SUBJECT: NEUROANATOMY

TOPIC: TOPIC SUMMARY AND CLINICAL

CORRELATIONS

DATE: FEBRUARY, 2011

NEUROANATOMY: TOPIC SUMMARY AND CLINICAL CORRELATIONS Page 1

TOPIC SUMMARY

A. BRAINSTEM
I. MEDULLA OBLONGATA

LEVEL LOCATION FIBERS CAVITY NUCLEI HIGHLIGHT OF LEVEL

Level of Most inferior level of the Motor Fiber: Central Canal -Nucleus Gracilis Decussation of pyramids
decussation of the brainstem
Corticospinal Tract -Nucleus Cuneatus
pyramids
Sensory Fibers: -Trigeminal Nerve
-Posterior Spinocerebellar nucleus
tract
-Accessory Nerve
-Lateral Spinothalamic tract nucleus
-Anterior Spinocerebellar tract
-Trigeminal nerve tract
Level of Above the level of the Motor Tract: Central Canal -Nucleus gracilis Decussation of lemnisci
decussation of decussation of the
-Corticospinal tract -Nucleus cuneatus
Lemnisci pyramids
-Trigeminal nerve nuclei
Sensory Tracts: -Accessory nerve nuclei
-Fasciculus Gracilis -Hypoglossal nerve
nuclei
-Fasciculus Cuneatus
-Lateral Spinothalamic tract
-Anterior Spinocerebellar tract
-Posterior Spinocerebellar
tract
Level of Above the level of Motor Tracts: Fourth Ventricle -Olivary nucleus Inferior olivary nucleus,
decussation of decussation of lemnisci nucleusambiguus.
-Corticospinal tract -Nucleus Ambiguus
olives Nucleus tractus solitarius
-Nucleus Tractus
Solitarius
Sensory Tracts:
-Medial Longitudinal tract
-Tectospinal tract
Medial Lemniscus
Level just above Inferior to the pons Fourth ventricle -Vestibular nuclei Appearance of vestibular
inferior pons and cochlear nuclei
-Cochlear nuclei

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 II. PONS
LEVEL FIBERS
Level of the facial colliculus Motor Tracts:
-Corticospinal tract
-Transverse pontine fibers
-Medial Longitudinal fasciculus
Sensory Tracts:
-Trigeminal nerve tract
-Medial lemniscus
-Lateral lemniscus
-Spinal tract
Level of the Trigeminal Nerve
NEUROANATOMY: TOPIC SUMMARY AND CLINICAL CORRELATIONS
CAVITY NUCLEI HIGHLIGHT OF LEVEL
Fourth ventricle -Facial nerve nuclei Presence of the facial colliculus
-Abducent nerve nuclei
-Vestibular nerve nuclei
-Trigeminal nerve nuclei
-Pontine nuclei
Fourth ventricle -Main motor nuclei of trigeminal Main sensory and main motor
nerve nuclei of trigeminal nerve can
be appreciated
-Main sensory nuclei of
trigeminal nerve
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 III. MIDBRAIN
LEVEL
Level of Superior
colliculus
Level of Inferior colliculus
TRACTS
Medial Longitudinal Fasciculus
Medial Lemniscus
Lateral Lemniscus
Corticospinal tract
Spinothalamic tract
NEUROANATOMY: TOPIC SUMMARY AND CLINICAL CORRELATIONS
FUNCTION FIBERS
OCULAR REFLEXES Motor Tracts:
such as:
-Corticospinal tract
-reflex center for
eyeball
-head movement in Sensory Tracts:
response to visual
stimuli -Trigeminal nerve tract
-Medial lemniscus
AUDITORY REFLEXES Sensory Tracts:
such as:
-Trigeminal nerve tract
-movement of head
and trunk in response -Medial lemniscus
to auditory stimuli
-Decussation of superior
cerebellar peduncle
FUNCTION
Eye movements; balance
Proprioception; light touch
Auditory
Motor
Pain and temperature
CAVITY NUCLEI
Cerebral Aqueduct of -Edinger Westphal nuclei
Sylvius
-Red nucleus
Cerebral Aqueduct of -Trochlear nucleus
Sylvius
Tectospinal tract
Corticobulbar tract
Lateral Spinothalamic tract
Anterior and Posterior Spinocerebellar Tract
Trigeminal Nerve tract
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HIGHLIGHT OF LEVEL
Presence of superior
colliculus nuclei at area of
tectum, oculomotor nerve
exiting the cerebral
peduncle
Presence of inferior
colliculus at the area of
tectum and the presence
of trochlear nucleus
Movement of head and eyes following image
Connects with the different cranial nuclei, motor
Somatosensory of neck down
Unconscious proprioception
Somatosensory of head and neck
 CRRANIAL NERVE NATURE NUCLEUS NERVE

I-Olfactory Pure sensory Olfactory receptor Location: upper part of nasal cavity Pass through the openings of the cribriform plate of ethmoid bone
nuerons above superior concha
Will synapse with olfactory bulb

