Brainstem

Objectives

To know the anatomy of the brainstem

To develop a three – dimensional picture of the interior of the brainstem

To know the positions of the cranial nerve nuclei, olivary nuclear complex and the
ascending and descending tracts

To assess the signs and symptoms associated with structural lesion

 Cranium
Skull Anatomy
• Cranium
• Frontal bone 1
• Parietal bone 2
• Occipital bone 1
• Temporal bone 2
• Sphenoid bone 1
• Ethmoid bone 1

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 Skull Anatomy
• Facial bone
• Zygomatic bones
• Maxillae
• Nasal bones
• Lacrimal bones
• Vomer

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overlies the anterior
division of the middle
meningeal
artery and vein.
 Cranial Cavity
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 Floor of Cranium

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 Floor of Cranium

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Mandible
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BRAINSTEM
Introduction to the Brainstem
Brainstem

Made up of Medulla
oblongata, Pons, Midbrain

Occupies the posterior

cranial fossa of the skull

Stalklike and connects SC with

expanded forebrain
Brainstem
Functions

Serves as conduit for the ascending tracts and descending tracts connect
spinal cord to higher centers in the forebrain

Contains important reflex centers associate with the control of respiration

and the cardiovascular system and with control of consciousness

Contains important nuclei of CNs III through XII

Medulla Oblongata
Anterior View
Medulla Oblongata
Posterior View
Medulla Oblongata
Internal Structure Levels

Level of decussation of pyramids

Level of decussation of lemnisci
Level of the olives
Level just inferior to the pons
Level of Pyramid Decussation
olives,
decussation of
Decussatioin of inferior just inferior
medial
pyramids cerebellar to pons
leminisci
peduncle
nucleus gracilis X X
nucleus cuneatus X X
spinal nucleus of CN V X X
accessory nucleus X X
hypoglossal nucleus X
inferior olivary nucleus X
vestibular nucleus X
Nuclei
glossopharyngeal X
vagal X
hypoglossal X
nucleus ambigusus X
nucleus tractus solitarius X
lateral vestibular nucleus X
cochlear nucleus X
Level of Pyramid Decussation
olives,
decussation just
Decussatioin inferior
of medial inferior to
of pyramids cerebellar
leminisci pons
peduncle
corticospinal X X X
Motor Tracts
pyramids X X X
spinal tract CN V X X X
Posterior spinocerebellar X X
lateral spinothalamic X X X
anterior spinocerebellar X X X
Sensory Tracts medial leminisci X X
fasciculus gracilis X
fasciculas cuneatus X
longitudinal fasciculus X
tectospinal tract X
Central Canal X X
cavity
Fourth Ventricle X X
PONS

Bridge
Connects the connecting
Anterior to
medulla About 1 inch the right and
the
oblongata to (2.5 cm) long left
cerebellum
the midbrain cerebellar
hemispheres
Pons
Pons
Midbrain

Colliculi
Connects the • Superior
pons and Traversed by colliculi: visual
0.8 in (2 cm) in reflexes
cerebellum the cerebral
length • Inferior colliculi:
with the aqueduct
lower auditory
forebrain centers
Midbrain
Midbrain
Midbrain
Clinical Notes
Clinical Significance of the Medulla
Oblongata
Raised pressure in posterior
cranial fossa
•Tumors of posterior cranial fossa
•Increased intracranial pressure
•Downward herniation of the medulla
and cerebellar tonsils
•Headache, neck stiffness, paralysis of
glossopharyngeal, vagus, accessory,
hypoglossal nerve
Arnold-Chiari Phenomenon
•Congenital anomaly
•Herniation of the tonsils of the
cerebellum and medulla oblongata
•Causing internal hydrocephalus
•Involvement of last 4 cranial nerves
Vascular Disorder of the
Medulla Oblongata
•Posterior inferior cerebellar artery
•Thrombosis: dysphagia and dysarthria
due to paralysis of palatal and laryngeal
muscles
•Analgesia and thermoanestheia
ipsilateral side of face
•Vertigo, nausea, vomiting, nystagmus
•Ipsilateral Horner syndrome
•Gait and limb ataxia
•Contralateral loss of sensations of pain
and temperature
Medial medullary syndrome
•Vertebral artery
•Contralateral hemiparesis, impaired
sensations of position, movement and
tactile discrimination
•Ipsilateral paralysis of tongue with
deviation to paralyzed side upon
tongue protrusion
Clinical Notes
Clinical Significance of the Pons

Tumors of the pons Pontine Hemorrhage Infarctions

• Astrocytoma of pons (most common tumor of • Basilar, anterior, inferior, and superior cerebellar • Thrombosis or embolism of basilar artery or
brainstem) arteries branches
• Ipsilateral cranial nerve paralysis • Facial paralysis on side of lesion, paralysis of
• Contralateral hemiparesis, weakness of facial limbs on opposite side
muscles (ipsilateral) • Poikilothermic due to cutting off from hear
• Weakness of lateral rectus muscle (abducent regulating centers
nerve), nystagmus, weakness of jaw, impairment
of hearing, contralateral hemiparesis,
quadriparesis
• Anesthesia to light touch, contralateral sensory
loss of trunk and limbs
• Ipsilateral cerebellar symptoms
Clinical Notes
Clinical Significance of the Midbrain
Trauma
• Trauma due to sudden lateral movement of
head
• Ipsilateral paralysis of levator palpebrae
superioris, superior, inferior, and medial
rectus muscles, and inferior oblique muscles
(oculomotor)
• Dilated pupil (parasympathetic nucleus of
oculomotor)
• Trochlear nucleus: contralateral paralysis of
superior oblique muscle
Blockage of Cerebral Aqueduct
• Hydrocephalus
Vascular lesions
• Weber syndrome: necrosis of oculomotor
nrve and crus cerebri; occlusion of PCA –
ipsilateral opthalmoplegia (eye pain),
contralateral paralysis of lower part of face,
tongue, arm and leg; Ptosis of upper lid,
dilated pupil dilated and fixed to light and
accommodation
• Benedikt Syndrome: necrosis of medial
lemniscus and red nucleus; contralateral
hemianesthesia and involuntary movements
of the limbs of the opposite side