The fastigial nucleus is the most medial deep cerebellar nucleus, sitting in the roof (fastigium) of the fourth ventricle on each side of the midline. It receives output from the vermis and flocculonodular lobe and projects to the vestibular nuclei and reticular formation to control posture, balance and eye movements.
| Location | Deep midline cerebellar white matter, in the roof of the fourth ventricle near the fastigium |
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| Blood Supply | Superior cerebellar artery; Posterior inferior cerebellar artery |
Controls balance, trunk posture and gait, and adjusts the size and accuracy of saccadic eye movements.
Damage to the fastigial nucleus causes truncal ataxia and saccadic dysmetria, where the eyes overshoot or undershoot targets. It also participates in autonomic responses such as blood pressure adjustments during posture change. Midline tumours in children frequently involve it.
Inaccurate rapid eye movements that overshoot or undershoot targets from lesions of the fastigial nucleus or dorsal vermis.
Unsteady trunk and gait from loss of fastigial output to the vestibular and reticular nuclei.
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