Brainstem

By Dr Manah Chandra Changmai IMS

Brainstem
Located between the cerebrum and the spinal cord Provides a pathway for tracts running
between higher and lower neural centers.

Consists of the midbrain, pons, and medulla oblongata. Each region is about an inch in length. Microscopically, it consists of deep
gray matter surrounded by white matter fiber tracts.

Midbrain Pons

Medulla obongata

Produce automatic behaviors necessary for survival.

Ventral surface of brain stem

Midbrain

Pons

Medulla oblongata

Ventral Lateral View

Midbrain
Cerebral peduncles

Pons
Basis pontis

Medulla

Vertical Columns of Cranial Nerves

Internal Columns of Nuclei

Subdivisions of Vertical Columns

Motor nuclei Sensory nuclei Somatic motor General sensory closest to midline lateral to branchial motor eyes, tongue Face, sinuses, meninges CN III, IV, VI, XII All modalities Branchial motor CN V mainly Lateral position Also CN VII, IX, X Branchial arches: chewing, Visceral sensory expression, middle ear, pharynx, lateral to visceral motor larynx, sternomastoic, trapezius Taste; cardiorespiratory, GI info CN V, VII, XI N. of the solitary tract (CN VII, N. ambiguus (IX, X) IX, X) Visceral motor Special sensory ventral / ventrolateral furthest lateral Parasympathetic: glands, smooth Balance; hearing muscle, heart, lungs, GI above CN VIII (vestibular) splenic flexure CN VIII (cochlear) Edinger-Westfall (III) Sup. & Inf. salivatory

Midbrain

Midbrain
Connects pons and cerebrum with forebrain Shortest brain stem,not more than 2cm in length,lies in the posterior cranial Fossa. For descriptive purpose,divided into Dorsal tectum and right and left cerebral Peduncles. Each cerebral peduncles divide further into ventral crus cerebri and a dorsal Tegmentum by a pigmented lamina Substantia nigra Crus cerebri

Cerebral peduncles contains: -Descending fibers that go to the cerebellum via the pons -Descending pyramidal tracts Running through the midbrain is the hollow cerebral aqueduct which connects the 3rd and 4th ventricles of the

brain.

Ventral Dorsal Organization

Tectum

Basis

Tegmentum

Patterning of the Midbrain

The roof of the aqueduct ( the tectum) contains the corpora quadrigemina
2 superior colliculi that control reflex movements of the eyes, head and neck in response to visual stimuli 2 inferior colliculi that control reflex movements of the head, neck, and trunk in response to auditory stimuli

Superior colliculi Inferior colliculi

Corpora quadregemina
Superior and inferior colliculi seperated by cruciform sulcus Superior colliculi larger and darker than inferior colliculi,the difference In colour due to superficial neurons in Superior colliculi

Internal Structure of Midbrain

Cross section at two levels
Level of inferior colliculus Level of superior colliculus

Internal structure
Transverse section of midbrain
Common to both at inferior and superior colliculus:

Crus cerebri (or basis pedunculi):

- Consists of fibres descending from cerebral cortex. - Its medial one-sixth is occupied by coticopontine fibres from frontal lobe,lateral one-sixth fibres from temporal,occipital and parietal lobes,the intermediate two third by corticospinal and corticonuclear fibres.

Substantia nigra :
- Present immediately behind and medial to basis pedunculi. - It appears dark as neuron within it contain pigment. ( neuromelanin )

Substantia nigra

Cerebral aqueduct

Substantia nigra

Basis pedunculi

Crus cerebri (cerebral peduncle)

Internal Structure of Midbrain

Cross section at inferior colliculus

Section at the level of inferior colliculus Inferior colliculus - large mass of grey matter lying in the tectum - Forms cell station in auditory pathway. Trochlear nucleus: - Lies in the ventral part of central grey matter Mesencephalic nucleus of trigeminal nerve: - Lies in lateral part of the central grey matter Medial leminiscus: - Fibres of ventral spinothalamic tract Spinal leminiscus: - Fibres of lateral spinothalamic and spinotectal tract. Trigeminal leminiscus

Inferior collicu

Inferior colliculus

Trochlear nerve(N)
Mesencephalic nucleus of V cranial nerve Medial longitudinal fasciculus

Cross section at
Level of superior colliculus

Section at the level of superior colliculus

Two large masses of grey matter seen at this level Superior colliculus in the tectum Receives visual input from retina and frontal and occipital eye fields Receives auditor input from inferior colliculus Mediates audiovisual refflexes Commissure of superior colliculus Connects two superior colliculus Brachium of superior colliculus Pathway for fibres from superior colliculus to Cortex

Section at the level of superior colliculuscontd.

