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Neurology · Topical Diagnosis in Neurology

Examination of the cerebellum and extrapyramidal system

Cerebellum

The cerebellum is a complex structure whose anatomical division is closely related to the evolutionary stages of the nervous system. It is generally classified into ancient and new divisions, each characterized by specific afferentation and distinct functional connections.

Largest partNeocerebellum is the youngest and most voluminous zone
SpinocerebellumReceives the main bulk of information from the spinal cord
Primary fissureLandmark dividing the anterior and posterior lobes
Neural connectionsFibers from the cortex transit through brainstem nuclei
5 min readFor medical studentsUpdated Sep 25, 2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Paleocerebellum: anatomy and features

The ancient part of the cerebellum, or paleocerebellum, is functionally oriented towards processing signals coming from below. Since the vast majority of afferent information arrives here directly from the spinal cord, a second, functional name for this region has become firmly established in neurology — spinocerebellum.

Topographically, this division encompasses most of the vermis structures as well as the immediately adjacent area — the intermediate part, referred to as the paravermian zone (paravermian).

The anatomical composition of the paleocerebellum includes the following structures:

  • Culmen of vermis.
  • Central lobule, located in the anterior lobe of the vermis.
  • Lingula.
  • Pyramis (located on the inferior lobe).
  • Paraflocculus, also known as the accessory flocculus.

Neocerebellum: evolution and connections

Neocerebellum represents the new part of the cerebellum. It is the largest in size and evolutionarily youngest structure. Anatomically, the neocerebellum is represented by two massive cerebellar hemispheres.

The phylogenetic formation of this division was not isolated. It proceeded strictly in parallel with three major evolutionary changes:

  1. A general increase in the volume of the cerebral cortex.
  2. A global transition of humans to an upright posture.
  3. The acquisition of bipedalism.

Functionally, the neocerebellum is distinguished by very close bilateral interrelationships with the cerebral cortex. It is important to note that these connections are not direct: conducting fibers from the cortex head toward the cerebellar structures in transit, necessarily relaying through the brainstem nuclei. Due to these anatomical features, the neocerebellum has two common synonyms: pontocerebellum (from the Latin term pons) and cerebrocerebellum.

Test your knowledge on this topicTasks from the Neurology course bank — immediate answers and explanations.

Topographic division (top view)

For the convenience of studying and clinically assessing cerebellar structures, two main principles of division are used: longitudinal and transverse.

Longitudinal division (zonal) distinguishes structures from the center to the periphery:

  • Superior vermis (located along the midline).
  • Intermediate part, or paravermian zone (surrounds the vermis).
  • Lateral part, represented by the cerebellar hemispheres.

Transverse division (lobar) divides the cerebellum into anterior and posterior lobes. The main visual and topographic landmark here is the primary fissure of the cerebellum, which clearly demarcates these lobes from each other.

When viewing the structures of the vermis from above in an anterior-to-posterior direction, they are arranged in a strict sequence: first comes the culmen of the vermis, followed by the declive, then the folium, and this series concludes with the tuber of the vermis.

Briefly: answers to topical questions

What anatomical structures form the extrapyramidal system?

The extrapyramidal system is formed by accumulations of gray matter deep within the cerebral hemispheres and brainstem nuclei. These anatomical structures include:

  • Caudate nucleus (nucleus caudatus)
  • Putamen (putamen)
  • Globus pallidus (globus pallidus)
  • Subthalamic nucleus
  • Substantia nigra (substantia nigra)
  • Red nucleus (nucleus ruber)
  • Reticular formation (formatio reticularis)

Through which specific brainstem nuclei do the pathways from the cerebral cortex to the neocerebellum relay?

The pathways from the cerebral cortex to the neocerebellum relay through the pontine nuclei. Impulses from the cerebral cortex travel via the corticopontine tract to the brainstem nuclei (pontine nuclei). From there, information is relayed and directed straight to the neocerebellar cortex to ensure coordination and regulation of voluntary movements.

Which anatomical structures belong to the archicerebellum?

The flocculonodular lobe of the cerebellum belongs to the archicerebellum. The archicerebellum is the most ancient part of the cerebellum, which is inextricably linked with the vestibular system. Its anatomical substrate includes:

  • Flocculus — structures located on both sides caudally relative to the inferior and middle cerebellar peduncles.
  • Nodule — the part of the vermis along the midline connecting the two flocculi.

What functions does the paleocerebellum perform?

The paleocerebellum (spinocerebellum) performs the functions of control and maintenance of balance during standing and walking. Its main tasks include:

  • Control of muscle tone.
  • Coordination of antagonist muscle activity during standing and walking.
  • Regulation of antigravity muscle activity (via efferent fibers).
  • Control of the intensity of muscle load during movement (compensation for inertial and centrifugal forces).

Which deep cerebellar nuclei are connected to the paravermian zone?

The cortex of the paravermian zone is connected to two deep cerebellar nuclei. Efferent fibers from the paravermian cortex project mainly to:

  • Emboliform nucleus (nucleus emboliformis)
  • Globose nucleus (nucleus globosus)

From these nuclei, efferent fibers proceed further to the contralateral red nuclei.

Through which cerebellar peduncles do the afferent pathways of the spinocerebellum pass?

The afferent pathways of the spinocerebellum include three main tracts:

  • Anterior spinocerebellar tract — enters the cerebellar vermis via the superior cerebellar peduncle and superior medullary velum.
  • Posterior spinocerebellar tract — enters the cerebellum via the inferior cerebellar peduncles.
  • Cuneocerebellar tract — originates from the accessory cuneate nucleus.

What clinical symptoms occur in case of neocerebellar lesion?

Lesions of the neocerebellum (involving the lateral parts or hemispheres of the cerebellum) result in pronounced coordination disturbances. The main clinical symptoms include:

  • Ataxia
  • Dysmetria
  • Asynergia
  • Adiadochokinesia
  • Intention tremor

Isolated lesion syndromes are rare, as damage limited to a single part is atypical.

How to memorize

For quick memorization of the vermis structures from anterior to posterior (top view), use the phrase: "Vertex of the Clivus — Folium on the Tuber" (Vertex, Clivus, Folium, Tuber).

Class and exam questions

Why is the paleocerebellum called the spinocerebellum?

This naming is due to its functional specialization: this area receives most of its afferent (incoming) information directly from spinal cord structures.

What evolutionary processes led to the development of the neocerebellum?

The evolution of the new part of the cerebellum occurred in parallel with the increase in the volume of the cerebrum, the transition to an upright posture, and the development of bipedalism.

How are the lobes of the cerebellum anatomically separated?

Transverse division distinguishes the anterior and posterior lobes. The topographic landmark separating them is the primary fissure of the cerebellum.

What is included in the paravermal zone?

The paravermal (intermediate) zone is the area immediately surrounding the vermis. Topographically, it belongs to the ancient part of the cerebellum (paleocerebellum).

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What else to study on this topic

  • Detailed anatomy of the flocculonodular lobe
  • Spinocerebellar pathways and their functions
  • Topography of brainstem nuclei transmitting signals from the cortex
  • Functional differences between the anterior and posterior lobes
  • Interaction of the neocerebellum and extrapyramidal system structures

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