Anatomy Of Brain Stem

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•Relevant weekly objectives
•Describe the anatomical organisation of the brainstem, with particular reference to the brainstem
reticular formation.
• 
•Lecture Objectives
•By the end of the session the student will be able to:
 Describe the external features of the brainstem.
 Describe the brainstem organization at different levels (ascending and descending tracts and
nuclei).
 Describe major nuclei forming the brainstem reticular formation.
 Describe the blood supply of the brainstem.
 iven a major clinical presentation of a brainstem lesion, identify the anatomical structures involved.
• 

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 Brain Stem
o Site: It lies on the basilar part
of occipital bone (Clivus).
o Parts: From above
downwards:
o Mid brain, Pons & Medulla
Oblongata
o Connections with
cerebellum:
o Each part of brain stem is
connected to cerebellum by
cerebellar peduncles (superior,
middle & inferior)
respectively.
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 Sagittal Section Of Brain

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 Functions Of Brain Stem
1-Pathway of tracts between
cerebral cortex & spinal cord.
2-Site of origin of nuclei of
cranial nerves (from 3rd to
12th).
3-Site of emergence of cranial
nerves (from 3rd to 12th).
4-Contains groups of nuclei &
related fibers known as
reticular formation responsible
for: control of level of
consciousness, perception of
pain, regulation of
cardiovascular & respiratory
systems.
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 Medulla oblongata (bulbus, myelencephalon)
• Superiorly it continues with pons, separated
from it anteriorly by transverse groove (exit
for 6th, 7th and 8th cranial nerves) and
Posteriorly by stria medullaries in the floor of
4th ventricle.
• Inferiorly: it continues with spinal cord.
• Size: 3 cm longitudinally. 2 cm transversally
• 2 Parts:
• Lower, closed part: contain central canal
• Upper, open part: related posteriorly to 4th
ventricle
• Functions:
• Relay station of motor tracts
• Contains respiratory, CVS & GIT centers
• Controls reflex activities such as Coughing,
gagging,
13/10/1444swallowing and vomiting
Anatomy of brain stem Dr Mostafa Kandil 7
 Anterior Aspect Of Medulla
• Anterior median fissure:
• Continuation of anterior median fissure
of spinal cord, its lower part is masked
by decussation of pyramidal tract.
• Pyramid:
• An elevation, lies on either side of
anterior median fissure produced by
corticospinal tract.
• Antero-lateral fissure: gives 12th
cranial N
• Olive:
• An elevation produced by inferior
olivary nucleus (important in control of
involuntary movement, extrapyramidal
system).
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• Nerves emerging from
Medulla (4 nerves):
1. Hypoglossal (12th): from
sulcus between pyramid &
olive
2. Glossopharyngeal (9th),
3. Vagus (10th)
4. Cranial part of accessory
(11th): from sulcus
dorsolateral to olive (from
above downwards)

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 Medulla – Dorsal surface
The features differ in the caudal part (closed
medulla) and the cranial part (open
medulla)
1-CLOSED MEDULLA
Cavity: central canal.
Composed of:
• Dorsal median sulcus: divides the closed
medulla into 2 halves.
• Fasciculus gracilis & tubercle : on either
side of dorsal median sulcus for tract and
its nucleus.
• Fasciculus cuneatus & tubercle : on either
side of fasciculus gracilis.
• Inferior cerebellar peduncle: band of fibers
connecting
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medulla with cerebellum
Anatomy of brain stem Dr Mostafa Kandil 10
o Cavity: lower ½ of floor of Open Medulla
4th ventricle
o On either side, an inverted
V-shaped sulcus divides the
area into 3 parts (from
medial to lateral):
o Hypoglossal triangle:
overlies hypoglossal
nucleus.
o Vagal triangle: overlies
dorsal vagal nucleus.
o Vestibular area: overlies
vestibular nuclei.
o This part separated from
upper part for pons by
medullary
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stria Anatomy of brain stem Dr Mostafa Kandil 11
 Internal structures of medulla
The main nuclei of the medulla
oblongata:
1. Gracile nucleus: proprioceptive
and fine touch from the lower 1/2 of
the body.
2. Cuneate nucleus: proprioceptive
and fine touch from the upper 1/2 of
the body.
3. Spinal nucleus of trigeminal
nerve: pain and temperature
sensations from the face and scalp
via the trigeminal nerve.
4. Inferior salivary nucleus:
parasympathetic function via the
glossopharyngeal
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5. Inferior olivary nucleus:
extrapyramidal function.
6. Solitary nucleus: taste
sensations via the facial,
glossopharyngeal and vagus
nerves.
7. Nucleus ambiguous: motor
function of the glosso-
pharyngeal, vagus and cranial
accessory nerves.
8. Dorsal nucleus of vagus
nerve: parasympathetic via the
vagus nerve.
9. Hypoglossal nucleus: motor
function of the tongue via the
hypoglossal nerve.
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• Remember:
• Medulla oblongata gives
attachment or exit to
lower 4 cranial nerves;
9th, 10th, 11th & 12th
nerves

