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Brain stem

The document discusses the basic structure and components of the brain stem. It describes the three main portions as the roof plate, tegmentum, and basal portion. It then provides detailed information on the descending tracts in the basal portion, including the corticospinal, corticobulbar, and corticopontocerebellar fibers. It also discusses the various cranial nerve nuclei, precerebellar nuclei, and ascending sensory pathways located within the brain stem that are involved in motor and sensory functions.

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Brain stem Brain stem 1
Basic Structure of Brain Stem  1. Roof Plate  2.Tegmentum  3. Basal Portion Brain stem 2
Basilar (Basal) Portion  Descending Fibers from Cerebral Cortex  1. Corticospinal Tract  2. Corticobulbar Tract  3. Corticopontocerebellar Fiber Corticopontine Fiber Pons Proper (Ventral Pons) Pontocerebellar Fiber Brain stem 3
Basal Portion Descending Tracts  Corticospinal Tract  Origin: Cerebral Cortex Brodmann Area 4 (Primary Motor Area, M I) Brodmann Area 6 (Premotor Area, PM ) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)  Corona Radiata  lnternal Capsule, Posterior Limb  Crus Cerebri, Middle Portion  Longitudinal Pontine Fiber  Pyramid - pyramidal decussation  Corticospinal Tract - Lateral and Anterior  Termination: Spinal Gray (Rexed IV-IX) Brain stem 4
 Corticobulbar Tract  - Corticofugal fibers projecting to, and terminating in, portions of lower brainstem  - Termination:  1) motor nuclei (upper motor neuron pathway) hypoglossal, ambiguus, facial motor, trigeminal motor, abducens, trochlear and oculomotor nucleus  2) sensory relay nuclei nuclei gracilis and cuneatus, trigeminal sensory nucleus, solitary tract nucleus  3) reticular formation (corticoreticular fiber) Basal Portion Descending Tracts Brain stem 5
Basal Portion Descending Tracts  Corticobulbar Tract - UMN Pathway  - Corticofugal fibers projecting to cranial motor nuclei  GSE - hypoglossal (XII), abducens (VI), trochlear (IV) and oculomotor (III) nucleus  SVE - ambiguus (IX, X, XI), facial motor (VII), trigeminal motor (V) nucleus  - largely bilateral laryngeal, pharyngeal, palatal and upper facial muscles of mastication and extraocular muscles  - unilateral lower facial musculature (facial palsy) SCM and trapezius (uncrossed) --- spinal accessory  - Pseudobulbar Palsy --- syndrome of bilateral UMN lesion Brain stem 6
Basal Portion Descending Tracts  Corticopontocerebellar Fiber  - Corticofugal fibers projecting to cerebellar hemisphere  - consists of 2 neuron chain  1. Corticopontine fiber projecting to pontine nuclei  2. Pontocerebellar fiber crossed mudline and enter cerebellum as middle cerebellar peduncle Brain stem 7
Roof Plate  Midbrain Superior Colliculus: vision Inferior Colliculus: hearing  Closed Medulla Nucleus Gracilis et Cuneatus: discriminative touch sensation  cf. Cerebelum: equilibrium Brain stem 8
Roof Plate of Hypothetized Chordate Ancestor  A. olfaction  B. vision  C. hearing  D. equilibrium  E. discriminative touch sensation  1. epithalamus  2. superior colliculus  3. inferior colliculus  4. cerebellum  5. nucleus gracilis et cuneatus Brain stem 9
Tegmentum  Cranial nerve Nuclei  Precerebellar Nuclei  Reticular Formation  Tracts  Ascending Cortical Pathway  Cerebellar Circuits  Descending Tract  Composite Bundle Brain stem 10
 Cranial Nerves  Columns of  Brain Stem  Motor Column  1. GSE  2. SVE  3. GVE  Sensory Column  4. VA (GVA & SVA)  5. GSA  6. SSA Brain stem 11
Components of Cranial Nerves Brain stem 12
General Somatic Efferent Nuclei (GSE)  Hypoglossal Nucleus XII  Abducens Nucleus VI  Trochlear Nucleus IV  Oculomotor Nucleus III Brain stem 13
Special Visceral Efferent Nuclei (SVE)  Nucleus Ambiguus IX, X, XI  Facial Motor Nucleus VII  Trigeminal Motor Nucleus V Brain stem 14
General Visceral Efferent Nuclei (GVE)  Dorsal Motor Nucleus of Vagus X  Inferior Salivatory Nucleus IX  Superior Salivatory Nucleus VII  Edinger-Westphal Nucleus III Brain stem 15
 Motor Nuclei of Cranial Nerves  1. GSE III, IV, VI, XII  2. SVE V, VII, IX, X, XI  3. GVE III, VII, IX, X Brain stem 16
General Somatic Afferent Nuclei (GSA)  Trigeminal Sensory Nucleus V, VII, IX, X  Mesencephalic Tract Nucleus  Principal (Main) Sensory Nucleus  Spinal Tract Nucleus pars oralis pars interpolaris pars caudalis Brain stem 17
Visceral Afferent Nuclei (VA)  Nucleus Tractus Solitarius VII, IX, X  General Visceral Afferent (GVA)  Special Visceral Afferent (SVA): Taste Gustatory Nucleus Brain stem 18
Special Somatic Afferent Nuclei (SSA)  Cochlear Nucleus VIIIc Dorsal Cochlear Nucleus Ventral Cochlear Nucleus  Vestibular Nucleus VIIIv Medial Vestibular Nucleus Lateral Vestibular Nucleus Superior Vestibular Nucleus Inferior Vestibular Nucleus Brain stem 19
 Sensory Nuclei of Cranial Nerves  1. VA GVA --- IX, X SVA --- VII, IX, X  2. GSA V, VII, IX, X  3. SSA VIIIc, VIIIv Brain stem 20
Precerebellar Nuclei  Accessory Cuneate Nucleus  Inferior Olivary Nuclear Complex  Vestibular Nuclus  Red Nucleus  Perihypoglossal Nucleus  Precerebellar Reticular Nuclei Brain stem 21
Precerebellar Nuclei  1. Red Nucleus  2. Vestibular Nucleus  3. Inferior Olivary Nucleus  4. Perhypoglossal Nuclei  5. Accessory Cuneate Nucleus Brain stem 22
 Reticular Formation   A. Raphe Nuclei  B. Central Nuclear Group  C. Lateral Nuclear Group  D. Precerebellar Reticular Nuclei A B C D Brain stem 23
Central Nuclear Group of Reticular Formation  Gigantocellular Reticular Nucleus  Caudal Reticulopontine Nucleus  Oral Reticulopontine Nucleus  Subcuneiform Nucleus  Cuneiform Nucleus Brain stem 24
Lateral Nuclear Group of Reticular Formation  Central Nucleus of Medulla Oblongata  Superficial Ventrolateral Reticular Area  Parvicellular Reticular Nucleus  Parabrachial Nucleus  Pedunculopontine Nucleus Brain stem 25
Raphe Nuclei - Serotonergic Neuron  Nucleus Raphe Obscrus, B2  Nucleus Raphe Pallidus, B1  Nucleus Raphe Magnus, B3  Pontine Raphe Nucleus, B5  Median Raphe or Superior Central Nucleus, B6, B8  Dorsal Raphe Nucleus, B7  Nucleus Linealis Brain stem 26
Norepinephrinergic & Dopaminergic Neuron  Norepinephrinergic Neuron Nucleus Locus Ceruleus, A6  Dopaminergic Neuron Retrorubral Area, A8 Ventral Tegmental Area, A10 Substantia Nigra, Pars Compacta, A9 Brain stem 27
Ascending Cortical Pathway Posterior White Column-Medial Lemniscal Pathway medial lemniscus Spinothalamic and Spinoreticular Tract spinal lemniscus Ventral and Dorsal Trigeminothalamic Tract trigeminal lemniscus Auditory Pathway: lateral lemniscus Taste (Gustatory) Pathway: central tegmental tract Vestibular Pathway: medial lemniscus Brain stem 28
Ascending Cortical System General Sensation  Brain Stem Pathways for General Sensation  Touch & Proprioception from body Posterior White Colum-Medial Lemniscal Pathway  Pain & Temperature from body Spinothalamic Tract cf. Spinoreticular or Spinoreticulothalamic Tract  General Sensation from Face Trigeminothalamic Tracts Brain stem 29
