Brainstem

M
P

MO

Asst. Prof.
A. Veli İsmailoğlu
 anterior view
Mesencephalon
(Midbrain)

Pons

Medulla oblangata
(bulbus)

Spinal cord
Posterior view
• Longitudinal parts
– Tectum
– Tegmentum
– Basis
• Only midbrain
consists of all three
longutidinal sections.
• Pons and M.O
formed by basis and
tegmentum.

Transverse section of
the midbrain
 Medulla oblangata
• Pyramis: made by
corticospinal tr. fibers.
• Pyramidal decussation:
is where corticospinal tr
fibers cross the midline.
• Olive: relays to the
cerebellum which
controls fine movements
and the postural balance.
• CN XII emerges medial
side; CN IX,X,XI emerge
lateral side of the olive.
 Posterior view

• Gracile tubercule
• Cuneate tubercule
 Rhomboid fossa
• Made by pons and
M.O.
• is the floor of the
4th ventricule.
 4th ventricule
• connected to the 3rd
ventricule by cerebral
aquaduct
(mesencephalic
aquaduct).

• CSF reaches to the

subarachnoid space and
the central canal
through 4th ventricule.
 Inferior cerebellar peduncle
• connects the M.O
to the cerebellum.
 Area postrema
• Rostral to obex
• On each side of 4th
ventricle
• A slightly rounded
eminence
• Emetic
chemoreceptor
trigger zone
Cranial n. nuclei of the MO
• Nucleus of spinal tract of V
• Nucleus of tractus solitarius (7,9,10)
• Nucleus ambiguus (9,10,11)
• Hypoglossal motor nucleus
• Inferior salivatory nucleus
(parasympathetic nucleus of 9)
• Dorsal vagal nucleus
• Medial and inferior vestibular
nuclei
 Pons
• «Pons»: means «bridge»
• Pyramidal eminence:
• Basillary sulcus: houses
basillar a.
• Transverse pontine fibers made up
the middle cerebellar peduncle
which is located between the pons
and the cerebellum.
Transverse pontine fibers
 Pons
• CN V is emerged at here
• at the intersection with
the M.O,
– CN VI
– CNVII ve intermediate n.
– CN VIII
• Middle
cerebellar
peduncle

Locus coeruleus consist of

noradrenergic neurons.
Related with stress, panic.

Facial colliculus contains

abducens nucleus and facial
nerve fibers.
Cranial nerve nuclei in PONS:
- 5 (trigeminal n.):
-Lower parts of mesencephalic nucleus (upper pons)
-Upper parts of spinal nucleus (lower pons)
-Sensory principle nucleus
- Motor nucleus (upper pons)

-6 (abducens n.):
- Motor nucleus (lower pons)
- 7 (facial n.):
-Superior salivatory nucleus (lower pons)
-Motor nucleus (lower pons)
- Solitary nucleus (lower pons)

-8 (vestibulocochlear n.):
-Sup. and lateral vestibular nuclei (lower pons)
- Ant. and post. cochlear nuclei (lower pons)
There are two main areas in the pons
for control of respiration:

1- The pneumotaxic center - upper

pons
decreases the frequency of breath

2- The apneustic center - lower pons

stimulates and controls the intensity
of breathing

Pons also plays a key role in sleep and dreaming,

particularly in its REM phase where dreaming is most
likely to occur.
 Mesencephalon
(Midbrain)
• Cerebral crus (cerebral
peduncle):
corticospinal tract
fibers pass through
• Interpeduncular fossa
• CN III, CN IV
• Structures in
tectum:
– Superior
colliculus: related
with vision
– Inferior colliculus:
related with
hearing.
• Pineal gland
• Superior cerebellar
peduncle
• CN IV
emerged from the
posterior surface of
the midbrain.
 Superior colliculus
Cerebral
aquaduct
Red
nucleus

Substantia
nigra Ce
re
b ra
l cr
us
 Cranial n. nuclei of the midbrain
• Parasympathetic nucleus of oculomotor
n. (Edinger- Westphal) (GVE)
• Somatic motor neuron groups of
oculomotor n. (GSE)
• Motor nucleus of trochlear n. (GSE)
• Mesencephalic nucleus of trigeminal n.
(GSA)
Tracts in the brainstem:

-Medial lemniscus ( Cont. of fasciculus gracilis and cuneatus)

- Lateral lemniscus (upper pons)
- MLF (medial longitudinal fasciculus)
- Tectospinal and spinotectal tracts
- Anterior and lateral spinothalamic tracts
- Anterior spinocerebellar tract
- Spinoreticular and reticulospinal fibers
- Vestibulospinal tract
- Rubrospinal and rubroreticular tracts
-Descending autonomic pathways
- Central tegmental tract
 Clinical notes
Lateral Medullary Syndrome of Wallenberg

• occurs following to the PICA occlusion

• dysphagia and dysarthria due to paralysis of the
ipsilateral palatal and laryngeal muscles (innervated by
the nucleus ambiguus);
• vertigo, nausea, vomiting, and nystagmus (vestibular
nuclei);
• analgesia and thermoanesthesia on the ipsilateral side
of the face (nucleus and spinal tract of the trigeminal
nerve);
• contralateral loss of sensations of pain and temperature
(spinal lemniscus—spinothalamic tract).
• ipsilateral Horner syndrome (descending sympathetic
fibers);
• ipsilateral cerebellar signs—gait and limb ataxia
(cerebellum or inferior cerebellar peduncle); and
 Medial Medullary Syndrome
• The medial part of the medulla oblongata is
supplied by the vertebral artery. Occlusion of the
vertebral a. produces the following signs and
symptoms:
– contralateral hemiparesis (pyramidal tract),
– contralateral impaired sensations of position
and movement and tactile discrimination
(medial lemniscus), and
– ipsilateral paralysis of tongue muscles with
deviation to the paralyzed side when the
tongue is protruded (hypoglossal nerve).
 Blockage of the Cerebral Aqueduct
• CSF contuniesly produced in lateral
and third ventricules and
• the CSF accumulates in these
ventricules which produces
hydrocephalus.
 Weber Syndrome

• commonly produced by occlusion of a

branch of the posterior cerebral
artery that supplies the midbrain,
• especially the oculomotor nerve and
the crus cerebri are affected.
• There is ipsilateral ophthalmoplegia
(paralysis of the extraocular mm.) and
• contralateral paralysis of the lower
part of the face, the tongue, and the
arm and leg.
• The eyeball is deviated laterally
because of the paralysis of the medial
rectus muscle; there is drooping
(ptosis) of the upper lid, and the pupil
is dilated and fixed to light and
accommodation.
 Benedikt Syndrome

• is 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.