Anatomy of Brain Stem

ANA 313
Neuro-anatomy Lecture
 Introduction to brainstem

 Function of Brainstem
Composition (1)Serves as a conduit for the ascending
tracts and descending tracts connecting
the spinal cord to the different parts of
Medulla oblongata the higher centers in the forebrain
Pons
(2) Contains important reflex centers
Midbrain associated with the control of respiration
and the cardiovascular system and with
the control of consciousness
occupies the posterior cranial fossa of the
skull.
(3) Contains the important nuclei of cranial
connects the narrow spinal cord with the nerves III through XII.
expanded forebrain.
 Medulla Oblongata: Gross appearance
• Connects the pons to spinal cord
• About 2.5 cm in length
• It is conical in shape
• Upper half surrounds the cavity of
fourth ventricle
• Lower half surrounds the central
canal
 Anterior View of the Medulla oblongata: Gross Cont.

• Anterior median fissure

• Pyramid » Cortico-spinal fibres
 Decussation of pyramids
• External Arcuate fibres
 Above the decussation
 Pass laterally to cerebellum
• The olives →inferior olivary Nu.
 Posterolateral to the pyramids
 Inferior Cerebellar peduncle
 Connects Medulla to
cerebellum
 Medulla Oblongata: Gross appearance cont.
Nerves that emerges from its surface

 Hypoglossal – groove b/t olive and

pyramid

Glossopharyngeal, Vagus and

Accessory (Cranial root) – Groove
between the olive and Inferior
Cerebellar peduncle

A- Anterior View of the Medulla Oblongata

 Posterior Surface of the Medulla oblongata
• Superior surface – lower part of the
floor of the 4th Ventricle

• Features:
Posterior Median Sulcus
Gracile tubercle – Nucleus
gracilis
Cuneate tubercle – Nucleus
Cuneatus
 The internal structure of the medulla oblongata
Considered at four levels:

1) level of decussation of pyramids – A

2) level of decussation of lemnisci – B
3) level of the olives
4) level just inferior to the pons.
 Medulla at the level of decussation of pyramids
A transverse section through
the inferior half of the
medulla oblongata
• through the decussation of the
pyramids, the great motor
decussation.

It contain the following

nuclei:
Nucleus gracilis, nucleus
cuneatus, spinal nucleus of
cranial nerve V, accessory
nucleus
 Medulla at the level of decussation of lemnisci
 Transverse section just above the
level of the decussation of the
pyramids
passes through the decussation of
lemnisci -the great sensory
decussation
 this decussation takes place
anterior to the central gray matter
and posterior to the pyramids.
It contain the following nuclei:
 Nucleus gracilis, nucleus cuneatus,
spinal nucleus of cranial nerve V,
accessory nucleus, hypoglossal
nucleus
 Medulla at the level of the olives
A transverse section through the
olives passes across the inferior part
of the fourth ventricle
The amount of gray matter has
increased at this level owing to the
presence of the many nuclei
It contain the following nuclei:
• Inferior olivary nu., spinal nucleus of
cranial nerve V, vestibular nu.,
glossopharyngeal nu., vagal nu.,
hypoglossal nu., nucleus ambiguus,
nucleus of tractus solitarius
 Medulla at the level just inferior to the pons
There are no major changes, in
comparison to the previous
level in the distribution of the
gray and white matter