Posterior White Column - medial Lemniscal Pathway & Spinothalamic Tract Brain stem 30
Posterior White Colum-Medial Lemniscal Pathway  Modality: Discriminative Touch Sensation (include Vibration) and Conscious Proprioception (Position Sensation, Kinesthesia) from body  Receptor: Most receptors except free nerve endings  Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Posterior White Column  2nd Neuron: Dorsal Column Nuclei (Nucleus Gracilis et Cuneatus) Internal Arcuate Fiber - Lemniscal Decussation - Medial Lemniscus  3rd Neuron: Thalamus (VPLc) Internal Capsule ----- Corona Radiata  Termination: Primary Somesthetic Area (S I)Brain stem 31
DRG: Dorsal Root Ganglion 1. Posterior White Column A. Nucleus gracilis B. Nucleus cuneatus 2. Medial Lemniscus 3. Corona Radiata C. Thalamus (VPLc) D. Cerebral Cortex (S I) Posterior White Column-Medial Lemniscal Pathway DRG D Brain stem 32
Spinothalamic Tract  Modality: Pain & Temperature Sensation, Light Touch from body  Receptor: Free Nerve Ending  Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)  2nd Neuron: Dorsal Horn (Lamina I, IV, V) Anterior White Commissure Spinothalamic Tract (Spinal Lemniscus)  3rd Neuron: Thalamus (VPLc & CL) Internal Capsule ----- Corona Radiata  Termination: Primary Somesthetic Area (S I) Brain stem 33
Spinoreticulothalamic Tract (Paleospinothalamic Tract)  Modality: Pain & Temperature Sensation, Light Touch from body  Receptor: Free Nerve Ending  Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)  2nd Neuron: Dorsal Horn (Lamina I, IV, V) Anterior White Commissure Spinothalamic Tract (Spinal Lemniscus)  3rd Neuron: Reticular Formation  4rd Neuron: Thalamus (CL, Sm, POm) Internal Capsule ----- Corona Radiata  Termination: Diffuse Cerebral Cotex Brain stem 34
DRG: Dorsal Root Ganglion A. Posterior (dorsal) horn 1. Spinothalamic tract B. Reticular formation 2. Spinoreticular tract C. Thalamus (VPLc, CL) 3. Corona Radiata D. Cerebral Cortex (S I) Spinothalamic Tract (Neospinothalamic Tract) Spinoreticular Tract (Paleospinothalamic Tract) DRG D Brain stem 35
Trigeminothalamic Tract  Modality: General Sensation from face  Receptor: Most receptors in the face  Ist Neuron: Trigeminal (Semilunar) Ganglia  2nd Neuron: Trigeminal Sensory Nucleus pain & temperature ---- pars caudaliS of spinal tract nucleus of V Ventral and Dorsal Trigeminothalamic Tract  3rd Neuron: Thalamus (VPM) Internal Capsule ----- Corona Radiata  Termination: Primary Somesthetic Area (S I) Brain stem 36
Trigeminothalamic Tract A. trigeminal ganglion B. trigeminal sensory nucleus C. thalamus (VPM) D. cerebral cortex (S I) 1. spinal tract of trigeminal nerve 2. ventral trigeminothalamic tract 3. dorsal trigeminothalamic tract 4. corona radiata V. trigeminal nerve Brain stem 37
Ascending Cortical System Special Sensation  Brain Stem Pathways for Special Sensation  Gustatory Sensation (Taste, SVA) ----- Taste Pathway  Auditory Sensation (Hearing, SSA) ----- Auditory Pathway  Vestibular Sensation (Equilibrium, SSA) ----- Vestibular Pathway Brain stem 38
Auditory Pathway  Modality: Auditory Sensation (Hearing)  Receptor: Organ of Coti of Cochlear Duct Cranial Nerve: VIIIc  1st Neuron: Spiral Ganglion  2nd Neuron: Cochlear Nucleus, Ventral & Dorsal dorsal, intermediate and ventral acoustic striae trapezoid body lateral lemniscus  3rd Neuron: Inferior Colliculus brachium of inferior colliculus  4th Neuron: Medial Geniculate Nucleus (MG) auditory radiation  Termination: Primary Auditory Area (A I) Brodmann area 31, 32 Brain stem 39
Auditory Pathways A. spiral ganglion B. dorsal and ventral cochlear nucleus C. inferior colliculus D. medial geniculate nucleus E. Primary auditory area F. superior olivary nucleus G. nucleus of lateral lemniscus 1. acoustic striae & trapezoid body 2. lateral lemniscus 3. brachium of inferior colliculus 4. auditory radiation 5. commissure of inferior colliculus VIIIc. cochlear division Brain stem 40
Auditory Pathway A. spiral ganglion B. dorsal cochlear nucleus C. ventral cochlear nucleus D. superior olivary nucleus 1. dorsal acoustic striae 2. intermediate acoustic striae 3. ventral acoustic striae 4. efferent cochlear bundle 5. trapezoid body 6. lateral lemniscus Brain stem 41
Vestibular Pathway  Modality: Equilibrium Sensation  Receptor: Macula & Crista Ampullaris Cranial Nerve: VIIIv  Ist Neuron: Vestibular Ganglion  2nd Neuron: Vestibular Nucleus vestibulothalamic fiber (medial lemniscus)  3rd Neuron: Thalamus (VPLo, VPI?) Internal Capsule ----- Corona Radiata  Termination: Primary Vestibular Area ----- Primary Somesthetic Area (Brodmann area 3a, 2v ) Brain stem 42
1. Vestibulocerebellar Tract 2. Vestibulospinal Tract 3. Vestibulothalamic Tract 4. Medial Longitudinal fasciculus (MLF) - ascending portion - descending portion - interstitiospinal tract Brain stem 43 Vestibular Pathway
Taste (Gustatory) Pathway  Modality: Taste Sensation  Receptor: Taste Bud Cranial Nerve: VII, IX, X  Ist Neuron: Geniculate Ganglion (VII) Inferior Ganglion (IX, X)  2nd Neuron: Nucleus Tractus Solitarius (Gustatory Nucleus) solitariothalamic fiber (central tegmental tract)  3rd Neuron: Thalamus (VPMpc) Internal Capsule ----- Corona Radiata  Termination: Gustatory Area Brodmann area 43 & parainsular cortex Brain stem 44
Taste Pathways A. nucleus tractus solitarius (gustatory nucleus) B. thalamus (VPMpc) C. Brodmann area 43 D. parainsular cortex E. parabrachial nucleus 1. solitariothalamic fiber (central tegmental tract) 2. corona radiata VII. facial nerve IX. glossopharyngeal nerve X. vagus nerve Brain stem 45
Cerebellar Circuits  Superior, Middle and Inferior Cerebellar Peduncle  Vestibulocerebellum - Vestibular Nucleus  Spinocerebellum - Red Nucleus and Spinal Cord  Pontocerebellum - Cerebral Cortex and Pontine Nuclei  Inferior Olivary Nuclear Complex Brain stem 46
Inferior Cerebellar Peduncle 1. posterior spinocerebellar tract 2. cuneocerebellar tract 3. vestibulocerebellar tract Middle cerebellar Peduncle - corticopontocerebellar pathway Superior Cerebellar Peduncle - anterior spinocerebellar tract Brain stem 47 Afferent Connections of Cerebellum
Superior Cerebellar Peduncle 1. dentatothalamic fiber 2. interpositorubral fiber 3. ascending portion of uncinate fasciculus of Russell Inferior Cerebellar Peduncle 1. direct fastigiovestibular fiber 2. descending portion of uncinate fasciculus of Russell Brain stem 48 Efferent Connections of Cerebellum
1. Olivocerebellar Tract 2. Cortico-olivary Tract 3. Rubro-olivary Tract 4. Vestibulo-olivary Tract 5. Spino-olivary Tract Brain stem 49 Connections of Inferior Olivary Nuclear Complex
Descending Tracts  Rubrospinal Tract  Tectospinal tract  Vestibulospinal Tract  Reticulospinal Tract pontine and medullary  Descending Autonomic Pathway Brain stem 50
Brain Stem Descending Tracts  Descending Tracts from Brain Stem  Dorsolateral (Motor) Pathway Rubrospinal Tract  Ventromedial (Motor) Pathway Tectospinal Tract  Vestibulospinal Tract  MLF (Medial Longitudinal Fasciculus) - interstitiospinal tract  Sensory Modulation pathways  Raphespinal & Cerulospinal Pathways  Descending Autonomic Pathways Brain stem 51
