to blood vessels, the direct influence of bacteria, and blood poisoning.
Tumors. A risk factor is the presence of tumors in the patient in the posterior part of the cranial fossa. As the tumor grows, pressure on the cerebellum and the brain regions located in close proximity increases. Because of this, blood flow to the organ may be disrupted, which subsequently provokes atrophic changes.
Hyperthermia. One of the causes of cerebellar damage is prolonged exposure to high temperature. This may be due to elevated temperature body against the background of any disease or heat stroke.
Vascular diseases. Often, cerebellar atrophy occurs against the background of cerebral atherosclerosis. The pathology is associated with a decrease in the patency of blood vessels, depletion of their walls and a decrease in tone caused by focal deposits. Against the background of atherosclerosis, oxygen deficiency develops and the flow of substances worsens, which, in turn, causes atrophic changes.
Complications after a stroke. Stroke is a sudden disruption of blood circulation in the brain caused by hemorrhages and cranial hematomas. Due to a lack of blood in the affected tissue areas, they die. Cerebellar atrophy acts as a consequence of this process.

The diseases described above have a direct impact on the functioning of the cerebellum, causing irreversible changes in it. The danger of atrophy of any part of the brain lies in the fact that they consist mainly of nerve tissue, which practically does not recover even after a long period of time. complex treatment.

Cerebellar atrophy can be caused by the following factors:

Constant drinking of alcohol.
Diseases of the endocrine system.
Traumatic brain injuries.
Hereditary predisposition.
Chronic intoxication.
Long-term use of certain medications.

Thus, cerebellar atrophy is a condition associated with acute deficiency of oxygen and nutrients, which can be provoked by diseases and wide range harmful factors.

Types of cerebellar atrophy

The form of the disease depends on a number of aspects, among which the most significant are the cause of the lesion and its location. Atrophic processes can occur unevenly and are more expressed in certain parts of the cerebellum. This also affects clinical picture pathology, which is why it is often individual for each specific patient.

Main types:

Cerebellar vermis atrophy is the most common form of the disease. The cerebellar vermis is responsible for conducting information signals between different parts of the brain and in separate parts bodies. Due to the lesion, vestibular disorders occur, manifested in imbalances and coordination of movements.

Diffuse atrophy. The development of atrophic processes in the cerebellum often occurs in parallel with similar changes in other brain regions. The simultaneous lack of oxygen in the nerve tissues of the brain is called diffuse atrophy. In the overwhelming majority of cases, atrophy of several brain regions occurs against the background of age-related changes. The most common manifestations of this pathology are Alzheimer's and Parkinson's diseases.

Atrophic processes of the cerebellar cortex. Atrophy of the tissues of the cerebellar cortex, as a rule, is a consequence of damage to other parts of the organ. The pathological process most often passes from the upper part of the cerebellar vermis, increasing the area of atrophic lesion. Subsequently, atrophy may extend to the cerebellar olives.

Determining the form of the disease is one of the important criteria for selecting a treatment method. However, it is quite common to make an accurate diagnosis, even when performing a comprehensive hardware examination turns out to be impossible.

In general, there are different types of cerebellar atrophy, the distinctive feature of which is the location of the lesion and the nature of the symptoms.

Clinical picture

The nature of symptoms in cerebellar atrophy manifests itself in different ways. Signs of the disease often differ in intensity and severity, which directly depends on the form and cause of the pathology, individual physiological and age characteristics patient, possible concomitant disorders.

The following symptoms are characteristic of cerebellar atrophy:

Motor disorders. The cerebellum is one of the organs that ensures normal human motor activity. Atrophy causes symptoms that occur both during movement and at rest. These include loss of balance, deterioration in motor coordination, drunken gait syndrome, and deterioration in hand motor skills.
Ophthalmoplegia. Given pathological condition associated with damage to the nerve tissues responsible for transmitting signals to the eye muscles. Such a violation is usually temporary.
Decreased mental activity. Impairment of the passage of nerve impulses caused by atrophy of the cerebellum affects the functioning of the entire brain. Due to the pathological process, the patient’s memory and ability to think logically and analytically deteriorate. Speech disorders are also observed - confusion or slowness of speech.
Reflex activity disorders. Due to damage to the cerebellum, many patients experience areflexia. With such a disorder, the patient may have no reaction to any stimulus that, in the absence of pathology, causes a reflex. The development of areflexia is associated with a violation of the signal patency in the nerve tissues, as a result of which the previously formed reflex chain is broken.

The symptoms and manifestations of cerebellar atrophy described above are considered the most common. However, in some cases, damage to the brain may be practically invisible.

