BRAIN STEM

Dr. Lalan Fernando

MMBS, PGDip, MSc, MphiL
Department of Anatomy
Faculty Of Medicine
Kotalawala Defence University
Brain Stem
● Medulla Oblongata
● Pons
● Mid Brain
 Functions

● Conduit
– Ascending and descending pathways

● Integrative functions
– Complex motor patterns
– Respiratory and cardiovascular activity
– Regulation of arousal and level of consciousness

● Cranial Nerve functions

MEDULLA OBLONGATA
 Pyramids

● Cortico spinal tracts

● Pyramidal Tracts
● Descending Motor
● ?? Extra Pyramidal
 Olive

● Shaped like a crumpled bag with its mouth directed

medially
● Send fibers medially across the midline to enter the
cerebellum through the inferior cerebellar peduncle
● Afferent fibers from the spinal cord (the spino-olivary
tracts) and from the cerebellum and cerebral cortex
● Function of the olivary nuclei is associated with
voluntary muscle movement
 Cuneate nucleus & Gracile nucleus

1st relay pint

Start 2nd Order neurone
Directly to cerebellum
● Stria Medullaris
– Arcuate nucleus to cerebellum via inferior cerebellar
peduncles
● Vagal Triangle
– The dorsal motor nucleus of the vagus
● Hypoglossal Triangle
– The hypoglossal nucleus
Fiber bundle containing afferent fibers from the septal nuclei,
lateral preoptico-hypothalamic region and anterior thalamic nuclei
to the habenula
● Spinal Lemniscus
– The lateral spinothalamic tract, the anterior
spinothalamic tract and the spinotectal tract.
● Medial Longitudinal Fasciculus
– connects the vestibular and cochlear nuclei with the
nuclei controlling the extraocular muscles
(oculomotor, trochlear, and abducent nuclei)
– mesencephalic nucleus – Jaw Jerk
– Facial Nucleus – Corneal Reflex
● Reticular formation
● Hypoglossal Nucleus
● Nucleus ambiguus
– Glossopharyngeal, vagus, and the cranial root of the
accessory Nerve ( soft palate, pharynx, and larynx
associated with speech and swallowing)
● Vestibular, Cochlear and Trigeminal nuclei
Trigeminal Nuclei
Pons
● Facial Colliculi
– Facial nerve motor fibers run around the abducent nerve nucleus
● Cortico bulbar and spinal fibers
● Pontine nuclei
– cortico-ponto-cerebellar circuit (carries information to the
contralateral cerebellum via the middle cerebellar peduncle)
– important in learning motor skills
● Middle cerebellar peduncle
● Trapezoid body
– The trapezoid body is made up of fibers derived from the
cochlear nuclei and the nuclei of the trapezoid body
● Anterior Cochlear nuclei
● Posterior Cochlea nuclei
● Superior Olivary nuclei
● Nuclei of lateral lemniscus
Mid Brain
 Corpora
quadrigemina

CN III

Cerebral
peduncles
Interpeduncular
cistern
● Substantia Nigra
– Connected with the brain areas which are important for motor
control as well as to the frontal lobes
– Neurotransmitter – Dopamine
– Important for attention and executive function
– Parkinson's disease - progressive death of neurons in the
substantia nigra, leading to motor and cognitive symptoms
● Red nucleus
– Motor pathway controlling movement of limbs Anatomically
● Oculomotor Nuclei
● Crus Cerebri
– Ascending and descending fibers
– Important descending tracts
● The corticospinal and corticonuclear fibers occupy the
middle two-thirds
● The frontopontine fibers occupy the medial part of the
crus
● The temporopontine fibers occupy the lateral part of
the crus
● Cerebral Aqueduct
● Superior and inferior colliculi

Auditory and visual body reflexes

Blood supply
1.The brain stem (medulla, pons midbrain) receives the
bulk of its blood supply from the vertebrobasilar
system. Except for the labyrynthine branch, all other
branches supply the brain stem and cerebellum
2.The posterior cerebral has only a small contribution, its
main target being the posterior cerebral hemispheres
3.Blood supply to the midbrain
1.Most of the blood supply is derived from branches
of the basilar artery
2.Posterior cerebral, Superior cerebellar, Posterior
communicating, Anterior choroidal
 Lateral Medullary Syndrome
(Wallenberg's Syndrome)
● Infarction of the lateral
medulla
● Occluded vessel is the PICA
● Symptoms
– Vertigo
– Diplopia
– Dysphasia
– Dysphonia
– ipsilateral facial pain
 Signs
Ipsilateral Horner's Syndrome
Loss of pain and temperature on the lesioned-side of the
face - (CN V nerve and nucleus)
Ipsilateral paralysis of the throat - (CN IX and CN X)
Ipsilateral lateral rectus and facial weakness - (CN VI and
CN VII)
Ipsilateral dysmetria, dysrhythmia and dysdiadochokinesia
- (cerebellum)
Spontaneous nystagmus - (vestibular nucleus)
Loss of pain and temperature sensation on the side of the
body opposite the lesion - (crossed spinothalamic tracts)
 Lateral Pontomedullary Syndrome

● Occlusion of the AICA (can affect the

pontomedullary area and parts of the
inferior cerebellum)
● The middle cerebellar peduncle is often
the area most affected
● Symptoms
– severe vertigo
– nausea and vomiting
– unilateral hearing loss
– Tinnitus
– facial paralysis
– poor coordination (asynergy) of the
cerebellum
 Signs
Ipsilateral hearing loss and/or tinnitus - (labyrinth and
auditory portion of CN VIII)
Spontaneous nystagmus - (labyrinth and vestibular
portion of CN VIII)
Ipsilateral weakness of the face - (CN VII and nucleus)
Ipsilateral cerebellar dysfunction - (anterior inferior
cerebellum)
Ipsilateral loss of pain and temperature sensation on
the face - (CN V and nucleus)
Contralateral loss of pain and temperature senstion on
the body - (crossed spinothalamic fibers)
 Weber‘s syndrome
● Involves the basal portion of
the midbrain due to occlusion
of a mesencephalic branch of
the posterior cerebral artery
● Area of infarction involves
– Pyramidal fibres- contralateral
hemiparesis
– Oculomotor nerve - ipslateral
paralysis of the ocular muscles
except the lateral rectus and
superior oblique.
Benedikt Syndrome
● similar to Weber syndrome, but the necrosis
involves the medial lemniscus and red nucleus
● producing contralateral hemianesthesia and
involuntary movements of the limbs of the
opposite side
 Syringobulbia

● Very rare entity

● Slit-like fluid cavity in brainstem
● Associated with
– Chiari malformation
– Tumors
– Tethered cord
– Idiopathic
 Symptoms

●
Head and neck pain
●
Snoring
●
Diplopia
●
Sensory disturbances
●
Unsteady gait
●
Dysphagia
●
Paresthesias and numbness
 Clinical Findings
●
Cranial nerve deficits
– All patients
– Unilateral not uncommon
●
Nystagmus
●
Weakness
●
Hyperreflexia
●
Scoliosis
MRI Findings