Composite Bundle  Medial Longitudinal Fasciculus (MLF)  Dorsal Longitudinal Fasciculus (DLF)  Central Tegmental Tract Brain stem 52
Components of Medial Longitudinal Fasciculus (MLF)  Descending Components Medial Vestibulospinal Tract from medial and inferior vestibular nucleus Interstitiospinal Tract from interstitial nucleus of Cajal  Ascending Components Efferents from Medial Vestibular Nucleus contralateral III, IV, interstitial nucleus bilateral VI nucleus Efferents from Superior Vestibular Nucleus ipsilateral III, IV, interstitial nucleus Brain stem 53
 Ascending Components solitariohypothalamic fiber (visceral afferent fiber) ascending serotonergic fiber  Descending Component descending fibers from hypothalamus to periaqueductal gray and dorsal tegmental nucleus Components of Dorsal Longitudinal Fasciculus (DLF, fasciculus of Schütz) Brain stem 54
Components of Central Tegmental Tract  Ascending Components reticulothalamic fiber solitariothalamic fiber (secondary taste fiber)  Descending Component rubro-olivary tract Brain stem 55
Spinomedullary Transition (Level of Pyramidal Decussation)  Roof Plate - fasciculus gracilis and fasciculus cuneatus  Tegmentum Cranial and Spinal Nerve Nuclei Supraspinal Nucleus Spinal Nucleus of Trigeminal Nerve, Pars Caudalis  Reticular Formation Central Nucleus of Medulla Oblongata (Ventral Reticular Nucleus)  Unclassified Nuclei Retroambiguus Nucleus  Tracts Spinal Tracts of Trigeminal Nerve  Basal Part - Pyramid, Pyramidal Decussation Brain stem 56
 Cranial & Spinal N. Nuclei 1. Supraspinal Nucleus 2. Spinal Accessory Nucleus  Cranial & Spinal Nerve XI. Accessory Nucleus C1. motor root of 1st cervical nerve Spinomedullary Transition (Level of Pyramidal Decussation) Brain stem 57
Lower Medulla (Level of Lemniscal Decussation)  Roof Plate - nucleus gracilis and nucleus cuneatus  Tegmentum  Cranial and Spinal Nerve Nuclei Hypoglossal Nucleus, Ambiguus Nucleus Solitary Tract Nucleus, Dorsal Motor Nucleus of X  Reticular Formation Lateral Reticular Nucleus  Precerebellar Nuclei Inferior Olivary Nuclear Complex  Tracts Ventral Trigeminothalamic Tract Internal Arcuate Fiber, Lemniscal Decussation  Basal Part - Pyramid, Pyramidal Decussation Brain stem 58
Lower Medulla (Level of Lemniscal Decussation) Roof Plate A. Nucleus Gracilis B. Nucleus Cuneatus Cranial Nerve Nuclei 1. Hypoglossal Nucleus 2. Nucleus Ambiguus 3. Dorsal Motor Nucleus of X 4. Nucleus Tractus Solitarius 5. Spinal Tract Nucleus of Trigeminal Nerve Brain stem 59
Lower Medulla (Level of Lemniscal Decussation) Precerebellar Nucleus 1. Inferior Olivary Nuclear Complex 1a. Principal Inferior Olivary Nucleus 1b. Medial Accessory Olivary Nucleus 1c. Dorsal Accessory Olivary Nucleus 2. Nucleus Intercalatus 3. Nucleus Conterminalis 4. Arcuate Nucleus Brain stem 60
Lower Medulla (Level of Lemniscal Decussation) Reticular Formation 1. Lateral Reticular Nucleus 2. Central Nucleus of Medulla Oblongata 2d. subnucleus dorsalis 2v. subnucleus ventralis Brain stem 61
 Clinical Syndromes of Lower Medulla A. Hypoglossal Alternating Hemiplegia B. Avelis Syndrome C. Jackson Syndrome D. Tapia Syndrome 1. pyramidal tract 2. hypoglossal nerve 3. spinothalamic tract 4. nucleus ambiguus Brain stem 62
Hypoglossal Palsy Lower Motor Neuron Syndrome Deviation of Tongue to affected side Atrophy of Tongue Muscles Brain stem 63
Open Medulla (Mid-olivary Level)  Tegmentum  Cranial Nerve Nuclei Medial Vestibular Nucleus Spinal Tract Nucleus of V, pars interpolaris  Precerebellar Nuclei Accessory Cuneate Nucleus Nucleus of Roller, Nucleus Interfascicularis Hypoglossi  Reticular Formation Lateral Reticular Nucleus, subtrigeminal portion  Unclassified Nuclei Area Postrema  Tracts: Inferior Cerebellar Peduncle, DLF  Basal Part - Pyramid Brain stem 64
Cranial Nerve Nuclei 1. Hypoglossal Nucleus 2. Nucleus Ambiguus 3. Dorsal Motor Nucleus of X 4. Nucleus Tractus Solitarius 5. Spinal Tract Nucleus, pars interpolaris 6. Medial Vestibular Nucleus Open Medulla (Mid-olivary Level) Brain stem 65
Open Medulla (Mid-olivary Level) Precerebellar Nucleus 1. Accessory Cuneate Nucleus 2. Inferior Olivary Nuclear Complex 2a. Principal Inferior Olivary Nuc. 2b. Medial Accessory Olivary Nuc. 2c. Dorsal Accessory Olivary Nuc. 3. Nucleus Intercalatus 4. Nucleus of Roller 5. Nucleus Interfascicularis Hypoglossi 6. Nucleus Conterminalis Brain stem 66
Open Medulla (Mid-olivary Level) XII. Hypoglossal Nerve 1. Hypoglossal Nucleus X. Vagus Nerve 2. Nucleus Ambiguus 3. Dorsal Motor Nucleus of X 4. Nucleus Tractus Solitarius 5. Spinal Tract Nucleus of V Brain stem 67
A. Dejerine’s Syndrome 1. pyramidal tract 2. hypoglossal nerve 3. medial lemniscus B. Wallenberg Syndrome 4. spinothalamic tract 5. spinal tract of trigeminal nerve 6. nucleus ambiguus 7. descending autonomic pathway Clinical Syndromes of Open Medulla Brain stem 68
Wallenberg Syndrome Spinothalamic tract - contralateral loss of pain and temperature sensation at the body Spinal tract of trigeminal nerve - ipsilateral loss of pain and temperature sensation at the face Nucleus ambiguus - dysphageia, dysarthria, hoarseness Descending autonomic pathway - Horner’s syndrome (meiosis, ptosis, anhydrosis) Brain stem 69
Open Medulla (Upper Level of Medulla)  Tegmentum  Cranial Nerve Nuclei Inferior Vestibular Nucleus Dorsal Cochlear Nucleus  Precerebellar Nuclei Nucleus Prepositus Hypoglossi  Reticular Formation Gigantocellular Reticular Nucleus Paragigantocellular Reticular Nucleus Parvocellular Reticular Nucleus Raphe Nuclei  Unclassified Nuclei retrofacial, supravestibular nucleus, nucleus interpositus  Tracts: stria medullaris of 4th ventricle  Basal Part - Pyramid Brain stem 70
Cranial Nerve Nuclei 1. Nucleus Ambiguus 2. Nucleus Tractus Solitarius 3. Spinal Tract Nucleus, pars oralis 4. Medial Vestibular Nucleus 5. Inferior Vestibular Nucleus 6. Dorsal Cochlear Nucleus Open Medulla (Upper Level of Medulla) Brain stem 71
Open Medulla (Upper Level of Medulla) Precerebellar Nucleus 1. Inferior Olivary Nuclear Complex 1a. Principal Inferior Olivary Nuc. 1b. Medial Accessory Olivary Nuc. 1c. Dorsal Accessory Olivary Nuc. 2. Nucleus Prepositus Hypoglossi 3. Pontobulbar Body 4. Arcuate Nucleus 5. Medial Vestibular Nucleus 6. Inferior Vestibular Nucleus Brain stem 72
Open Medulla (Upper Level of Medulla) Reticular Formation 1. Paramedian reticular Nucleus 2. Gigantocellular Reticular Nucleus 3. paragigantocellular Reticular Nucleus 4. Parvocellular Reticular Nucleus 5. Nucleus raphe Obscrus (B2) 6. Nucleus Raphe Pallidus (B1) 7. Nucleus Raphe Magnus (B3) Unclassifiied Nuclei A. Nucleus Retrofacialis B. Supravestibular Nucleus C. Nucleus Interpositus Brain stem 73
IX. glossopharyngeal Nerve 1. Nucleus Ambiguus 2. Inferior Salivatory Nucleus 3. Nucleus Tractus Solitarius 4. Spinal Tract Nucleus of V Open Medulla (Upper Level of Medulla) Brain stem 74
Pontomedullary Junction  Tegmentum  Cranial Nerve Nuclei Facial Motor Nucleus Ventral Cochlear Nucleus  Precerebellar Nuclei  Reticular Formation  Unclassified Nuclei nucleus ovalis  Tracts  Basal Part - Pyramid  Cranial Nerve - Vestibulocochlear Nerve (VIII) Facial Nerve (VII) Brain stem 75