The clinical picture is sometimes supplemented by the following manifestations:

Nausea and regular vomiting.
Headache.
Involuntary urination.
Trembling in the limbs, eyelids.
Slurred speech.
Increased intracranial pressure.

Thus, a patient with cerebellar atrophy may experience various symptoms, the nature of which depends on the form and stage of the disease.

Diagnostic methods

Many methods and tools are used to detect cerebellar atrophy. In addition to directly confirming the presence of atrophic processes, the purpose of diagnosis is to determine the form of the disease, detect accompanying pathologies, possible complications, prediction regarding treatment methods.

To implement diagnostic procedures the patient must seek the help of a neurologist. You should visit a medical facility if any manifestations of atrophy occur, since timely assistance provided significantly reduces the likelihood of serious consequences for the patient’s health.

Basic diagnostic methods:

Examination and interview of the patient is in the primary way diagnostics, which is aimed at identifying complaints and signs of disease. During the examination, the neurologist checks nervous reactions patient, notes possible motor and speech disorders and other symptoms. In addition, anamnesis is studied - the history of diseases that could act as a provoking factor for atrophy.
MRI is considered the most reliable diagnostic method, as it can detect even minor atrophic changes. Using this method, the exact location and area of damage to the cerebellum, as well as possible concomitant changes in other parts of the brain, are determined.
Computed tomography is also a very reliable diagnostic method, allowing you to confirm the diagnosis and obtain additional information about the nature of the disease. Usually prescribed in cases where MRI is contraindicated for some reason.
Ultrasound examination. This method used to diagnose extensive brain damage caused by stroke, trauma, age-related changes. Ultrasonography allows you to identify areas of atrophy and, similarly to other hardware methods, determine the stage of the disease.

Diagnosis of cerebellar atrophy is carried out using various hardware and non-hardware methods when early signs of the disease appear.

Therapy

Unfortunately, special methods There are no treatments aimed at eliminating cerebellar atrophy. This is due to the fact that medications, physiotherapy or surgical methods therapies are not able to restore nerve tissue damaged due to circulatory disorders and oxygen starvation. Therapeutic measures are reduced to eliminating pathological manifestations, reducing negative consequences for other parts of the brain and the whole body, preventing complications.

With careful diagnosis, the cause of the disease is determined. Eliminating it allows for positive changes in the patient’s condition, especially if treatment began at an early stage.

The following medications can be used to relieve symptoms:

"Teralen."
"Alimemazine."
"Levomepromazine."
"Thioridazine."
"Sonapax".

The action of such drugs is aimed at eliminating psychotic disorders caused by pathological processes in the cerebellum. In particular, medications are used for manic-depressive states, neuroses, panic attacks, increased anxiety, sleep problems.

Depending on the medication, administration can be carried out orally (when using tablets), intravenously and intramuscularly (if using appropriate solutions). The optimal method of administration, dosage and duration of the therapeutic course are prescribed by a neurologist individually, in accordance with the diagnosis.

During therapy, it is extremely important to provide the patient with careful care. Because of this, many experts recommend implementing initial stages treatment at home. However, it is strictly prohibited self-treatment and the use of non-traditional traditional methods, as they may cause even more harm.

The patient should regularly undergo repeated examinations and examinations by a neurologist. The main purpose of secondary diagnostics is to monitor the effectiveness of treatment, provide recommendations to the patient, and adjust drug dosages.

Thus, cerebellar atrophy is not amenable to direct therapeutic intervention, which is why treatment is symptomatic.

Undoubtedly, cerebellar atrophy is a very serious pathological condition, accompanied by deterioration of functions and tissue death this department brain Due to the lack of special treatment methods and the high likelihood of complications, you should pay attention to any potential signs of the disease and promptly visit a neurologist.

7. Types of cerebellar lesions

When the archecerebellum is damaged, there is an imbalance when standing and walking - cerebellar ataxia. When the eyes are closed, cerebellar ataxia does not change. The cause of its occurrence is muscle asynergy. Efferent impulses from the paleocerebellum, activating anti-gravity muscles, form the muscle tone necessary for uprightness and upright walking. The function of paleo- and archicerebellum is aimed at controlling the tone of skeletal muscles. Also, these formations coordinate the function of antagonist and agonist muscles, determining normal gait and static behavior. When the paleocerebellum is damaged, trunk ataxia develops.

Ataxia is a lack of coordination of movements.

Ataxia is divided into static, static-locomotor and dynamic. Static ataxia is characterized by impaired balance in sitting and standing positions. With static-locomotor ataxia, balance is disturbed when walking and standing. Dynamic ataxia is characterized by imbalance when performing any movements, especially with the upper limbs.