Cerebral aqueduct and periaqueductal gray matter

Red nucleus in the tegmentum - Lies in the anterior part of the tegmentum, dorsomedial to the substantia nigra - It is called because of reddish colour which is due to the presence of iron pigment in its neurons.
Oculomotor nucleus - Related to the ventral part of central grey matter

Medial longitundinal fasciculus Vestibular fibres that coordinate eye movements Interconnects ocular motor CN 3, 4, 6
Central tegmental tract

Section at the level of superior colliculuscontd.

Medial lemniscus Spinal afferent tract Spinal lemniscus Spinal afferent tract Substantia nigra Receives GAGAergic input from caudate putamen Projects dopaminergic fibres to caudate putamen Projects nondopminergic fibres to thalamus Superior colliculus

Crus cerebri

Superior colliculus

Edinger westfal nucleus

Occulomotor nucleus

Red nucleus relay from cortex and cerebellum to spinal cord, inferior olive, reticular formation, cerebellum Controls arm movement

Corticobulbar Fibers
Arise from precentral and postcentral Gyri May synapse directly on motor neurons or indirectly via interneurons (corticoreticular fibers) Innervate sensory relay nuclei Innervate cranial nerve motor nuclei bilaterally, with the exception of upper face division of the facial nucleus Innervates the ipsilateral spinal nucleus of CN 11, which supplies the sternocleidomastoid muscle and the contralateral spinal nucleus of CN 11, which innervates the trapezius muscle

Pons

Pons
The pons shows a convex anterior surface with prominent transversely running fibres. These fibres collect to form bundles,the middle cerebellar peduncles. Trigeminal nerve emerges from the anterior surface,at the junction between pons and middle cerebellar peduncle. The anterior surface of pons is marked in the midline by a shallow groove,the sulcus basilaris which lodges the basilar artery.
s Sulcus basilaris

Pons

Subdivided into ventral and dorsal part Ventral part of the pons contains Pontine nuclei: Recieves corticopontine fibres from frontal, temporal,parietal and occipital lobes of cerebrum The efferent fibres form the transverse fibres of pons. It has been estimated that there are about twenty million neurons in pontine nuclei.Most of them are glutaminergic. Vertically running corticospinal and corticopontine fibres. Transversely running fibres arising in pontine nuclei

Pontine nuclei

Dorsal part of pons

Midpons

The dorsal part of the pons may be regarded as continuation of the part of the medulla behind the pyramids. Superiorly continous with the tegmentum of the midbrain. Occupied predominately by reticular formation Posterior surface help to form floor of fourth ventricle

DORSAL PART

The dorsal part is bounded laterally by inferior cerebellar peduncle in the lower part of the pons and superior cerebellar peduncle in upper part.
Upper pons

Dorsal surface of pons

Six ascending tract

1 Dorsal and ventral cochlear nuclei Receives auditory input from the cochlea through CN 8 2 Trapezoid body Formed by decussating fibres of the ventral cochlear nuclei 3 Superior olivary nucleus Auditory relay nucleus that receives input from the cochlear nuclei and contributes to lateral lemniscus 4 Lateral lemniscus Auditory pathway that conducts most contralateral cochlear input 5 Medial lemniscus Spinal afferent pathway 6 Spinal lemniscus Spinal afferent pathway

4th Ventricle Connection of pons to cerebellum

Restiform body (inf. cerebellar peduncle) Middle cerebellar peduncle

Medial lemniscus Ascending 2nd order sensory neurons Descending upper motor neurons

Section through lower part of the pons

Abducent nucleus of CN 6 Lateral gaze Dorsal and ventral cochlear nuclei of CN8 Medial, lateral and superior vestibular nuclei of CN 8 Receive proprioceptive input from vestibular systems and cerebellum Projects to cerebellum and medial longitudinal fasciculus Spinal trigeminal tract of CN 5 Facial nucleus of CN 7 Gives rise to fibres that innervate the muscles of facial expression Superior olivary nucleus Auditory relay nucleus that receives input from the cochlear nuclei and contributes to lateral lemniscus

Cranial Nerves of Lower Pons

Vestibular Nuclei
Pure sensory lateral location Balance

Cranial Nerves of Lower Pons

At a slightly higher level Abducens N. nucleus Abduction of eye Longest, most vulnerable CN

Facial N. nucleus Muscles of face

Mid Pons
4th Ventricle Middle cerebellar peduncle

Descending fibers

Corticospinal tract,
corticobulbar tract, corticopontine fibers

Mid Pons
Lateral lemniscus Trapezoid body

fibers from dorsal column (position and vibration) Medial leminiscus fibers from dorsal column (position and vibration)