It contain the following

nuclei:
• Lateral vestibular nucleus,
cochlear nuclei
Transverse section of the medulla oblongata at the level
of decussation of the pyramids
Transverse section of the medulla oblongata at the
level of decussation of the medial lemnisci
Transverse section of the medulla oblongata at the level of the
middle of the olivary nuclei
 Summary of some structures in the Medulla Oblongata
Vestibulocochlear Nuclei
• Vestibular complexes:
(1) medial vestibular nucleus
(2) inferior vestibular nucleus
(3) lateral vestibular nucleus
(4) superior vestibular nucleus
• Cochlear nuclei:
(1) anterior cochlear nucleus
(2) posterior cochlear nucleus
The Nucleus Ambiguus
• consists of large motor neurons
• Situated deep within the reticular
formation
• It joins the glossopharyngeal, vagus, and
cranial part of the accessory nerve and
are distributed to voluntary skeletal
muscle of larynx, soft palate, pharynx
• Olivary complex
= Inferior olivary nu + dorsal olivary nu +
medial accessory olivary nu.
 Summary of some structures in the Medulla Oblongata
The medial lemniscus
• forms a flattened tract on each side of the
midline posterior to the pyramid,
• Its fibers emerge from the decussation of the
lemnisci and convey sensory information to the
thalamus.
The medial longitudinal fasciculus
• forms a small tract of nerve fibers situated on
each side of the midline posterior to the medial
lemniscus and anterior to the hypoglossal
nucleus
• It consists of ascending and descending fibers
The inferior cerebellar peduncle
• is situated in the posterolateral corner of the
section on the lateral side of the fourth ventricle
The spinal tract of the trigeminal nerve
• With its nucleus is situated on the
anteromedial aspect of the inferior cerebellar
peduncle
The reticular formation:
• consisting of a diffuse mixture of nerve fibers
and small groups of nerve cells, is deeply
placed posterior to the olivary nucleus
• The reticular formation represents, at this
level, only a small part of this system
• The reticular formation is present at all levels
of Medulla oblongata, it also present in the
pons and midbrain
Blood supply of Medulla oblongata:

 Ventrally = branches from vertebral + basilar arteries

• Also branches from anterior spinal artery
 Dorso-laterally: by posterior inferior cerebellar artery

Venous drainage:
ventrally: basilar venous plexus and inf. petrosal sinus
Dorsally and dorsolaterally to occipital sinus
Medullary veins communicate with sinuses and spinal veins
 Clinical Correlates: Lateral Medullary Syndrome of Wallenberg
The lateral part of the medulla
oblongata is supplied by the posterior
inferior cerebellar artery, which is
usually a branch of the vertebral artery.
Thrombosis of either of these arteries
produces the following signs and
symptoms:
• dysphagia and dysarthria due to paralysis
of the ipsilateral palatal and laryngeal
muscles (innervated by the nucleus
ambiguus);
• Analgesia and thermoanesthesia on the
ipsilateral side of the face (nucleus and
spinal tract of the trigeminal nerve);
• Vertigo,
• Nausea and vomiting
• Nystagmus (vestibular nuclei);
• Ipsilateral Horner syndrome
(descending sympathetic fibers);
• Ipsilateral cerebellar signs - gait
and limb ataxia (cerebellum or
inferior cerebellar peduncle)
• contralateral loss of sensations of
pain and temperature (spinal
lemniscus and spinothalamic
tract).
 Clinical Correlates: Medial Medullary
Syndrome
The medial part of the medulla oblongata is supplied by the vertebral
artery and anterior spinal arteries.
Thrombosis of the medullary branch produces the following signs
and symptoms:
• contralateral hemiparesis (pyramidal tract),
• contralateral impaired sensations of position and movement and tactile
discrimination (medial lemniscus)
• ipsilateral paralysis of tongue muscles with deviation to the paralyzed side
when the tongue is protruded (hypoglossal nerve).
 Gross Anatomy of Pons: Introduction

• Connect the medulla oblongata to

midbrain
• Lies anterior to the cerebellum
• It is about 1 inch (2.5 cm) long
• Its name is due to its appearance
presented on the anterior surface
• a bridge connecting the right and left
cerebellar hemispheres

Anterior surface of the brainstem showing the pons

 Gross Anatomy of Pons: Anterior Surface
• Anterior surface is convex
• Has multiple transverse fibers that converge
on each side = middle cerebellar peduncle
• Has a shallow groove in the midline =
basilar groove - basilar artery
• From its anterolateral surface the
trigeminal nerve emerges on each side.
• Each nerve consists of a smaller, medial part,
known as the motor root, and a larger, lateral
part, known as the sensory root

• From the groove between the pons and

medulla oblongata emerges - abducent,
facial, and vestibulocochlear nerves (from
medial to lateral).
Anterior surface of the brainstem showing the pons
 Gross Anatomy of Pons: Posterior Surface
• It is triangular in shape
Lateral boundary = Superior cerebellar
peduncle

