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Brainstem
It is made up of midbrain, pons and medulla
oblongata
Occupies the posterior cranial fossa of the skull
Stalklike in shape
Functions:
1. serves as conduit for ascending tracts and
descending tracts
2. has important reflex centers associated with
respiration, cardiovascular system,
conciousness
3. contains nuclei of CN III to XII
MIDBRAIN
Gross Appearance
2cm (0.8 inch) in
length
Connects the pons
& cerebellum with
the forebrain
Traversed by a
narrow channel,
filled with CSF
cerebral
aqueduct
Posterior Surface
Rounded
eminences
4 Colliculi
(corpora
quadrigemina)
divided into
superior & inferior
pairs by a vertical
& transverse
groove
Posterior Surface
Superior colliculi
centers for visual
reflexes
Inferior colliculi
lower auditory
centers
Posterior Surface
Trochlear nerves
emerge in the
midline below the
inferior colliculi;
small diameter
nerves that wind
around the lateral
aspect of midbrain
& enters lateral wall
of cavernous sinus
Inferior brachium
connects inferior
colliculus to MGB
Posterior
perforated
substance
region where
several small blood
vessels perforate
the floor of
interpeduncular
fossa
Crus cerebri
INTERNAL STRUCTURE OF
MIDBRAIN
Cerebral
Peduncles
two lateral halves of
the midbrain,
Divided into A & P
part
Crus Cerebri
anterior part
Tegmentum
posterior part
INTERNAL STRUCTURE OF
MIDBRAIN
Substantia Nigra
pigmented band of
gray matter that
divides the
peduncles
INTERNAL STRUCTURE OF
MIDBRAIN
Cerebral aqueduct
narrow cavity of the
midbrain that connects
3rd & 4th ventricle
Tectum
part of midbrain
posterior to the cerebral
aqueduct, contains 4
swellings (corpora
quadrigemina)
Decussation of
superior
cerebellar
peduncles
occupies central
part of tegmentum
anterior to cerebral
Spinal &
trigeminal nuclei
lateral to medial
lemniscus
Lateral
Lemniscus
posterior to
trigeminal
Crus Cerebri
separated from
tegmentum by substantia
nigra
contains impt descending
tracts
corticospinal &
corticonuclear fibers
occupy the middle 2/3 of
crus
frontopontine fibers
occupy medial part of crus
temporopontine fibers
occupy lateral part of crus
these descending tracts
connect cerebral cortex to
anterior gray column of
cells of spinal cord, cranial
nerve nuclei, pons &
Crus Cerebri
contains corticospinal,
corticonuclear &
corticopontine fibers
(same at the level of
inferior colliculus)
Webers Syndrome
Basal Midbrain Infarct
caused by occlusion of a
branch of posterior
cerebral artery that
supplies the midbrain
results in necrosis of
brain tissue involving
oculomotor nerve & crus
cerebri
S/Sx:
Ipsilateral ophthalmoplegia
Contralateral paralysis of
lower part of face, tongue,
& arm & leg
Lateral deviation of eyeball
(paralysis of medial rectus)
Ptosis
Benedikts Syndrome
Paramedian
Midbrain Infarct
Necrosis involves
medial lemniscus &
red nucleus
Contralateral
hemianesthesia &
involuntary
movements of limbs
to opposite side
PONS
GROSS APPEARANCE
Anterior to the
cerebellum
Connects the
medulla oblongata to
the midbrain
it is one inch (2.5cm)
long
bridge connecting
the right & left
cerebellar
hemispheres
GROSS APPEARANCE
Anterior Surface
GROSS APPEARANCE
Anterolateral surface
trigeminal nerve
emerges on each
side
medial part:
smaller, motor root
lateral part: larger,
sensory root
GROSS APPEARANCE
Groove between
pons & medulla
(medial to
lateral)
Abducent,
facial,
vestibulocochl
ear nerves
GROSS APPEARANCE
Posterior Surface
hidden from view by
cerebellum
forms upper half of
floor of 4th ventricle
triangular in shape
Limited laterally by
superior cerebellar
peduncles, divided
into symmetrical
halves by median
sulcus
GROSS APPEARANCE
Posterior Surface
Medial
eminence
elongated
elevation
lateral to the
sulcus,
bounded
laterally by
sulcus limitans
GROSS APPEARANCE
Posterior Surface
Facial colliculus
expansion at
inferior end of
medial eminence
produced by the
root of facial
nerve winding
around nucleus
of abducent
nerve
GROSS APPEARANCE
Posterior Surface
Substantia
furruginea
bluish-gray floor of
the superior part of
sulcus limitans
Area Vestibuli
lateral to sulcus
limitans, produced
by underlying
vestibular nuclei
Passes through
the facial
collicullus
Medial
Lemniscus
rotates as it
passes from the
medulla into
the pons
situated in most
anterior part of
tegmentum
accompanied
by the spinal &
Medial Longitudinal
Fasciculus
situated beneath the
floor of 4th ventricle on
either side of midline
main pathway that
connects vestibular &
cochlear nuclei with
the nuclei controlling
EOM (oculomotor,
trochlear & abducent
nuclei)
Spinal nucleus of
trigeminal nerve
& its tract
anteromedial to
inferior cerebellar
peuncle
Trapezoid body
made up of
fibers derived
from cochlear