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 PONS
• Shape –"knob-like“
• Size: 2 cm long
• Composition: transverse fibers
superiorly continuous with midbrain
and inferiorly with medulla and
cerebellum dorso-laterally.
• Functions:
1-Relay station from medulla to higher
cortical structures
2-Assists in the control of movements
3-Control of sleep and arousal
4-Contains respiratory center and
Regulates respiration
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 Ventral Surface Of Pons
1-Basilar sulcus: divides the
pons into 2 halves, occupied
by basilar artery.
3-Transverse pontine:
(pontocerebellar) fibers:
originate from pontine nuclei,
cross the midline & pass
through the contralateral
middle cerebellar peduncle to
enter the opposite cerebellar
hemisphere.
3-Middle cerebellar peduncle:
Connect
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Pons with cerebellumAnatomy of brain stem Dr Mostafa Kandil 16
• Nerves emerging from Pons (4
nerves):
• Trigeminal (5th): from the middle of
ventrolateral aspect of pons, as 2
roots: a small medial motor root & a
large lateral sensory root.
• Abducent (6th): from sulcus between
pons & pyramid.
• Facial (7th) & vestibulocochlear
(8th): at cerebellopontine angle
(junction between medulla, pons &
cerebellum).
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 Pons – Dorsal Surface
• It is separated from the medulla
by medullary stria.
• It forms the upper part of floor
of 4th ventricle which shows:
• 1- Median sulcus
• 2- Medial eminence
• 3- Facial colliculus: turn of
facial nerve around Abducent
nucleus.
• 4-Vestibular area: overlies
vestibular nuclei for 8th cranial
nerve.
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 Internal Structures Of Pons
1. Pontine nuclei: they form part of the
cortico-ponto- cerebellar pathway.
2. Transverse fibers: pontocerebellar
fibers.
3. Longitudinal fibers: which include
pyramidal and cortico-pontine fibers.
4. Nuclei of the trigeminal nerve:
a. Motor nucleus.
b. Sensory nuclei.
5. Nucleus of the abducent nerve.
6. Nuclei of the facial nerve:
a. Motor nucleus.
b. Superior salivary nucleus:
parasympathetic function.
7. Nuclei
13/10/1444of the vestibulocochlear nerve.
Anatomy of brain stem Dr Mostafa Kandil 19
8. Lateral lemniscus: for auditory
sensation.
9. Spinal lemniscus: it is a band of
ascending fibers carrying pain,
temperature and crude touch from the
opposite side of the body below the head.
10. Trigeminal lemniscus: it is a band of
ascending fibers carrying pain,
temperature and touch and
proprioception from the opposite side of
the face and scalp.
11. Medial lemniscus: for deep sensation
and fine touch from the opposite side of
the body below the head.

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Nuclei of middle 4 cranial nerves in Pons
1-Trigeminal nuclei:
Motor nuclei (medial in position)
Main sensory nucleus( lateral)
2- Abducent nucleus: in the floor of 4th
ventricle
3- Facial nerve nuclei:
Motor nucleus bellow trigeminal
Superior salivary nucleus: parasympathetic
4- Vestibulocochlear nerve:
Vestibular nuclei: superior, medial &lateral
nuclei
Cochlear nuclei: dorsal & ventral nuclei
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 .Length:1.5 cm long
Extension: from the pons to the
Mid brain
.diencephalon
It connects the pons and cerebellum with
.the cerebrum
Its cavity: is narrow lumen called cerebral
aqueduct (Equaduct of sylvius) filled with
.CSF
:Anterior surface
1) Cerebral peduncle (crus cerebri) two
nervous cord one on each side of the
midline.
2) Inter-peduncular fossa: between the 2
peduncles
3) The oculomotor nerve: emerges from
the medial aspect of the crus.
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 The interpeduncular fossa:
 Site:  at the base of the brain
 Boundaries:
 Anteriorly: by optic chiasma,
 Posteriorly: by the antero-superior
surface of the pons
 Antero-laterally: by optic tracts
 Postero-laterally: by cerebral
peduncles.
 Contents:
  Posterior perforated substance, 
 Mammillary bodies, 
Tuber Cinereum, Infundibulum,
and Pituitary gland.
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 Dorsal Aspect Of Midbrain = Tectum
o Marked by 4 elevations:
o Two superior colliculi: connect with
lateral genculate body by superior
brachium, concerned with visual
reflexes.
o Two inferior colliculi: connect with
medial genculate body by inferior
brachium forming part of auditory
pathway.
o Nerve emerging from dorsal
Midbrain (one):
o Trochlear (4th): just caudal to inferior
colliculus (The only cranial nerve
emerging from dorsal surface of brain
stem).
o Superior cerebellar peduncle :
connecting
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midbrain with cerebellum
Anatomy of brain stem Dr Mostafa Kandil 24
 Internal Features Of Midbrain
Cerebral peduncle (Ventral part ) 3 parts -
A- Crus cerebri : contain fronto-pontin
fibers, corticospinal& corticobulbar fibers
B- Substantia nigra (extrapyramidal motor
nuclei)
C- Tegmentum: contain tracts & nuclei as:
Cranial nerve nuclei:
o Occlumotor nuclei (3rd): at the level of
superior colliculus
o Trochlear nuclei (4th): at the level of
inferior colliculus
o Mesenchephalic nuclus of trigeminal
nerve (5th)
o Red nucleus
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 Hypoglossal
Palsy

Lower Motor
Neuron
Syndrome Deviation of Tongue to affected side
Atrophy of Tongue Muscles

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 Facial Palsy
(Bell’s Palsy)

Lower Motor
Neuron
Syndrome
Triple W Sign - Wrinkle, Wink, Whistle

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 Facial Palsy (Bell’s Palsy)

Right facial paralysis

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 Central Type
Facial Palsy

Upper Motor
Neuron
Syndrome
facial motor nucleus neurons
supplying forehead muscle

Bilateral Corticobulbar Tract

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 Abducens
Palsy

Lower Motor
Neuron
Syndrome Lateral Gaze Paralysis

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 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

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 Weber Syndrome
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

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