II-Optic Pure sensory Part of the visual pathway

Oculomotor Nucleus Location: superior colliculus

-fibers will cross the red Function: supplies all extrinsic

nucleus muscles of the eye except superior
oblique and left rectus Arises at the anterior midbrain in between the cerebral peduncles
(INTERPEDUNCULAR FOSSA)
III-Oculomotor Pure Motor Edinger Westphal Function: Parasympathetic function
Nucleus for PUPILLARY LIGHT REFLEX -enters the orbit through the SUPERIOR ORBITAL FISSURE

IV- Trochlear Pure Motor Main motor nucleus of Location: inferior colliculus Only nerve that will:
trochlear nerve nuclei
Function: innervates superior oblique - Cross the midline
muscle - Exit the posterior surface
**longest cranial nerve INTRACRANIALLY

Exits along the inferior surface of the inferior colliculus (posterior)

Main motor nucleus of Location: midpons (above facial Sensory nerve

CN V colliculus)
With 3 divisions:
Function: supplies muscles of
mastication, Anterior belly of OPHTHALMIC
digastrics and tensor tympani
- Pure sensory
Main sensory nucleus of Function: Discriminate touch MAXILlARY
CN V
- Pure sensory
MANDIBULAR
Mesencephalic nucleus Location: above the main sensory
nucleus
V-Trigeminal Motor and - Mixed nerve (sensation and innervating muscles of
Sensory mastication)
Function: proprioception - Only division that carries motor fibers

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 Spinal nucleus Location: below the main sensory **sensory nerves carry sensory impulses of head and neck
nucleus
(nucleus shared by CN **sensation of tongue (pain stimulus)  carried by CN V
VII, IX, X) Function: pain and temperature
** all divisions will form the TRIGEMINAL GANGLION for pain,
temperature, light touch, etc.

TRIGEMINAL GANGLION  similar with the dorsal root ganglion that

contains a series of 1st order neurons

TRIGEMINOTHALAMIC TRACT

- Similar with spinothalamic tract

- Will blend with the medial lemniscus and synapse with the VPM
of thalamus

VI-Abducent Pure Motor Motor nucleus of CN VI Location: in the caudal portion of the Will exit the brainstem at the pontomedullary junction
pons (level of the facial colliculus)
Will also enter the superior orbital fissure
Function: innervates lateral rectus
muscle

Main motor nucleus of Location: at the level of the facial

CN VII colliculus

-Dorsal motor nucleus Function: innervates muscles for

supplies upper face ; expression
bilateral innervations

-Ventral motor nucleus

 supplies lower face;
unilateral input from the
CONTRALATERAL
corticobulbar tract

Superior Salivatory Location: upper portion of nucleus NERVOUS INTERMEDIUS

nucleus tractus solitarius
Motor - Carries nerves of superior salivatory nucleus and nucleus
Function: parasympathetic function tractus solitaries
VII-Facial Sensory - Serves as sensory nucleus of facial nerve
CHORDA TYMPANI: submandibular - Carries parasympathetic and sensory component
and submlingual glands

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 Parasympathetic VIDIAN NERVE: lacrimal gland

Nucleus Tractus Fuction: taste sensation of anterior

Solitarius 2/3 of tongue

(rostral)

VIII-Auditory Pure sensory - Lateral, medial, superior and inferior vestibular nuclei Vestibular nerve  for conduction of signals that provide information
- Cochlear nuclei regarding the position and information regarding the movements of the
head for balance

Cochlear nerve  for impulses concerned with sound from organ of Corti
in the cochlea

IX-Glossopharyngeal Motor Nucleus Ambiguus Innervates stylopharyngeus muscle Exit the brainstem BESIDE the upper medulla

Sensory (shared by CN IX, X, XI)

Parasympathetic Inferior Salivatory Innervates the parotid gland

Nucleus

Nucleus Tractus Taste of posterior 2/3 of tongue

Solitarius

Spinal nucleus of Tympanic membrane (Jacobson nerve)

Trigeminal nerve

Nucleus Ambiguus Main motor Arises at the sides of the upper medulla

-innervates larynx and pharynx With branches:

Nucleus Tractus Main sensory - Auricular

Solitarius - Pharyngeal
Motor - Superior Larygneal
- Recurrent laryngeal
X-Vagus Sensory Dorsal motornucleus Main parasympathetic - Cardiac branch
- Pulmonary plexus
Parasympathetic -supplies the viscera - Esophageal plexus

Nucleus ambiguous -cranial part

-blends with fibers of CN X to supply

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 pharynx

Spinal accessory -spinal part Arises at medulla

nucleus
XI-Spinal Accessory Pure Motor -supplies the SCM and trapezius

-bilaterally supplied by corticobulbar

tract

Hypoglossal nucleus -unilateral from CONTRALATERAL

corticobulbar tract

-innervates tongue except

XII-Hypoglossal Pure Motor palatoglossus and posterior belly of
digastrics muscle