• Forms the upper half of the 4th ventricle

• It is divided symmetrically by median

sulcus

• Medial eminence – elongated elevation

just lateral to the median sulcus

• Sulcus Limitans – lateral boundary of

median eminence Posterior surface of the brainstem showing the pons. The cerebellum has been
removed
 Gross Anatomy of Pons: Posterior Surface
• Facial colliculus
Slightly expanded inferior end of medial
eminence
Produced by root of facial nerve winding
around abducent nucleus

• Substantia ferruginea
Floor of the superior part of sulcus
limitans
Bluish-gray colour

• Area of Vestibuli
Produced by underlying vestibular nucleus
Lateral to sulcus limitans
Posterior surface of the brainstem showing the pons. The cerebellum has been
removed
 Internal structure of the pons
It is commonly divided into a posterior part, the tegmentum, and an
anterior basal part by the transversely running fibers of the trapezoid
body
The structure of the pons may be studied at two levels:
(1) transverse section through the caudal part
- Passes through the facial colliculus
(2) transverse section through the cranial part
- passes through the trigeminal nuclei
 Reticular formation is present at all levels in the transverse section of
the pons
 Internal structures of the Pons at the level of Facial Colliculus
Nuclei:
• Facial nu., Abducent nu., Medial
vestibular nu., spinal nucleus of
CNV, Pontine nu., Trapezoid nu.
Motor Tracts:
• Cortico-spinal and cortico-
nuclei tracts
• transverse pontine fibres,
• medial longitudinal fasciculus.
Sensory Tracts:
• Spinal tract of CNV
• Lateral, spinal and medial
lemnisci Transverse section through the caudal part of the
pons at the level of the facial colliculus
 Internal structures of the Pons at the level of the
trigeminal nuclei
Nuclei:
• Main sensory and motor nucleus
of trigeminal nerve
• Pontine nuclei
• Trapezoid nuclei
Motor Tracts:
• Cortico-spinal and cortico-nuclei
tracts
• transverse pontine fibres,
• medial longitudinal fasciculus.
Sensory Tracts:
• Lateral, spinal and medial lemnisci Transverse section through the pons at the level of
the trigeminal nuclei
 Blood supply to the Pons
Pontine artery- branches of the
basilar artery
• Contributions can come from
superior cerebellar and anterior
inferior cerebellar artery
Venous drainage – inferior
petrosal sinus and basilar plexus
Clinical correlates
1. Unilateral lesion in the
lower part of pons =
Paralysis of facial nerve on the
side of the lesion
+
paralysis of limbs (hemiplegia)
on the opposite side (cross
hemiplegia or Mullard Gubler
syndrome)
 Midbrain: Gross
• About 0.8 inch (2 cm) in length
• Connects the pons and cerebellum with
fore-brain
• It is traversed by a narrow channel =
cerebral aqueduct of Sylvius
Anterior aspect of Midbrain
• Has a deep depression in the midline =
interpeduncular fossa
• Crus cereberi – lateral boundary of the
interpeduncular fossa (I.F)
• Posterior perforated substance –
perforated floor of I.F, due to small
vessels
• Oculomotor nerve- emerges from a
groove on the medial side of the crus Anterior aspect of the Midbrain
 Mid Brain: Gross cont.
 On the posterior surface:
4 colliculi (corpora quadrigemina)
• Superior colliculus – center for
visual reflexes
• Inferior colliculus – lower auditory
centers
• Trochlear nerves emerges in the
midline below inferior colliculi
On the lateral aspect of midbrain:
Superior and inferior brachium
• Superior brachium: from superior
colliculus → lateral geniculate body
+ optic tract
• Inferior brachium: from inferior
colliculus → medial geniculate body Lateral View of the mid brain
Internal structure of Mid Brain
• The midbrain comprises two lateral
halves, called the cerebral peduncles
• Each Half is divided into an anterior
part- the crus cerebri and a posterior
part, the tegmentum,
• This division is by the substantia
nigra (pigmented band of gray
matter)
• The tectum is the part of the
midbrain posterior to the cerebral
aqueduct.
• consist of the four small surface
swellings-
Transverse section of the midbrain through the inferior colliculi shows
• For description, two levels are studied for the division of the midbrain into the tectum and the cerebral
the internal structure of midbrain- level of peduncles. Note that the cerebral peduncles are subdivided by the
superior and inferior colliculus substantia nigra into the tegmentum and the crus cerebri
 Mid brain at the level of Inferior colliculus
• Nuclei:
• Inferior colliculus, trochlear,
mesencephalic nuclei of CN V and
substantial nigra.
• Motor Tracts
• Cortico-spinal and cortico-nuclei
tracts
• Temporo-pontine and fronto-pontine
tracts
• Medial longitudinal fasciculus
• Sensory tracts
• Lateral, trigeminal, spinal and medial
lemniscus, decussation of superior
cerebellar peduncle
 Mid brain at the level of Superior colliculus
• Nuclei:
• Superior colliculus, oculomotor nu.,
Edinger-Westphal nu., red nu.,
mesencephalic nuclei of CN V and
substantial nigra.
• Motor Tracts
• Cortico-spinal and cortico-nuclei
tracts
• Temporo-pontine and fronto-pontine
tracts
• Medial longitudinal fasciculus
• Decussation of ruburo-spinal tract
• Sensory tracts
• Trigeminal, spinal and medial
lemnisci.
 Blood supply of the Mid Brain
Arteries
• Posterior cerebral arteries
• Superior cerebellar arteries
Venous drainage
• Basal veins
• From the colliculus – great cerebral
veins
Clinical Correlates
1. Lesion in the area of tegmentum may
involve the following
a. 3rd nerve – paralysis of extra ocular muscles
b. Sensory tracts – loss of sensation
c. Substantial Nigra + subthalmic nucleus =
involuntary movements
2. Lesion in the vicinity of cerebral peduncle =
oculomotor paralysis +hemiplegia of the
opposite side
3. Argyll-Robertson pupil – light reflex is loss
but accommodation is intact
a) Results from lesion in the vicinity of pretectal
nucleus
b) Causes = diabetes, tertiary syphilis, encephalitis
The Cranial Nerves and Cranial Nerve Nuclei of the Brain
Stem