Cranial Nerve Nuclei 1. Facial Motor Nucleus 2. Nucleus Ambiguus 3. Spinal Tract Nucleus, pars oralis 4. Medial Vestibular Nucleus 5. Inferior Vestibular Nucleus 6. Ventral Cochlear Nucleus Pontomedullary Junction Brain stem 76
Pontomedullary Junction Precerebellar Nucleus 1. Principal Inferior Olivary Nucleus 2. Nucleus Prepositus Hypoglossi 3. Pontobulbar Body 4. Arcuate Nucleus 5. Medial Vestibular Nucleus 6. Inferior Vestibular Nucleus Brain stem 77
Pontomedullary Junction Reticular Formation 1. Paramedian reticular Nucleus 2. Gigantocellular Reticular Nucleus 3. paragigantocellular Reticular Nucleus 4. Parvocellular Reticular Nucleus 7. Nucleus Raphe Magnus (B3) Unclassifiied Nuclei A. Nucleus Interpositus B. Nucleus Ovalis Brain stem 78
Lower Pons (Level of Abducens Nucleus)  Tegmentum  Cranial Nerve Nuclei Abducens Nucleus, Main Sensory Nucleus of V  Nuclei of Auditory Pathway Superior Olivary Nuclear Complex  Reticular Formation Caudal Pontine Reticular & Subceruleus Nucleus  Tracts Trapezoid Body, lateral Lemniscus, Central tegmental Tract  Basal Part: Pons Proper: Pontine Nuclei, Transverse Pontine Fiber, Longitudinal Pontine Fiber (Pyramidal Tract) Brain stem 79
Lower Pons (Level of Abducens Nucleus) Cranial Nerve Nuclei 1. Abducens Nucleus 2. Main Sensory Nucleus of V 3. Lateral vestibular Nucleus 4. Superior Vestibular Nucleus Auditory Relay Nuclei A. Superior Olivary Nucleus B. Nucleus of Trapezoid body Brain stem 80
Lower Pons (Level of Abducens Nucleus) Reticular Formation 1. Gigantocellular Reticular Nucleus 2. Caudal Pontine Reticular Nucleus 3. Parvocellular Reticular Nucleus 4. Nucleus Subceruleus Brain stem 81
VII. Facial Nerve 1. Facial Motor Nucleus 2. Superior Salivatory Nucleus 3. Nucleus Tractus Solitarius 4. Spinal Tract Nucleus of V VI. Abducens Nerve 5. Abducens Nucleus Brain stem 82
A. Facial Palsy B. A + decreased salivation C. A + B + hyperacusis D. A + B + C + decrased lacrimal secretion E. Central Type Facial Palsy 1. Facial Motor Nucleus 2. Superior Salivatory Nucleus 3. Solitary Nucleus 4. Spinal Tract Nucleus of Trigeminal Nerve Brain stem 83
Facial Palsy (Bell’s Palsy) Lower Motor Neuron Syndrome Triple W Sign - Wrinkle, Wink, Whistle Brain stem 84
Right facial paralysis Facial Palsy (Bell’s Palsy) Brain stem 85
Central Type FacialPalsy Upper Motor Neuron Syndrome facial motor nucleus neurons supplying forehead muscle Bilateral Corticobulbar Tract Brain stem 86
Abducens Palsy Lower Motor Neuron Syndrome Lateral Gaze Paralysis Brain stem 87
Upper Pons (Level of Trigeminal Motor Nucleus)  Tegmentum  Cranial Nerve Nuclei Trigeminal Motor Nucleus, Mesencephalic Tract Nucleus of Trigeminal Nerve  Nuclei of Auditory Pathway Nucleus of Lateral Lemniscus  Reticular Formation Reticular Tegmental Nucleus  Unclassified Nucleus Pontine Central Gray: Ch6  Tracts Trigeminal Nerve Fiber  Basal Part: Pons Proper Brain stem 88
Upper Pons (Level of Trigeminal Motor Nucleus)  Cranial Nerve Nuclei 1. Trigeminal Motor Nucleus 2. Main Sensory Nucleus of V 3. Mesencephalic Tract Nucleus of V 4. Superior Vestibular Nucleus Auditory Relay Nuclei A. Nucleus of Lateral Lemniscus Brain stem 89
Upper Pons (Level of Trigeminal Motor Nucleus) Reticular Formation 1. Caudal Pontine Reticular Nucleus 2. Nucleus Subceruleus 3. Reticular Tegemntal Nucleus of Bekhterew (Nucleus Papilloformis of Olszewski and Baxter) Brain stem 90
A. Millard-Gubler Syndrome B. Raymond Syndrome C. Foville Syndrome D. Raymond-Cestan Syndrome E. Marie-Poix Syndrome 1. pyramidal tract 2. MLF 3. medial lemniscus 4. spinothalamic tract 5. trigeminal motor nucleus 6. main sensory nucleus of V 7. spinal tract of trigeminal nerve 8. middle cerebellar peduncle Clinical Syndromes of Pons Brain stem 91
Trigeminal Neuralgia (tic douloureux) - excruciating episodic pain in the area supplied by trigeminal nerve, especially second and third division - trigger point - intense pain makes the patient grimace (tic) - antiepileptic drug (phenytoin, carbamazepine) is effective - surgical treatment Brain stem 92
Lower Midbrain (Level of Inferior Colliculus)  Roof Plate - Tectum: Inferior Colliculus  Tegmentum  Cranial Nerve Nuclei Trochlear Nucleus  Reticular Formation Cuneiform, Pedunculopontine, Parabrachial and Median Raphe (Superior Central) Nucleus  Unclassified Nuclei Periaqueductal Gray  Tracts Decussation of Superior Cerebellar Peduncle  Basal Part - Crus Cerebri, Pons Proper Brain stem 93
Roof Plate A. Inferior Colliculus Cranial Nerve Nuclei 1. Mesencephalic Tract Nucleus of Trigeminal Nerve 2. Trochlear Nucleus Brain stem 94 Lower Midbrain (Level of Inferior Colliculus)
Reticular Formation 1. Cuneiform Nucleus 2. Pedunculopontine Nucleus 3. Nucleus Locus ceruleus 4. Parabrachial Nucleus 5. Dorsal Raphe Nucleus 6. Median Raphe Nucleus Unclassified Nuclei A. Periaqueductal Gray B. Dorsal Tegmental Nucleus of Gudden C. Interpeduncular Nucleus D. Parabigeminal Nucleus C 6 5 Brain stem 95 Lower Midbrain (Level of Inferior Colliculus)
Upper Midbrain (Level of Superior Colliculus)  Roof Plate - Tectum: Superior Colliculus  Tegmentum  Cranial Nerve Nuclei Oculomotor and Edinger-Westphal Nucleus  Reticular Formation - Subcuneiform Nucleus  Precerebellar Nuclei Red Nucleus  Unclassified Nuclei Substantia Nigra, Paranigral, Paralemniscal Nucleus Ventral Tegmental Area (VTA)  Tracts Brachium of Inferior Colliculus  Basal Part - Crus Cerebri Brain stem 96
Roof Plate A. Superior Colliculus Precerebellar Nucleus B. Red Nucleus Cranial Nerve Nuclei 1. Mesencephalic Tract Nucleus of V 2. Oculomotor Nucleus 3. Edinger-Westphal Nucleus Brain stem 97 Upper Midbrain (Level of Superior Colliculus)
Reticular Formation A. Cuneiform Nucleus B. Subcuneiform Nucleus Unclassified Nuclei 1. Periaqueductal Gray 2. Paralemniscal Nucleus 3. Substantia Nigra 3a. Pars Compacta 3b. Pars Reticulata 4. Paranigral Nucleus 5. Ventral Tegmental Area Brain stem 98 Upper Midbrain (Level of Superior Colliculus)
A. Weber Syndrome B. Foix Syndrome C. Benedikt’s Syndrome D. Claude Syndrome E. Parinaud’s Syndrome 1. pyramidal tract 2. superior cerebellar peduncle 3. red nucleus 4. medial lemniscus 5. superior colliculus 6. cerebral aqueduct 7. MLF 8. oculomotor nucleus Brain stem 99 Clinical Syndromes of Upper Midbrain
 Pyramidal tract - contralateral UMN syndrome at the body and lower face (contralateral hemiparesis)  Oculomotor Nerve - ipsilateral ocular palsy - external strabismus - mydriasis - loss of accommodation - normal consensual light reflex Brain stem 100

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Brain stem

  • 1.
  • 2.
    Basic Structure ofBrain Stem  1. Roof Plate  2.Tegmentum  3. Basal Portion Brain stem 2
  • 3.
    Basilar (Basal) Portion Descending Fibers from Cerebral Cortex  1. Corticospinal Tract  2. Corticobulbar Tract  3. Corticopontocerebellar Fiber Corticopontine Fiber Pons Proper (Ventral Pons) Pontocerebellar Fiber Brain stem 3
  • 4.