Static and static-locomotor ataxia is manifested by a disturbance in the patient’s gait. She becomes unsteady, with her legs spread wide apart. The patient also cannot stand straight. When walking, the patient deviates in the direction on which the lesion is located. Static and static-locomotor ataxia is also detected using some tests.

The Romberg test requires the patient to stand with his eyes closed. At the same time, your arms are extended in front of you, your toes and heels are shifted.

There is another version of the Romberg test, in which one of the patient’s legs is in front of the other. When performing this test, pay attention to which direction the patient’s body deviates.

Tests for dysmetria and hypermetry are also carried out. Dysmetria is a violation of the measure of movements performed, which become impetuous, quickly performed and excessive. The test that reveals this pathology involves asking the patient to pick up two objects that are different in size. In this case, the patient cannot place his fingers adequately to the size of the objects. The second test involves the patient standing with his arms extended forward, palms facing upward. He is asked to rotate his hands, palms down. If there is pathology, then on the affected side the movements performed are made more slowly and with greater rotation. An increase in the volume of movements performed is hypermetry.

During the Schilder test, the patient must close his eyes, extend both arms forward, raise one arm up, and then lower it to the level where the other arm is located, and vice versa. When the cerebellum is damaged, the raised arm drops below the level of the outstretched arm.

When the cerebellum is damaged, scanned speech appears.

Damage to the cerebellum is accompanied by the appearance of hyperkinesis various types. Tremor or intention tremor may be observed.

Pathology of the cerebellum is accompanied by a decrease in muscle tone.

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G11.1 Early cerebellar ataxia

Causes of cerebellar damage

Of all tumor-like formations of the brain, both benign and malignant processes, damage to the cerebellum is observed most often. Strokes and traumatic hemorrhages also most often damage the basal part of the brain (injuries are characterized by a direct blow to the back of the head). Inflammatory pathology is characterized by transitions of the otogenic process, especially with mastoiditis, to the postcranial fossa.

Structure of the cerebellum

The cerebellum is located in the posterior cranial fossa above the medulla oblongata and the pons. From above it is separated from the occipital lobes of the cerebral hemispheres by the cerebellar tentorium. The surface of the cerebellar cortex is significantly increased due to deep parallel arcuate grooves dividing the cerebellum into sheets. Physiologically, the cerebellum is divided into the ancient part (flocculus and nodule), the old part (vermis) and the new part (hemispheres).

The white matter of the hemisphere and the cerebellar vermis has several nuclei. The paired nucleus of the tent (nucl. fastigii) is located paramedianly, lateral to it there are small islands of gray matter - the spherical nucleus (nucl. globusus), even more laterally, protruding into white matter hemisphere - corky nucleus (nucl. emboliformis). In the white matter of the hemisphere there are dentate nuclei (nucl. dentatus).

The cerebellum has three pairs of peduncles. In the lower cerebellar peduncles, afferents pass (posterior spinocerebellar tract, from the superior nucleus of the vestibular nerve - vestibulo-cerebellar tract, from the nuclei of the thin and cuneate fasciculi - bulbo-cerebellar tract, from the reticular formation - reticulo-cerebellar tract, from the inferior olive - olivocerebellar tract) and efferent tracts (cerebellar-reticulospinal, cerebellar-vestibular-spinal - through the lateral nucleus of the vestibular nerve, cerebellar-olivospinal), mainly associated with the structures of the cerebellar vermis.

In the largest middle cerebellar peduncles pass the cerebellopontine fibers, which are part of the cortical-pontocerebellar tract from the superior frontal gyrus and the lower parts of the occipital and temporal lobe to the cerebellar cortex. In the superior cerebellar peduncles there are afferent pathways from spinal cord(anterior spinocerebellar tract) and the descending cerebellar-rednuclear-spinal cord tract, running from the dentate nucleus of the cerebellar hemispheres through the red nucleus to the anterior horn of the spinal cord.

Symptoms of cerebellar damage

Damage to the cerebellum or its pathways causes a rather pronounced symptom complex.

Ataxia always comes to the fore: imbalance of the body at rest and when walking (he sways like a drunk, especially at dusk or darkness, the inability to perform simple orthostatic tests), static disturbances when walking; especially on uneven surfaces, steps, inclined planes, dynamic when performing involuntary movements, disproportionality of movements (hypermetry); intermittent, adiadochokinesis (difficulty alternating opposite movements), intention tremor, nystagmus, speech disorder - scanned speech. The pathogenetic basis of all cerebellar manifestations is a violation of coordination in the actions of antagonist muscles (asynergia).