CRRANIAL NERVE INNERVATION CLINICAL CORRELATIONS LESIONS

OLFACTORY NERVE INJURY: strong force received by the

brain can cause the brain to be displaced posteriorly,
pulling the olfactory bulb away from the nerves cutting
the connection
I-Olfactory Sense of smell

II-Optic Transmits visual

information from the
retina to the brain

Supplies all extrinsic SACCADE –rapid eye scanning -Lesion on one side of the cortex  no paralysis because there is dual
muscles of the eye innervations of the CORTICOBULBAR TRACT
except the SUPERIOR SMOOTH PURSUIT –target moves and image is kept in
OBLIQUE and LEFT sharp focus -Lesion of the nerve BEFORE entering the superior orbital fissure 
RECTUS paralysis will occur because oculomotor nerve is damaged
CONJUGATE GAZE –both eyes move in the same direction
III-Oculomotor -Lesion in the red nucleus  affects the motor component of the CN III
VERGENCE –fixating on a single point because it lies near the oculomotor nucleus (main motor nucleus)

OPHTHALMOPIEGIA -Lesion AFTER the nucleus  paralysis

- Strabismus (squint) -Lesion of the nucleus itself  paralysis

- Diplopia (double vision)
- Ptosis (lid drop)

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 IV- Trochlea Innervates the superior TROCHLEAR NERVE LESION –double vision -Lesion at the RIGHT CN IV  paralysis of the LEFT superior oblique
oblique muscle of eyeball muscle.
which assists in the TROCHLEAR NUCLEUS LESION –contralateral paralysis of
downward and lateral superior oblique muscle -Lesion on one side of the cortex  no paralysis because there is dual
movement of eyes innervations of the corticobulbar tract

V-Trigeminal -Sensation to the face TRIGEMINAL NEUROLGIA –stab-like pain felt on the skin Lesions that will result in paralysis:
areas innervated by the mandibular branch
-Motor to muscles of - Lesion in Area 3,1,2
mastication, anterior WALLENBERG’S SYNDROME –crossed lesion - Lesion along the trigeminothalamic tract
belly of digastrics and Lesion in Area 4  no paralysis because motor component has dual
tensor tympani innervations by corticobulbar tract

VI-Abducent Innervates the Lateral -Lesion of CN VI BEFORE the pontomedullary junction  no paralysis
Rectus muscle because there is dual innervations by corticobulbar tract

-Lesion of CN VI AFTER pontomedullary junction  paralysis since nerve is

affected

-Hemisection of midbrain  no paralysis

-Cut whole brainstem  bilateral lesion of abducent nerve

VII-Facial -Motor to muscles of Bell’s Palsy  injury to facial nerve or nucleus; causes -Lesion of LEFT CEREBRAL HEMISPHERE  lower half of the face is
expression IPSILATERAL facial muscle paralysis if one sided affected

-Taste of anterior 2/3 of Crocodile tears syndrome  improper communication -Lesion AFTER the motor nucleus half of the face is affected
tongue between the superior salivatory nucleus and nerve
innervating lacrimal gland
-glandular substance
production

VIII-Auditory -Transmission of sound

-balance

IX-Glossopharyngeal Fuction: taste sensation

of anterior 2/3 of tongue

Innervates
stylopharyngeus muscle

I-nnervates the parotid

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 gland

-Taste of posterior 2/3 of

tongue

X-Vagus -innervates the muscles

of the larynx and pharynx

-innervates the viscera

XI-Spinal Accessory Innervates

sternocleidomastoid and
trapezius muscle

XII-Hypoglossal innervates tongue except

palatoglossus and
posterior belly of
digastrics muscle

LESIONS:

**SUPRATENTORIAL LESIONS  always on the contralateral side

- Lesions from the cerebral cortex, thalamus, basal nuclei, midbrain, pons, upper medulla  always contralateral

- For CRANIAL NERVE lesions above the tentorium cerebella, just be aware of 2 cranial nerves  HYPOGLOSSAL and FACIAL NERVE (ventral nuclei) since these two are supplied ONLY by the CONTRALATERAL
corticobulbar tracrt so definitely you’ll have a lesion on the contralateral side of the face.

- Example: Lesion at the level of the LEFT Cerebral cortex

o Upper Limb = weakness on R o Facial deviation = L lower quadrant (because muscles on the left side of the face are
stronger than those on the left so it will deviate to the left)
o Lower Limb = weakness on R
o Tongue devation = deviate to the R (same reason)
o Pain sensation = loss of sensation on R
 Tongue will always deviate/ point AWAY from the lesion
o Proprioception = lost on R
 Eye gaze will always point TOWARDS the lesion
o Ligh touch = lost on R

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**INFRATENTORIAL LESION  body lesions will be on the CONTRALATERAL SIDE while facial lesions will be on the IPSILATERAL SIDE

**HEMISECTION OF THE SPINAL CORD  CST and DC affected in IPSILATERAL SIDE while STT will be on the CONTRALATERAL SIDE

SUPRATENTORIAL INFRATENTORIAL

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