    Basal Portion DescendingTracts  Corticospinal Tract  Origin: Cerebral Cortex Brodmann Area 4 (Primary Motor Area, M I) Brodmann Area 6 (Premotor Area, PM ) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)  Corona Radiata  lnternal Capsule, Posterior Limb  Crus Cerebri, Middle Portion  Longitudinal Pontine Fiber  Pyramid - pyramidal decussation  Corticospinal Tract - Lateral and Anterior  Termination: Spinal Gray (Rexed IV-IX) Brain stem 4
  • 5.
     Corticobulbar Tract - Corticofugal fibers projecting to, and terminating in, portions of lower brainstem  - Termination:  1) motor nuclei (upper motor neuron pathway) hypoglossal, ambiguus, facial motor, trigeminal motor, abducens, trochlear and oculomotor nucleus  2) sensory relay nuclei nuclei gracilis and cuneatus, trigeminal sensory nucleus, solitary tract nucleus  3) reticular formation (corticoreticular fiber) Basal Portion Descending Tracts Brain stem 5
  • 6.
    Basal Portion DescendingTracts  Corticobulbar Tract - UMN Pathway  - Corticofugal fibers projecting to cranial motor nuclei  GSE - hypoglossal (XII), abducens (VI), trochlear (IV) and oculomotor (III) nucleus  SVE - ambiguus (IX, X, XI), facial motor (VII), trigeminal motor (V) nucleus  - largely bilateral laryngeal, pharyngeal, palatal and upper facial muscles of mastication and extraocular muscles  - unilateral lower facial musculature (facial palsy) SCM and trapezius (uncrossed) --- spinal accessory  - Pseudobulbar Palsy --- syndrome of bilateral UMN lesion Brain stem 6
  • 7.
    Basal Portion DescendingTracts  Corticopontocerebellar Fiber  - Corticofugal fibers projecting to cerebellar hemisphere  - consists of 2 neuron chain  1. Corticopontine fiber projecting to pontine nuclei  2. Pontocerebellar fiber crossed mudline and enter cerebellum as middle cerebellar peduncle Brain stem 7
  • 8.
    Roof Plate  Midbrain SuperiorColliculus: vision Inferior Colliculus: hearing  Closed Medulla Nucleus Gracilis et Cuneatus: discriminative touch sensation  cf. Cerebelum: equilibrium Brain stem 8
  • 9.
    Roof Plate ofHypothetized Chordate Ancestor  A. olfaction  B. vision  C. hearing  D. equilibrium  E. discriminative touch sensation  1. epithalamus  2. superior colliculus  3. inferior colliculus  4. cerebellum  5. nucleus gracilis et cuneatus Brain stem 9
  • 10.
    Tegmentum  Cranial nerveNuclei  Precerebellar Nuclei  Reticular Formation  Tracts  Ascending Cortical Pathway  Cerebellar Circuits  Descending Tract  Composite Bundle Brain stem 10
  • 11.
     Cranial Nerves  Columnsof  Brain Stem  Motor Column  1. GSE  2. SVE  3. GVE  Sensory Column  4. VA (GVA & SVA)  5. GSA  6. SSA Brain stem 11
  • 12.
    Components of CranialNerves Brain stem 12
  • 13.
    General Somatic EfferentNuclei (GSE)  Hypoglossal Nucleus XII  Abducens Nucleus VI  Trochlear Nucleus IV  Oculomotor Nucleus III Brain stem 13
  • 14.
    Special Visceral EfferentNuclei (SVE)  Nucleus Ambiguus IX, X, XI  Facial Motor Nucleus VII  Trigeminal Motor Nucleus V Brain stem 14
  • 15.
    General Visceral EfferentNuclei (GVE)  Dorsal Motor Nucleus of Vagus X  Inferior Salivatory Nucleus IX  Superior Salivatory Nucleus VII  Edinger-Westphal Nucleus III Brain stem 15
  • 16.
     Motor Nucleiof Cranial Nerves  1. GSE III, IV, VI, XII  2. SVE V, VII, IX, X, XI  3. GVE III, VII, IX, X Brain stem 16
  • 17.
    General Somatic AfferentNuclei (GSA)  Trigeminal Sensory Nucleus V, VII, IX, X  Mesencephalic Tract Nucleus  Principal (Main) Sensory Nucleus  Spinal Tract Nucleus pars oralis pars interpolaris pars caudalis Brain stem 17
  • 18.
    Visceral Afferent Nuclei(VA)  Nucleus Tractus Solitarius VII, IX, X  General Visceral Afferent (GVA)  Special Visceral Afferent (SVA): Taste Gustatory Nucleus Brain stem 18
  • 19.
    Special Somatic AfferentNuclei (SSA)  Cochlear Nucleus VIIIc Dorsal Cochlear Nucleus Ventral Cochlear Nucleus  Vestibular Nucleus VIIIv Medial Vestibular Nucleus Lateral Vestibular Nucleus Superior Vestibular Nucleus Inferior Vestibular Nucleus Brain stem 19
  • 20.
     Sensory Nuclei ofCranial Nerves  1. VA GVA --- IX, X SVA --- VII, IX, X  2. GSA V, VII, IX, X  3. SSA VIIIc, VIIIv Brain stem 20
  • 21.
    Precerebellar Nuclei  AccessoryCuneate Nucleus  Inferior Olivary Nuclear Complex  Vestibular Nuclus  Red Nucleus  Perihypoglossal Nucleus  Precerebellar Reticular Nuclei Brain stem 21
  • 22.
    Precerebellar Nuclei  1. RedNucleus  2. Vestibular Nucleus  3. Inferior Olivary Nucleus  4. Perhypoglossal Nuclei  5. Accessory Cuneate Nucleus Brain stem 22
  • 23.
     Reticular Formation   A.Raphe Nuclei  B. Central Nuclear Group  C. Lateral Nuclear Group  D. Precerebellar Reticular Nuclei A B C D Brain stem 23
  • 24.
    Central Nuclear Groupof Reticular Formation  Gigantocellular Reticular Nucleus  Caudal Reticulopontine Nucleus  Oral Reticulopontine Nucleus  Subcuneiform Nucleus  Cuneiform Nucleus Brain stem 24
  • 25.
    Lateral Nuclear Groupof Reticular Formation  Central Nucleus of Medulla Oblongata  Superficial Ventrolateral Reticular Area  Parvicellular Reticular Nucleus  Parabrachial Nucleus  Pedunculopontine Nucleus Brain stem 25
  • 26.
    Raphe Nuclei -Serotonergic Neuron  Nucleus Raphe Obscrus, B2  Nucleus Raphe Pallidus, B1  Nucleus Raphe Magnus, B3  Pontine Raphe Nucleus, B5  Median Raphe or Superior Central Nucleus, B6, B8  Dorsal Raphe Nucleus, B7  Nucleus Linealis Brain stem 26
  • 27.
    Norepinephrinergic & DopaminergicNeuron  Norepinephrinergic Neuron Nucleus Locus Ceruleus, A6  Dopaminergic Neuron Retrorubral Area, A8 Ventral Tegmental Area, A10 Substantia Nigra, Pars Compacta, A9 Brain stem 27
  • 28.
    Ascending Cortical Pathway PosteriorWhite Column-Medial Lemniscal Pathway medial lemniscus Spinothalamic and Spinoreticular Tract spinal lemniscus Ventral and Dorsal Trigeminothalamic Tract trigeminal lemniscus Auditory Pathway: lateral lemniscus Taste (Gustatory) Pathway: central tegmental tract Vestibular Pathway: medial lemniscus Brain stem 28
  • 29.
    Ascending Cortical SystemGeneral Sensation  Brain Stem Pathways for General Sensation  Touch & Proprioception from body Posterior White Colum-Medial Lemniscal Pathway  Pain & Temperature from body Spinothalamic Tract cf. Spinoreticular or Spinoreticulothalamic Tract  General Sensation from Face Trigeminothalamic Tracts Brain stem 29
  • 30.
    Posterior White Column- medial Lemniscal Pathway & Spinothalamic Tract Brain stem 30
  • 31.
    Posterior White Colum-MedialLemniscal Pathway  Modality: Discriminative Touch Sensation (include Vibration) and Conscious Proprioception (Position Sensation, Kinesthesia) from body  Receptor: Most receptors except free nerve endings  Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Posterior White Column  2nd Neuron: Dorsal Column Nuclei (Nucleus Gracilis et Cuneatus) Internal Arcuate Fiber - Lemniscal Decussation - Medial Lemniscus  3rd Neuron: Thalamus (VPLc) Internal Capsule ----- Corona Radiata  Termination: Primary Somesthetic Area (S I)Brain stem 31
  • 32.
    DRG: Dorsal RootGanglion 1. Posterior White Column A. Nucleus gracilis B. Nucleus cuneatus 2. Medial Lemniscus 3. Corona Radiata C. Thalamus (VPLc) D. Cerebral Cortex (S I) Posterior White Column-Medial Lemniscal Pathway DRG D Brain stem 32
  • 33.