• Cranial Nerves III through XII arise from

the Brain Stem:
• Midbrain: CN III- Oculomotor and CNIV-
Trochlear
• Pons: CNV –Trigeminal, CNVI-Abducens
and CNVII- Facial
• Medulla: CNVIII- Vestibulocochlear,
CNIX- Glossopharyngeal, CNX- Vagus and
CNXII -Hypoglossal
• Cranial Nerve XI - Spinal Accessory
Nerve arises from the Spinal Cord
The Cranial Nerves and Cranial Nerve Nuclei of the Brain
Stem
The Cranial Nerves and Cranial Nerve Nuclei of the Brain Stem
• The cranial nerves innervate the head and • Thus seven functionally-distinct
neck columns of cells
• Cranial nerve fibers include the same four • in the brain stem comprise the
“general” functional components as the cranial nerve nuclei:
spinal nerves :
• GSE, GVE, GVA and GSA. • GSE somatic motor
• In addition the head contains: • GVE preganglionic parasympathetic
1. “special” visceral sensory organs for • SVE branchial motor
olfaction and taste, • GVA visceral sensory
2. “special” somatic sensory organs for vision, • SVA olfaction and taste
audition, and balance
3. a “special” group of muscles • GSA somatosensory
embryologically derived from the branchial • SSA audition and vestibular
arches. function
The Cranial Nerves and Cranial Nerve Nuclei of the
Brain Stem
The Cranial Nerves and Cranial Nerve Nuclei of the
Brain Stem
The Cranial Nerves and Cranial Nerve Nuclei of the Brain Stem

Position of some of the cranial nerve nuclei in the brainstem. A: Surface projection on the posterior
aspect of the brainstem. B: Cross sections. The motor nuclei are in red and the sensory nuclei in blue