Pontine nuclei

Trapezoid body : transverse fibers in pontine tegmentum

Mid Pons
Motor trigeminal nucleus Medial lemniscus fibers from dorsal column (position and vibration)

Principal trigeminal sensory nucleus

Trigeminal tract pain, temperature, touch from contralateral face

Cranial nerve nuclei and Lemniscal sensory system in tegmentum of the pons

Section through upper part of pons

Superior cerebellar peduncle Principal sensory nucleus of CN 5 Receives discriminative tactile and pressure sensation from face, terminates in thalamus Lateral lemniscus Auditory pathway that conducts most contralateral cochlear input Trapezoid body Formed by decussating fibres of the ventral cochlear nuclei

Upper Pons
Periaqueductal gray matter Superior cerebellar peduncle Transverse pontocerebellar fibers Medial longitudinal fasciculus

decussation

Upper Pons
Locus ceruleus Parabrachial Nucleus Some neurons release acetylcholine Pediculopontine Nucleus

Other neurons release glutamate

They assist in learning and voluntary motor control, e.g. locomotion, saccadic e

MEDULLA OBLONGATA

External structure of medulla

Most inferior region of the brain stem.

Becomes the spinal cord at the level of the foramen magnum.

Medulla is broad above ,joins with pons narrow below, continous with spinal cord Length is about 3cm, width is about 2cm at its upper end Surfaces shows series of fissures Anterior median fissure Spinal cord Posterior median fissure

Medulla oblongata

External surface of medulla

Ventral surface of medulla oblongata contains Pyramid elevation between anterior median and anterolateral sulcus Formed due to decussation of corticospinal fibres.

Olive Oval swelling between anterolateral posterolateral sulcus,half an inch long Produced by large mass of gray matter called inferior olivary nucleus

Olive

Pyramid

Pyramid Olive

Anterolateral fissure Anterior median fissure

Posterior part of medulla oblongata

The posterior part of medulla contains Fasciculus gracilis medially ending in rounded elevation ,called nucleus gracilis Fasciculus cuneatus laterally ending in rounded elevation,called nucleus cuneatus Posterior part of the medulla forms the floor of the fourth ventricle Tuberculum cinereum, longitudinal elevation in the lower part of medulla lateral to fasciculus cuneatus.

DORSAL SURFACE OF MEDULLA OBLONGATA

Floor of fourth ventricle

Gracile tubercle

Obex

Cuneate tubercle

Posterior median sulcus Posterior median fissure

Internal Structure of Medulla

Cross section at three levels

Level of pyramidal decussation

Level of Pyramidal Decussation

Lateral corticospinal tract 75 90% Gracile nucleus

spinal nucleus of V
From pons to C4

Pyramidal tract Anterior corticospinal tract innervate muscles of trunk -- fibers to

Internal Structure of Medulla

Cross section at level of lemniscal decussation

Level of Lemniscal Decussation

Gracile nucleus Cuneate nucleus Medial longitudinal fasciculus

Medial lemniscus Internal arcuate fibers Carries 2nd order sensory neurons to VPL thalamus

Cross section at level of Level of inferior olivary nuclei

Level of Inferior Olives

Hypoglossal nucleus CN XII Vestibular nuclei Medial Inferior

Inferior cerebellar peduncle = Restiform body

Inferior olivary nuclei Relay between cortex, vestibular nuclei, cerebellum, basal ganglia, and dorsal column nuclei

Cranial Nerves of the Medulla

Vestibular nuclei

N. solitarious
Sensory nucleus for

CN VII, IX, X Dorsal motor nucleus of X Posterior 1/3 of the tongue

N. ambiguus Spinal trigeminal tract

CN V, VII, IX, X

Motor nucleus for CN IX,

X & XI
Stylopharyngeus (lifts pharynx)

Sensation behind ear

CN IX: Glossopharyngeal Nerve

Inf. salivatory nucleus Parotid gland, parasympathetic N. solitarious Sensory nucleus for

CN VII, IX, X
Posterior 1/3 of the tongue

N. ambiguus Spinal trigeminal tract

CN V, VII, IX, X
Sensation behind ear

Motor nucleus for CN IX,

X & XI
Stylopharyngeus (lifts pharynx)

CN X: Vagus Nerve
Dorsal motor nucleus of X Parasympathetic, preganglionic N. solitarious Sensory nucleus for

CN VII, IX, X
Taste, epiglottis Cardiorespiratory N. ambiguus

Spinal trigeminal tract

CN V, VII, IX, X
Ear

Motor nucleus for CN

IX, X & XI
Pharynx Larynx

Mnemonic

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