    Spinothalamic Tract  Modality:Pain & Temperature Sensation, Light Touch from body  Receptor: Free Nerve Ending  Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)  2nd Neuron: Dorsal Horn (Lamina I, IV, V) Anterior White Commissure Spinothalamic Tract (Spinal Lemniscus)  3rd Neuron: Thalamus (VPLc & CL) Internal Capsule ----- Corona Radiata  Termination: Primary Somesthetic Area (S I) Brain stem 33
  • 34.
    Spinoreticulothalamic Tract (PaleospinothalamicTract)  Modality: Pain & Temperature Sensation, Light Touch from body  Receptor: Free Nerve Ending  Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)  2nd Neuron: Dorsal Horn (Lamina I, IV, V) Anterior White Commissure Spinothalamic Tract (Spinal Lemniscus)  3rd Neuron: Reticular Formation  4rd Neuron: Thalamus (CL, Sm, POm) Internal Capsule ----- Corona Radiata  Termination: Diffuse Cerebral Cotex Brain stem 34
  • 35.
    DRG: Dorsal RootGanglion A. Posterior (dorsal) horn 1. Spinothalamic tract B. Reticular formation 2. Spinoreticular tract C. Thalamus (VPLc, CL) 3. Corona Radiata D. Cerebral Cortex (S I) Spinothalamic Tract (Neospinothalamic Tract) Spinoreticular Tract (Paleospinothalamic Tract) DRG D Brain stem 35
  • 36.
    Trigeminothalamic Tract  Modality:General Sensation from face  Receptor: Most receptors in the face  Ist Neuron: Trigeminal (Semilunar) Ganglia  2nd Neuron: Trigeminal Sensory Nucleus pain & temperature ---- pars caudaliS of spinal tract nucleus of V Ventral and Dorsal Trigeminothalamic Tract  3rd Neuron: Thalamus (VPM) Internal Capsule ----- Corona Radiata  Termination: Primary Somesthetic Area (S I) Brain stem 36
  • 37.
    Trigeminothalamic Tract A. trigeminalganglion B. trigeminal sensory nucleus C. thalamus (VPM) D. cerebral cortex (S I) 1. spinal tract of trigeminal nerve 2. ventral trigeminothalamic tract 3. dorsal trigeminothalamic tract 4. corona radiata V. trigeminal nerve Brain stem 37
  • 38.
    Ascending Cortical SystemSpecial Sensation  Brain Stem Pathways for Special Sensation  Gustatory Sensation (Taste, SVA) ----- Taste Pathway  Auditory Sensation (Hearing, SSA) ----- Auditory Pathway  Vestibular Sensation (Equilibrium, SSA) ----- Vestibular Pathway Brain stem 38
  • 39.
    Auditory Pathway  Modality:Auditory Sensation (Hearing)  Receptor: Organ of Coti of Cochlear Duct Cranial Nerve: VIIIc  1st Neuron: Spiral Ganglion  2nd Neuron: Cochlear Nucleus, Ventral & Dorsal dorsal, intermediate and ventral acoustic striae trapezoid body lateral lemniscus  3rd Neuron: Inferior Colliculus brachium of inferior colliculus  4th Neuron: Medial Geniculate Nucleus (MG) auditory radiation  Termination: Primary Auditory Area (A I) Brodmann area 31, 32 Brain stem 39
  • 40.
    Auditory Pathways A. spiralganglion B. dorsal and ventral cochlear nucleus C. inferior colliculus D. medial geniculate nucleus E. Primary auditory area F. superior olivary nucleus G. nucleus of lateral lemniscus 1. acoustic striae & trapezoid body 2. lateral lemniscus 3. brachium of inferior colliculus 4. auditory radiation 5. commissure of inferior colliculus VIIIc. cochlear division Brain stem 40
  • 41.
    Auditory Pathway A. spiralganglion B. dorsal cochlear nucleus C. ventral cochlear nucleus D. superior olivary nucleus 1. dorsal acoustic striae 2. intermediate acoustic striae 3. ventral acoustic striae 4. efferent cochlear bundle 5. trapezoid body 6. lateral lemniscus Brain stem 41
  • 42.
    Vestibular Pathway  Modality:Equilibrium Sensation  Receptor: Macula & Crista Ampullaris Cranial Nerve: VIIIv  Ist Neuron: Vestibular Ganglion  2nd Neuron: Vestibular Nucleus vestibulothalamic fiber (medial lemniscus)  3rd Neuron: Thalamus (VPLo, VPI?) Internal Capsule ----- Corona Radiata  Termination: Primary Vestibular Area ----- Primary Somesthetic Area (Brodmann area 3a, 2v ) Brain stem 42
  • 43.
    1. Vestibulocerebellar Tract 2. VestibulospinalTract 3. Vestibulothalamic Tract 4. Medial Longitudinal fasciculus (MLF) - ascending portion - descending portion - interstitiospinal tract Brain stem 43 Vestibular Pathway
  • 44.
    Taste (Gustatory) Pathway Modality: Taste Sensation  Receptor: Taste Bud Cranial Nerve: VII, IX, X  Ist Neuron: Geniculate Ganglion (VII) Inferior Ganglion (IX, X)  2nd Neuron: Nucleus Tractus Solitarius (Gustatory Nucleus) solitariothalamic fiber (central tegmental tract)  3rd Neuron: Thalamus (VPMpc) Internal Capsule ----- Corona Radiata  Termination: Gustatory Area Brodmann area 43 & parainsular cortex Brain stem 44
  • 45.
    Taste Pathways A. nucleustractus solitarius (gustatory nucleus) B. thalamus (VPMpc) C. Brodmann area 43 D. parainsular cortex E. parabrachial nucleus 1. solitariothalamic fiber (central tegmental tract) 2. corona radiata VII. facial nerve IX. glossopharyngeal nerve X. vagus nerve Brain stem 45
  • 46.
    Cerebellar Circuits  Superior,Middle and Inferior Cerebellar Peduncle  Vestibulocerebellum - Vestibular Nucleus  Spinocerebellum - Red Nucleus and Spinal Cord  Pontocerebellum - Cerebral Cortex and Pontine Nuclei  Inferior Olivary Nuclear Complex Brain stem 46
  • 47.
    Inferior Cerebellar Peduncle 1.posterior spinocerebellar tract 2. cuneocerebellar tract 3. vestibulocerebellar tract Middle cerebellar Peduncle - corticopontocerebellar pathway Superior Cerebellar Peduncle - anterior spinocerebellar tract Brain stem 47 Afferent Connections of Cerebellum
  • 48.
    Superior Cerebellar Peduncle 1.dentatothalamic fiber 2. interpositorubral fiber 3. ascending portion of uncinate fasciculus of Russell Inferior Cerebellar Peduncle 1. direct fastigiovestibular fiber 2. descending portion of uncinate fasciculus of Russell Brain stem 48 Efferent Connections of Cerebellum
  • 49.
    1. Olivocerebellar Tract 2.Cortico-olivary Tract 3. Rubro-olivary Tract 4. Vestibulo-olivary Tract 5. Spino-olivary Tract Brain stem 49 Connections of Inferior Olivary Nuclear Complex
  • 50.
    Descending Tracts  RubrospinalTract  Tectospinal tract  Vestibulospinal Tract  Reticulospinal Tract pontine and medullary  Descending Autonomic Pathway Brain stem 50
  • 51.
    Brain Stem DescendingTracts  Descending Tracts from Brain Stem  Dorsolateral (Motor) Pathway Rubrospinal Tract  Ventromedial (Motor) Pathway Tectospinal Tract  Vestibulospinal Tract  MLF (Medial Longitudinal Fasciculus) - interstitiospinal tract  Sensory Modulation pathways  Raphespinal & Cerulospinal Pathways  Descending Autonomic Pathways Brain stem 51
  • 52.
    Composite Bundle  MedialLongitudinal Fasciculus (MLF)  Dorsal Longitudinal Fasciculus (DLF)  Central Tegmental Tract Brain stem 52
  • 53.
    Components of MedialLongitudinal Fasciculus (MLF)  Descending Components Medial Vestibulospinal Tract from medial and inferior vestibular nucleus Interstitiospinal Tract from interstitial nucleus of Cajal  Ascending Components Efferents from Medial Vestibular Nucleus contralateral III, IV, interstitial nucleus bilateral VI nucleus Efferents from Superior Vestibular Nucleus ipsilateral III, IV, interstitial nucleus Brain stem 53
  • 54.
     Ascending Components solitariohypothalamicfiber (visceral afferent fiber) ascending serotonergic fiber  Descending Component descending fibers from hypothalamus to periaqueductal gray and dorsal tegmental nucleus Components of Dorsal Longitudinal Fasciculus (DLF, fasciculus of Schütz) Brain stem 54
  • 55.
