PONS and MEDULLA

Pons
basilar groove

cerebral peduncle of
midbrain

transverse fibers

motor root of trigeminal

6
middle cerebellar
peduncle
medulla

cerebellum

sensory root of trigeminal

substantia ferruginea
midbrain
superior cerebellar peduncle

median sulcus
sulcus
limitans

medial eminence
vestibular area

middle cerebellar peduncle

pons

facial colliculus
inferior cerebellar peduncle

medulla

Internal structures of the pons

1. Transverse section through the cranial part passing

through the trigeminal nuclei
2. Transverse section through the caudal part passing
through the facial colliculus

Transverse section through the

pons at the level of the trigeminal nuclei
cavity of fourth ventricle
reticular formation

motor nucleus of trigeminal

nerve
main sensory nucleus
of trigeminal nerve
pontine nuclei

spinal lemniscus

transverse fibers

medial lemniscus

trapezoid body

Bundles of corticospinal
and corticonuclear fibers

Transverse section of the pons at the level of the

facial colliculus

medial longitudinal fasciculus

medial vestibular n.
inferior cerebellar
peduncle

facial colliculus

nucleus of abducent

middle cerebellar
peduncle

nucleus of facial nerve

medial lemniscus
transverse pontine fibers

trapezoid body
pontine nuclei

Bundles of corticospinal and

corticonuclear fibers

Blood supply to the pons

The pons is supplied by the basilar artery through its

branches:
1. pontine arteries
2. anterior inferior cerebellar artery
3. superior cerebellar artery

Medulla

medulla

Gross appearance of the medulla oblongata

pons

(9)
(10)

hypoglossal
nerve

(11)

anterior median fissure

pyramid
olives

decussation of the pyramids

Posterior view of the medulla

inferior cerebellar
peduncle

floor of the fourth

ventricle
fourth ventricle

central canal
central canal

Posterior view of the medulla

cuneate tubercle
gracile tubercle

posterior median sulcus

Internal structures of the medulla

1.
2.
3.
4.

Level of Decussation of pyramid

Level of Decussation of Lemnisci
Level of the olives
Level just inferior to the pons

Transverse section of the medulla

posterior median
sulcus

corticospinal tract

posterior spinocerebellar tract

lateral spinothalamic tract
decussation of the
pyramids

anterior spinocerebellartract

level of decussation
of the pyramid

anterior median
fissure

posterior median
sulcus
spinal nucleus of trigeminal
nerve

fasciculus gracilis
nucleus gracilis
fasciculus cuneatus
nucleus cuneatus

central canal

anterior median
fissure

level of decussation
of the pyramid

Transverse section at the level

of Decussation of Lemnisci

nucleus gracilis
nucleus cuneatus

spinal nucleus of
trigeminal nerve

internal arcuate fibers

posterior spinocerebellar tract

decussation of medial lemnisci

lateral spinothalamic tract

anterior spinocerebellar tract
pyramid

Transverse section at the level

of Decussation of Lemnisci
nucleus gracilis

hypoglossal nucleus

nucleus cuneatus

spinal root of
accessory nerve

spinal nucleus of
trigeminal nerve
decussation of medial lemnisci

pyramid

Transverse section at the

level of the olives
medial longitudinal fasciculus
inferior cerebellar
peduncle

reticular formation

tectospinal tract
medial lemniscus

pyramids

olives
hypoglossal nerve

anterior median fissure

Transverse section at the

level of the olives
dorsal vagal nucleus
nucleus of tractus
solitarius

medial vestibular nuclei

posterior cochlear nucleus
inferior vestibular nucleus

nucleus ambiguus

anterior cochlear nucleus

dorsal accesory olivary nucleus
inferior olivary nucleus
medial accesory olivary nucleus
arcuate nuclei

1.

The olivary nuclear complex:

a. inferior olivary nucleus
b. medial accessory olivary nucleus
c. dorsal accessory olivary nucleus.

