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CEREBELLUM AND BRAIN-STEM

BY PROFESSOR R. S. WOODWORTH
Columbia University

Several methods have recently been employed in the study of the functions of the cerebellum and their localization. Preisig (6), from a thorough histological examination of the nervous system in a case of congenital or very early atrophy of the cerebellum, with idiocy and defect of locomotion and other motor functions, reaches the conclusion that the mental defect need not be connected with the condition of the cerebellum, since the cerebrum also was affected. There had been a meningeal inflammation with involvement of the adjacent cortex of both cerebrum and cerebellum. The motor defects shown by the patient can be attributed to the condition of the cerebellum, and the mental defect to the cerebrum. This case. throws light on similar cases in the literature, in which idiocy appeared in cerebellar atrophy, but in which the cerebrum was not histologically examined. Secondary atrophy was found in several structures connected with the cerebellum on the afferent side, such as the middle peduncle and pontine nuclei, the olives, the column of Clarke, direct cerebellar tract and inferior peduncles. On the other hand, little change was visible on the efferent side, namely, the dentate nucleus, superior peduncles and red nucleus.

Rothmann (7) extirpated limited portions of the cerebellar cortex in dogs, and found evidence of localization of function, inasmuch as destruction of the cortex of the quadrangular lobe affected the action of the fore leg, and destruction of the semilunar lobe, the hind leg, while destruction of the vermis affected the trunk muscles. In this last case, the effect was contralateral and is described as a paralysis, but in the former two cases the limb affected was on the side of the lesion, and the effect was an apparent disturbance of the sense of position.

Löwy (4), by cutting the nerves of the hind limb in a young animal, caused delayed myelinization in the median posterior lobe of the

cerebellum, and concluded that this part of the vermis is connected with the hind limbs.

Beck and Bikeles (3) stimulated various peripheral nerves, having first connected the surface of the vermis to a galvanometer, so as to detect action currents aroused in the cortex of this part of the cerebellum by impulses coming in from these peripheral nerves. An action current in the vermis under these conditions would be evidence of an afferent pathway thither from the nerve stimulated. In fact, action currents were in evidence with sufficient frequency to indicate such a connection, though they appeared somewhat less regularly in the vermis than in the motor area of the cerebrum, which was similarly examined for purposes of comparison. No evidence of sensory localization within the vermis was obtained, since action currents appeared in any part of it, no matter whether the fore or the hind limb was stimulated. Evidence of a path to the vermis from the vagus nerve was also obtained by this method.

The same authors (2) used the method of action currents in a study of the reciprocal connections of the cerebellum and cerebrum. Not getting satisfactory results from the usual electrical stimulation of the cortex, they tried a thermal stimulus, consisting of a temperature of 55°-58° C., applied in the same manner as in temperature sense experiments, and found this to be very effective. When they thus excited the motor cortex cerebri, they obtained action currents in the cortex of the cerebellar hemispheres. These action currents, without being absolutely regular, were still very frequent-most frequent in the side of the cerebellum opposite to the part of the cerebrum stimulated, but fairly frequent also on the same side as the stimulation-indicating therefore both a crossed and an uncrossed path from the cerebral to the cerebellar cortex. When, instead of the motor area, the region behind this was stimulated, there was little sign of effect on the cerebellum. When, finally, the experiment was reversed, the cerebellum stimulated and the cerebrum examined, action currents appeared less frequently than before, but still frequently enough to indicate a path leading from the cerebellar to the cerebral cortex. The currents appeared most frequently in the motor area, but sometimes also behind it.

The book by André-Thomas (1), now translated, gives a very useful account of present knowledge regarding cerebellar functions. Part I. is devoted to an exposition of facts, including the anatomy and connections of the cerebellum, the results of extirpation and excitation experiments (including many of the author's own), and

the symptoms of cerebellar disease in man. Part II. is devoted to interpretation. Gall's theory of a sexual function of the cerebellum is rejected as based on a few coincidences, which are more than offset by negative instances. The theory that this is an organ of intelligence is also based on no real evidence; and, though many sensory pathways lead into the cerebellum, especially perhaps from the muscles, the evidence is against the cerebellum being the organ for conscious sensation or perception. Even the vestibular nerve, which has often been regarded as having its center in the cerebellum, has probably a cerebral center, and is not, as a matter of fact, connected very richly with the cerebellum. It is true that a few fibers find their way from this nerve into the base of the cerebellum, and also that many fibers pass between the cerebellum and the terminal nucleus of this nerve (nuclei of Deiters and Bechterew and triangular nucleus), but these last fibers are found to be efferent, enabling the cerebellum not to be affected by the vestibular nerve, but to affect its terminal nucleus and the motor paths that lead out of the latter. Thus is explained the curious similarity between the symptoms of injury to the vestibular nerve or its end-organs in the inner ear, on the one hand, and the symptoms of cerebellar injury on the other. Since both act, in part, on the same lower mechanisms, their actions are similar though not identical. The vestibular nerve contributes to the maintenance of equilibrium against impressed movements, while the cerebellum aids in the equilibrium of active movements, both reflex and voluntary (pp. 196–197).

The author rejects some of Luciani's generalizations regarding cerebellar function. The muscular asthenia after cerebellar lesion, which led Luciani to infer a sthenic function for the cerebellum, is not confirmed as a fact by André-Thomas; and the atonia is not general, but affects only the muscles most concerned in maintaining equilibrium. Luciani's astasia, or tremor in muscular contraction, due to a want of fusion of the elementary contractions, is fully accepted by the present author, who adds, as a further general symptom of cerebellar lesion, a dysmetria, or lack of proper measure in the force of muscular contraction. The lack of measure shows itself as an excess of movement. The legs are lifted too high, the trunk pushed too strongly to one side or the other, and the excess of upward and backward thrust, in mounting stairs, is likely to cause the subject, whether man or dog, to fall over backwards. The function of the cerebellum is thus to exert a steadying and moderating influence on movements initiated by the cerebrum or by reflex paths.