    Components of CentralTegmental Tract  Ascending Components reticulothalamic fiber solitariothalamic fiber (secondary taste fiber)  Descending Component rubro-olivary tract Brain stem 55
  • 56.
    Spinomedullary Transition (Levelof Pyramidal Decussation)  Roof Plate - fasciculus gracilis and fasciculus cuneatus  Tegmentum Cranial and Spinal Nerve Nuclei Supraspinal Nucleus Spinal Nucleus of Trigeminal Nerve, Pars Caudalis  Reticular Formation Central Nucleus of Medulla Oblongata (Ventral Reticular Nucleus)  Unclassified Nuclei Retroambiguus Nucleus  Tracts Spinal Tracts of Trigeminal Nerve  Basal Part - Pyramid, Pyramidal Decussation Brain stem 56
  • 57.
     Cranial &Spinal N. Nuclei 1. Supraspinal Nucleus 2. Spinal Accessory Nucleus  Cranial & Spinal Nerve XI. Accessory Nucleus C1. motor root of 1st cervical nerve Spinomedullary Transition (Level of Pyramidal Decussation) Brain stem 57
  • 58.
    Lower Medulla (Levelof Lemniscal Decussation)  Roof Plate - nucleus gracilis and nucleus cuneatus  Tegmentum  Cranial and Spinal Nerve Nuclei Hypoglossal Nucleus, Ambiguus Nucleus Solitary Tract Nucleus, Dorsal Motor Nucleus of X  Reticular Formation Lateral Reticular Nucleus  Precerebellar Nuclei Inferior Olivary Nuclear Complex  Tracts Ventral Trigeminothalamic Tract Internal Arcuate Fiber, Lemniscal Decussation  Basal Part - Pyramid, Pyramidal Decussation Brain stem 58
  • 59.
    Lower Medulla (Level ofLemniscal Decussation) Roof Plate A. Nucleus Gracilis B. Nucleus Cuneatus Cranial Nerve Nuclei 1. Hypoglossal Nucleus 2. Nucleus Ambiguus 3. Dorsal Motor Nucleus of X 4. Nucleus Tractus Solitarius 5. Spinal Tract Nucleus of Trigeminal Nerve Brain stem 59
  • 60.
    Lower Medulla (Level ofLemniscal Decussation) Precerebellar Nucleus 1. Inferior Olivary Nuclear Complex 1a. Principal Inferior Olivary Nucleus 1b. Medial Accessory Olivary Nucleus 1c. Dorsal Accessory Olivary Nucleus 2. Nucleus Intercalatus 3. Nucleus Conterminalis 4. Arcuate Nucleus Brain stem 60
  • 61.
    Lower Medulla (Level ofLemniscal Decussation) Reticular Formation 1. Lateral Reticular Nucleus 2. Central Nucleus of Medulla Oblongata 2d. subnucleus dorsalis 2v. subnucleus ventralis Brain stem 61
  • 62.
     Clinical Syndromes ofLower Medulla A. Hypoglossal Alternating Hemiplegia B. Avelis Syndrome C. Jackson Syndrome D. Tapia Syndrome 1. pyramidal tract 2. hypoglossal nerve 3. spinothalamic tract 4. nucleus ambiguus Brain stem 62
  • 63.
    Hypoglossal Palsy Lower Motor Neuron Syndrome Deviation ofTongue to affected side Atrophy of Tongue Muscles Brain stem 63
  • 64.
    Open Medulla (Mid-olivaryLevel)  Tegmentum  Cranial Nerve Nuclei Medial Vestibular Nucleus Spinal Tract Nucleus of V, pars interpolaris  Precerebellar Nuclei Accessory Cuneate Nucleus Nucleus of Roller, Nucleus Interfascicularis Hypoglossi  Reticular Formation Lateral Reticular Nucleus, subtrigeminal portion  Unclassified Nuclei Area Postrema  Tracts: Inferior Cerebellar Peduncle, DLF  Basal Part - Pyramid Brain stem 64
  • 65.
    Cranial Nerve Nuclei 1.Hypoglossal Nucleus 2. Nucleus Ambiguus 3. Dorsal Motor Nucleus of X 4. Nucleus Tractus Solitarius 5. Spinal Tract Nucleus, pars interpolaris 6. Medial Vestibular Nucleus Open Medulla (Mid-olivary Level) Brain stem 65
  • 66.
    Open Medulla (Mid-olivary Level) PrecerebellarNucleus 1. Accessory Cuneate Nucleus 2. Inferior Olivary Nuclear Complex 2a. Principal Inferior Olivary Nuc. 2b. Medial Accessory Olivary Nuc. 2c. Dorsal Accessory Olivary Nuc. 3. Nucleus Intercalatus 4. Nucleus of Roller 5. Nucleus Interfascicularis Hypoglossi 6. Nucleus Conterminalis Brain stem 66
  • 67.
    Open Medulla (Mid-olivaryLevel) XII. Hypoglossal Nerve 1. Hypoglossal Nucleus X. Vagus Nerve 2. Nucleus Ambiguus 3. Dorsal Motor Nucleus of X 4. Nucleus Tractus Solitarius 5. Spinal Tract Nucleus of V Brain stem 67
  • 68.
    A. Dejerine’s Syndrome 1.pyramidal tract 2. hypoglossal nerve 3. medial lemniscus B. Wallenberg Syndrome 4. spinothalamic tract 5. spinal tract of trigeminal nerve 6. nucleus ambiguus 7. descending autonomic pathway Clinical Syndromes of Open Medulla Brain stem 68
  • 69.
    Wallenberg Syndrome Spinothalamic tract -contralateral loss of pain and temperature sensation at the body Spinal tract of trigeminal nerve - ipsilateral loss of pain and temperature sensation at the face Nucleus ambiguus - dysphageia, dysarthria, hoarseness Descending autonomic pathway - Horner’s syndrome (meiosis, ptosis, anhydrosis) Brain stem 69
  • 70.
    Open Medulla (UpperLevel of Medulla)  Tegmentum  Cranial Nerve Nuclei Inferior Vestibular Nucleus Dorsal Cochlear Nucleus  Precerebellar Nuclei Nucleus Prepositus Hypoglossi  Reticular Formation Gigantocellular Reticular Nucleus Paragigantocellular Reticular Nucleus Parvocellular Reticular Nucleus Raphe Nuclei  Unclassified Nuclei retrofacial, supravestibular nucleus, nucleus interpositus  Tracts: stria medullaris of 4th ventricle  Basal Part - Pyramid Brain stem 70
  • 71.
    Cranial Nerve Nuclei 1.Nucleus Ambiguus 2. Nucleus Tractus Solitarius 3. Spinal Tract Nucleus, pars oralis 4. Medial Vestibular Nucleus 5. Inferior Vestibular Nucleus 6. Dorsal Cochlear Nucleus Open Medulla (Upper Level of Medulla) Brain stem 71
  • 72.
    Open Medulla (Upper Levelof Medulla) Precerebellar Nucleus 1. Inferior Olivary Nuclear Complex 1a. Principal Inferior Olivary Nuc. 1b. Medial Accessory Olivary Nuc. 1c. Dorsal Accessory Olivary Nuc. 2. Nucleus Prepositus Hypoglossi 3. Pontobulbar Body 4. Arcuate Nucleus 5. Medial Vestibular Nucleus 6. Inferior Vestibular Nucleus Brain stem 72
  • 73.
    Open Medulla (Upper Levelof Medulla) Reticular Formation 1. Paramedian reticular Nucleus 2. Gigantocellular Reticular Nucleus 3. paragigantocellular Reticular Nucleus 4. Parvocellular Reticular Nucleus 5. Nucleus raphe Obscrus (B2) 6. Nucleus Raphe Pallidus (B1) 7. Nucleus Raphe Magnus (B3) Unclassifiied Nuclei A. Nucleus Retrofacialis B. Supravestibular Nucleus C. Nucleus Interpositus Brain stem 73
  • 74.
    IX. glossopharyngeal Nerve 1. NucleusAmbiguus 2. Inferior Salivatory Nucleus 3. Nucleus Tractus Solitarius 4. Spinal Tract Nucleus of V Open Medulla (Upper Level of Medulla) Brain stem 74
  • 75.
    Pontomedullary Junction  Tegmentum Cranial Nerve Nuclei Facial Motor Nucleus Ventral Cochlear Nucleus  Precerebellar Nuclei  Reticular Formation  Unclassified Nuclei nucleus ovalis  Tracts  Basal Part - Pyramid  Cranial Nerve - Vestibulocochlear Nerve (VIII) Facial Nerve (VII) Brain stem 75
  • 76.