.
2. Vestibular nuclear complex:
a. medial vestibular
b. inferior vestibular
c. lateral vestibular
d. superior vestibular
3. Cochlear nuclei: the anterior and posterior
4. Nucleus ambiguus
5. Nucleus of tractus solitarius
6. Dorsal nucleus of the vagus
7. Hypoglossal nuclei
8. Arcuate nuclei

Transverse section just inferior

to the pons
lateral vestibular nucleus
posterior cochlearnucleus

reticular formation

inferior cerebellar peduncle

anterior cochlear nucleus

medial lemniscus

pyramid

Blood supply to the

medulla
The medulla oblongata is supplied by the
*Vertebral artery through its branches:
1. Anterior spinal
2. Posterior spinal
3. Posterior inferior cerebellar
4. Medullary arteries
*Basilar artery through its branch:
1. Anterior inferior cerebellar artery

Rule of four
1. There are 4 structures in the midline beginning with M

2. There are 4 structures to the side (lateral) beginning with S

3. There are 4 cranial nerves in the medulla, 4 in
the pons and 4 above the pons(2 in the midbrain)
4. The 4 motor nuclei that are in the midline are multiples of
12: ( 3, 4, 6 and 12)

(5, 7, 9 and 11 are in the lateral brainstem)

The 4 structures in the midline:

1. Motor pathway (or corticospinal tract):
2. Medial Lemniscus:
3. Medial longitudinal fasciculus:
4. Motor nucleus and nerve (3,4,6,12)

The 4 side (lateral) structures:

1. Spinocerebellar pathway:
2. Spinothalamic pathway:
3. Sensory nucleus of the 5th cranial nerve:
4. Sympathetic pathway:

The 4 cranial nerves in the medulla are CN9-12:

1. Glossopharyngeal (CN9):
2. Vagus (CN10)
3. Spinal accessory (CN11):
4. Hypoglossal (CN12):

The 4 cranial nerves in the pons are CN5-8:

1.
2.
3.
4.

Trigeminal (CN5
Abducent (CN6)
Facial (CN7)
Vestibulocochlear (CN8)

The 4 cranial nerves above the pons are CN1-4:

1. Olfactory (CN1):
2. Optic (CN2):
3. Oculomotor (CN3):
4. Trochlear (CN4):

Clinical conditions involving the medulla

1.

Lateral medullary syndromes of Wallenberg

The lateral part of the medulla is supplied by the posterior inferior
cerebellar artery which is a branch of the vertebral artery.

Affected Structures
1. Nucleus ambiguus
2. Spinal nucleus of trigeminal
3. Vestibular nuclei
4. Inferior cerebellar peduncle
5. Spinal lemniscus/spinothalamic
tract

Affected Structures
1. Nucleus ambiguus (dysphagia and dysarthria)
2. Spinal nucleus of trigeminal (analgesia and
thermoanesthesia on the ipsilateral side of the face)
3. Vestibular nuclei (vertigo, nausea, vomiting, nystagmus)
4. Inferior cerebellar peduncle ipsilateral cerebellar signs gait and limb ataxia
5. Spinal lemniscus/spinothalamic tract (contralateral loss of
sensation of pain and temperature)
6. Descending sympathetic fibers - ipsilateral Horner Syndrome

2. Medial medullary syndrome

The medial part of the medulla is supplied by the vertebral
artery. Thrombosis of the medullary branch produces signs
due to structures affected by the lesion:
Affected structures:
1. Pyramid : contralateral
hemiparesis
2. Medial lemniscus:
contralateral impaired
sensations of position and
movement and tactile
discrimination
3. Hypoglossal nerve:
ipsilateral paralysis of
tongue muscles

Clinical condition involving the pons

Astrocytoma of the pons occuring in
childhood is the most common tumor of the
brainstem.

Affected structures:
1. facial nerve nucleus
weakness of facial muscles
2. abducent nerve nucleus
weakness of the lateral rectus muscle
3. vestibular nucleus
nystagmus
4. trigeminal nerve
weakness of the jaw muscles
5. cochlear nucleus
impairment of hearing
6. corticospinal fibers
contralateral hemiparesis
7. medial and spinal lemniscus
contralateral sensory defects of the trunk and
limbs