When the cerebellar vermis is damaged, the synergies that stabilize the center of gravity are disrupted. As a result, balance is lost, trunk ataxia sets in, and the patient cannot stand (static ataxia); walks with legs wide apart and staggers, which is especially clearly observed during sharp turns. When walking, there is a deviation towards the affected part of the cerebellum (homolateral).

When the cerebellar hemispheres are damaged, limb ataxia, intention tremor, overshooting, and hypermetry (dynamic ataxia) predominate. Speech is slow and chanted. Megalography (large handwriting with uneven letters) and diffuse muscle hypotonia are detected.

In a pathological process of one hemisphere of the cerebellum, all these symptoms develop on the side of the lesion of the cerebellum (homolateral).

Diagnosis of cerebellar lesions

Tests characterizing cerebellar damage and dynamic ataxia:

heel-knee (performed while lying on your back with your eyes closed) - they suggest raising your leg and hitting the patella with your heel (misses); pass along the front surface of the shin towards the heel (slides);
heel-fist - the doctor places his own fist under the heel and asks to raise the foot and lower it again onto the fist (he misses);
finger-nasal (with closed gases index finger when swinging your arm, reaching the tip of your nose is a miss);

finger-finger - first with open and then with closed eyes, they offer to use their index finger to take out the other (with with open eyes It's easy to do, but when closed it misses).

Tests characterizing cerebellar damage and static ataxia (carried out while standing, with eyes closed, but with absolute insurance by the doctor in case the patient falls) are aimed at identifying stability (this group includes the entire complex of orthostatic tests):

with legs spread wide apart, there is staggering with a large tilt towards the affected lobe of the cerebellum, especially pronounced when turning the body from side to side;
Romberg pose - standing with eyes closed (feet closed), arms extended forward - deviation or fall towards the affected hemisphere or to any side in case of pathology (cerebellar vermis); if the picture is unclear, a Romberg sensitization test is performed (or they are asked to put one leg in front of the other or bend the knee);
ataxia-abasia symptom - the patient cannot move on his own, but within the bed all active movements are preserved.

Tests characterizing cerebellar damage and kinetic ataxia:

tonic - decreased muscle tone (flabbiness, lethargy);
gait - asked to walk 2-3 m without support in a straight line: cannot walk, when walking he moves his legs forward, but his torso lags behind, makes intricate movements with his legs, making the gait atypical;
Magnus-Klein symptoms (“magnetic reaction”)
- when you carefully touch the foot, a stretching sensation is observed throughout the entire limb;
- in small children, when turning the head to the side, the legs bend at the knees or hip joints on the side where head turned; on the opposite side, the limb, on the contrary, extends;
asynergic Babinski symptoms
- standing, they suggest bending back, throwing back their head - falls;
- lying down, they offer to sit down - he swings and raises his legs, then sits down with a jerk;
- sitting, they offer to stand on their feet - he sways, then stands up.

Other tests characterizing cerebellar damage:

synergistic - when looking up, the head does not tilt back; with a strong handshake, there is no extension in the wrist joint, no wrinkling of the forehead;
adiodochokinesis - pronation and supination of the hands are carried out simultaneously - movements on the injured side are slow;
dismetric –
- with fingers extended forward and spread apart, the palms rotate sharply, on the side of the injury there is excessive rotation;
- Orzechowski's symptom - the patient leans firmly on the doctor's palms; when the support is abruptly removed, the patient leans forward (a healthy person, on the contrary, leans back);
dysarthria - chanted speech with emphasis on each syllable;
Stewart-Holmes symptom - a person fixes a bent elbow joint supinated arm, the doctor tries to straighten it and sharply removes his hand, the patient hits him on the chest, since he cannot slow down the movement of his arm;
Thomas-Jumanti symptom (grasping) - a person grabs an object, already at the beginning of grasping he opens his palm very wide;
Tom's symptoms:
- if you push a person, standing sideways, then this will cause the leg to rise on the side of the impact and fall in the opposite direction;
- with the patient lying on his back, the bent knees are pulled apart and brought in several times, then abruptly released - on the affected side, the limb is involuntarily abducted;
- in a standing position, a person needs to bend to the side, on the healthy side there is an increase in the tone of the extensors and abduction of the leg in the opposite direction, on the injured side this does not happen;
- a person moves like a pillar due to rigidity of the trunk muscles, noted when the worm is affected;
Foix-Thevenard symptom - with a slight push into the piles forward or backward, the patient easily loses balance, healthy person balance is maintained.

An examination of patients who have cerebellar damage should be carried out in a neurosurgical hospital - with the involvement of a neurophysiologist, otoneurologist and ENT doctor, neuro-oculist.