    Cranial Nerve Nuclei 1.Facial Motor Nucleus 2. Nucleus Ambiguus 3. Spinal Tract Nucleus, pars oralis 4. Medial Vestibular Nucleus 5. Inferior Vestibular Nucleus 6. Ventral Cochlear Nucleus Pontomedullary Junction Brain stem 76
  • 77.
    Pontomedullary Junction Precerebellar Nucleus 1. PrincipalInferior Olivary Nucleus 2. Nucleus Prepositus Hypoglossi 3. Pontobulbar Body 4. Arcuate Nucleus 5. Medial Vestibular Nucleus 6. Inferior Vestibular Nucleus Brain stem 77
  • 78.
    Pontomedullary Junction Reticular Formation 1. Paramedianreticular Nucleus 2. Gigantocellular Reticular Nucleus 3. paragigantocellular Reticular Nucleus 4. Parvocellular Reticular Nucleus 7. Nucleus Raphe Magnus (B3) Unclassifiied Nuclei A. Nucleus Interpositus B. Nucleus Ovalis Brain stem 78
  • 79.
    Lower Pons (Levelof Abducens Nucleus)  Tegmentum  Cranial Nerve Nuclei Abducens Nucleus, Main Sensory Nucleus of V  Nuclei of Auditory Pathway Superior Olivary Nuclear Complex  Reticular Formation Caudal Pontine Reticular & Subceruleus Nucleus  Tracts Trapezoid Body, lateral Lemniscus, Central tegmental Tract  Basal Part: Pons Proper: Pontine Nuclei, Transverse Pontine Fiber, Longitudinal Pontine Fiber (Pyramidal Tract) Brain stem 79
  • 80.
    Lower Pons (Levelof Abducens Nucleus) Cranial Nerve Nuclei 1. Abducens Nucleus 2. Main Sensory Nucleus of V 3. Lateral vestibular Nucleus 4. Superior Vestibular Nucleus Auditory Relay Nuclei A. Superior Olivary Nucleus B. Nucleus of Trapezoid body Brain stem 80
  • 81.
    Lower Pons (Levelof Abducens Nucleus) Reticular Formation 1. Gigantocellular Reticular Nucleus 2. Caudal Pontine Reticular Nucleus 3. Parvocellular Reticular Nucleus 4. Nucleus Subceruleus Brain stem 81
  • 82.
    VII. Facial Nerve 1.Facial Motor Nucleus 2. Superior Salivatory Nucleus 3. Nucleus Tractus Solitarius 4. Spinal Tract Nucleus of V VI. Abducens Nerve 5. Abducens Nucleus Brain stem 82
  • 83.
    A. Facial Palsy B.A + decreased salivation C. A + B + hyperacusis D. A + B + C + decrased lacrimal secretion E. Central Type Facial Palsy 1. Facial Motor Nucleus 2. Superior Salivatory Nucleus 3. Solitary Nucleus 4. Spinal Tract Nucleus of Trigeminal Nerve Brain stem 83
  • 84.
    Facial Palsy (Bell’s Palsy) LowerMotor Neuron Syndrome Triple W Sign - Wrinkle, Wink, Whistle Brain stem 84
  • 85.
    Right facial paralysis FacialPalsy (Bell’s Palsy) Brain stem 85
  • 86.
    Central Type FacialPalsy Upper Motor Neuron Syndrome facialmotor nucleus neurons supplying forehead muscle Bilateral Corticobulbar Tract Brain stem 86
  • 87.
  • 88.
    Upper Pons (Levelof Trigeminal Motor Nucleus)  Tegmentum  Cranial Nerve Nuclei Trigeminal Motor Nucleus, Mesencephalic Tract Nucleus of Trigeminal Nerve  Nuclei of Auditory Pathway Nucleus of Lateral Lemniscus  Reticular Formation Reticular Tegmental Nucleus  Unclassified Nucleus Pontine Central Gray: Ch6  Tracts Trigeminal Nerve Fiber  Basal Part: Pons Proper Brain stem 88
  • 89.
    Upper Pons (Levelof Trigeminal Motor Nucleus)  Cranial Nerve Nuclei 1. Trigeminal Motor Nucleus 2. Main Sensory Nucleus of V 3. Mesencephalic Tract Nucleus of V 4. Superior Vestibular Nucleus Auditory Relay Nuclei A. Nucleus of Lateral Lemniscus Brain stem 89
  • 90.
    Upper Pons (Levelof Trigeminal Motor Nucleus) Reticular Formation 1. Caudal Pontine Reticular Nucleus 2. Nucleus Subceruleus 3. Reticular Tegemntal Nucleus of Bekhterew (Nucleus Papilloformis of Olszewski and Baxter) Brain stem 90
  • 91.
    A. Millard-Gubler Syndrome B.Raymond Syndrome C. Foville Syndrome D. Raymond-Cestan Syndrome E. Marie-Poix Syndrome 1. pyramidal tract 2. MLF 3. medial lemniscus 4. spinothalamic tract 5. trigeminal motor nucleus 6. main sensory nucleus of V 7. spinal tract of trigeminal nerve 8. middle cerebellar peduncle Clinical Syndromes of Pons Brain stem 91
  • 92.
    Trigeminal Neuralgia (tic douloureux) -excruciating episodic pain in the area supplied by trigeminal nerve, especially second and third division - trigger point - intense pain makes the patient grimace (tic) - antiepileptic drug (phenytoin, carbamazepine) is effective - surgical treatment Brain stem 92
  • 93.
    Lower Midbrain (Levelof Inferior Colliculus)  Roof Plate - Tectum: Inferior Colliculus  Tegmentum  Cranial Nerve Nuclei Trochlear Nucleus  Reticular Formation Cuneiform, Pedunculopontine, Parabrachial and Median Raphe (Superior Central) Nucleus  Unclassified Nuclei Periaqueductal Gray  Tracts Decussation of Superior Cerebellar Peduncle  Basal Part - Crus Cerebri, Pons Proper Brain stem 93
  • 94.
    Roof Plate A. InferiorColliculus Cranial Nerve Nuclei 1. Mesencephalic Tract Nucleus of Trigeminal Nerve 2. Trochlear Nucleus Brain stem 94 Lower Midbrain (Level of Inferior Colliculus)
  • 95.
    Reticular Formation 1. CuneiformNucleus 2. Pedunculopontine Nucleus 3. Nucleus Locus ceruleus 4. Parabrachial Nucleus 5. Dorsal Raphe Nucleus 6. Median Raphe Nucleus Unclassified Nuclei A. Periaqueductal Gray B. Dorsal Tegmental Nucleus of Gudden C. Interpeduncular Nucleus D. Parabigeminal Nucleus C 6 5 Brain stem 95 Lower Midbrain (Level of Inferior Colliculus)
  • 96.
    Upper Midbrain (Levelof Superior Colliculus)  Roof Plate - Tectum: Superior Colliculus  Tegmentum  Cranial Nerve Nuclei Oculomotor and Edinger-Westphal Nucleus  Reticular Formation - Subcuneiform Nucleus  Precerebellar Nuclei Red Nucleus  Unclassified Nuclei Substantia Nigra, Paranigral, Paralemniscal Nucleus Ventral Tegmental Area (VTA)  Tracts Brachium of Inferior Colliculus  Basal Part - Crus Cerebri Brain stem 96
  • 97.
    Roof Plate A. SuperiorColliculus Precerebellar Nucleus B. Red Nucleus Cranial Nerve Nuclei 1. Mesencephalic Tract Nucleus of V 2. Oculomotor Nucleus 3. Edinger-Westphal Nucleus Brain stem 97 Upper Midbrain (Level of Superior Colliculus)
  • 98.
    Reticular Formation A. CuneiformNucleus B. Subcuneiform Nucleus Unclassified Nuclei 1. Periaqueductal Gray 2. Paralemniscal Nucleus 3. Substantia Nigra 3a. Pars Compacta 3b. Pars Reticulata 4. Paranigral Nucleus 5. Ventral Tegmental Area Brain stem 98 Upper Midbrain (Level of Superior Colliculus)
  • 99.
    A. Weber Syndrome B.Foix Syndrome C. Benedikt’s Syndrome D. Claude Syndrome E. Parinaud’s Syndrome 1. pyramidal tract 2. superior cerebellar peduncle 3. red nucleus 4. medial lemniscus 5. superior colliculus 6. cerebral aqueduct 7. MLF 8. oculomotor nucleus Brain stem 99 Clinical Syndromes of Upper Midbrain
  • 100.
     Pyramidal tract -contralateral UMN syndrome at the body and lower face (contralateral hemiparesis)  Oculomotor Nerve - ipsilateral ocular palsy - external strabismus - mydriasis - loss of accommodation - normal consensual light reflex Brain stem 100