nuclei & nuclei of
trapezoid body
lie transversely
on anterior part
of tegmentum
Pontine nuclei
small masses of
nerve cells
where corticopontine
fibers of crus cerebri
of midbrain terminate
Axons of pontine
nuclei give origin to
Transverse fibers of
pons
Transverse
Fibers
Middle
Cerebellar
Peduncle
Cerebellum
forms the main
pathway
linking the
cerebral cortex
Pontine Hemorrhage
Blood supply of pons: basilar artery,
& anterior, inferior, superior
cerebellar arteries
S/Sx: Ipsilateral facial paralysis &
contralateral paralysis of limbs
Paralysis of conjugate eye deviation
(abducent nucleus & MLF)
olives
posterolateral to the pyramids
oval elevations by inferior olivary nuclei
rootlets of Hypoglossal nerve- groove between
pyramid and olive
roots of Glossopharyngeal and vagus nerves and
cranial roots of the accessory nerve- groove
between olive and inferior cerebellar peduncle
posterior to the olives are the INFERIOR
CEREBELLAR PEDUNCLES-> connect medulla to
INTERNAL STRUCTURE
expansion of neural tube-> form hindbrain
vesicle-> 4th ventricle-> extensive lateral
spread-> alteration if position of derivatives
of alar and basal plates of the embryo
Four levels
1. level of decussation of pyramids
2. level of decussation of lemnisci
3. level of the olives
4. level just inferior to the pons
1. LEVEL of DECUSSATION of
PYRAMIDS
the great motor decussation
superior corticospinal occupy and form
pyramid
inferior ->cross median plane->continue
down the SC in lateral white column as
lateral corticospinal tract
fasciculus gracilis and cuneatus ascend
superiorly posterior to the central gray
matter
nucleus gracilis and cuneatus appear as
posterior extensions of the central gray
Olivary (contd)
Inferior cerebellar peduncle- where fibers of
inferior olivary nucleus cross to enter
cerebellum
Afferent fibers: reach inferior olivary nuclei
from spinal cord (spino-olivary tracts) and
from the cerebellum and cerebral cortex
FUNCTION: voluntary muscle movement
B. vestibulocochlear nuclei
Made up of ff nuclei:
medial vestibular nucleus
inferior vestibular nucleus
lateral vestibular nucleus
superior vestibular nucleus
two cochlear nuclei : anterior and posterior
cochlear nucleus
anterior cochlear nucleus on anterolateral
aspect of the inferior cerebellar peduncle
posterior cochlear nucleus on posterior
aspect of the peduncle lateral to floor of the
fourth ventricle
C. nucleus ambiguus
consists of large motor neuron
situated deep within the reticular formation
emerging nerve fibers join the
glossopharyngeal, vagus and cranial part of
the accessory n
FUNCTION: contribute to voluntary skeletal
mucle
pontine nuclei
arcuate nuclei (inferiorly displaced)
situated on anterior of pyramids
receives nerve fibers from the cerebral cortex and
send efferent fibers to the cerebellum through the
ANTERIOR EXTERNAL ARCUATE FIBERS
pyramids
situated in anterior part of the medulla separated
by anterior median fissure
contain the corticospinal and some corticonuclear
fibers
corticospinal fibers descend to spinal cord
corticonuclear fibers are distributed to motor
nuclei of cranial nerves w/in medulla
reticular formation
Has diffuse mixture of nerve fibers and cells
deeply placed posterior to the olivary nucleus
also present in pons and medulla
CN IX,X and cranial part of CN XI
run forwad and laterally through the reticular formation
Emerge from between the olives and inferior cerebellar
peduncles
CN XII
run anteriorly and laterally through the reticular formation
and emerge between the pyramids and the olives
CLINICAL NOTES
Medulla Oblongata
contains many cranial nerve nuclei that are concerned with
vital functions (e.g., regulation of heart rate and respiration)
serves as a conduit for the passage of ascending and
descending tracts connecting the spinal cord to the higher
centers of the nervous system.
Involved in demyelinating diseases, neoplasms, and vascular
disorders.
Raised Pressure in the Posterior Cranial Fossa and Its
Effect on the Medulla Oblongata
tumors of the posterior cranial fossa-> ICP-> tends to be
pushed toward the area of least resistance ->downward
herniation of the medulla and cerebellar tonsils through the
foramen magnum.
Symptoms of headache, neck stiffness, and paralysis of the
glossopharyngeal, vagus, accessory, and hypoglossal nerves
owing to traction
extremely dangerous to perform a lumbar puncture
Arnold-Chiari Phenomenon
congenital anomaly in which there is a
herniation of the tonsils of the cerebellum
and the medulla oblongata through the
foramen magnum into the vertebral canal.
blockage of the exits in the roof of the fourth
ventricle to the cerebrospinal fluid->internal
hydrocephalus.
S/Sx involvement of last four cranial nerves