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Upper
SURFACE OF MEDULLA:
PYRAMIDS-
Swelling
Tapers
1. Anterior
median fissure
2. Olive
3. Pyramids
4.Cerebellum
MEDULLA OBLONGATA
OLIVES-
posterolateral to pyramids
Groove between PYRAMIDS & OLIVE:
Rootlets of HYPOGLOSSAL N.
INFERIOR CEREBELLAR PEDUNCLES Posterior to olives
Connects MO-cerebellum
Groove between OLIVES & INFERIOR
CEREBELLAR PEDUNCLES:
Rootlets of GLOSSOPHARYNGEAL, VAGUS &
CRANIAL ROOTS OF ACCESSORY N.
1.Glossopharyngeal
nerve
2.Vagus nerve
3.Hypoglossal nerve
4.Accessory nerve
5.First cervical spinal
nerve
6.Spinal root of accessory
nerve
MEDULLA OBLONGATA
POSTERIOR
MEDULLA OBLONGATA
CUNEATE
Internal
Structure:
Considered at 4 levels:
1. pyramids
2. lemnisci
3. olives
4. just inferior to pons
1.Median sulcus
2.Superior cerebellar
peduncle
3.Dentate nucleus
4.Floor of fourth
ventricle
LEVEL OF DECUSSATION OF
PYRAMIDS
Great
motor decussation
Superior part of MO: corticospinal fibers occupy &
form the pyramid
Inferiorly: about of fibers cross median plane &
continue down the SC in the lateral white column as
LATERAL CORTICOSPINAL TRACT ( crosses
midline )
Continue
LEVEL OF DECUSSATION OF
LEMNISCI
Great
sensory decussation
Takes place anterior to central gray matter &
posterior to pyramids
Have
LEVEL OF DECUSSATION OF
LEMNISCI
NUCLEUS
LEVEL OF DECUSSATION OF
LEMNISCI
SPINOCEREBELLAR,
VESTIBULOSPINAL &
RUBROSPINAL TRACTS Situated anterolateral region of Medulla Oblongata
LEVEL OF OLIVES
Transverse
ventricle
Amount of gray matter has increased at this level
OLIVARY
NUCLEAR COMPLEX:
INFERIOR OLIVARY NUCLEUS
Largest nucleus of this complex
Gray matter shaped-bag, mouth directed medially
Responsible for elevation on surface of medulla called
OLIVES
VESTIBULOCOCHLEAR NUCLEI
VESTIBULAR
COMPLEX:
1. medial vestibular nucleus
2. inferior vestibular nucleus
3. lateral vestibular nucleus
4. superior vestibular nucleus
2
COCHLEAR NUCLEI:
1. anterior cochlear ( anterolat of ICP )
2. posterior cochlear ( post of ICP )
NUCLEUS AMBIGUUS
Large motor neurons
Situated deep w/in reticular formation
Joins CN IX, X, XI ( cranial part ) distributed to
voluntary muscles
CENTRAL
GRAY MATTER
Lies beneath floor of 4th ventricle ( M-L )
1. hypoglossal nucleus
2. dorsal nucleus of vagus
3. nucleus of tractus solitarius
4. medial & inferior vestibular nuclei
ARCUATE NUCLEI
Inferior displaced pontine nuclei
Efferent fibers to cerebellum- EXTERNAL
ARCUATE FIBERS
PYRAMIDS
MEDIAL
LEMNISCUS
SPINAL
ANTERTIOR
RETICULAR
SPINOCEREBELLAR TRACT
FORMATION
1.Nuclei of oculomotor
nerve
2.Trochlear nucleus
3.Pons
4.Fourth ventricle
5.Abducent nucleus
6.Vestibular nucleus
7.Medial longitudinal
fasciculus
1.Inferior cerebellar
peduncle
2.Floor of fourth ventricle
3.Hypoglossal nucleus
4.Medial longitudinal
fasciculus
5.Reticular formation
6.Medial lemniscus
7.Arcuate nuclei
8.Inferior olivary nucleus
9.Pyramids
major changes
Lateral vestibular nucleus has replaced
inferior vestibular nucleus
Cochlear nucleus now are visible on anterior
& posterior surface of ICP
PONS
GROSS
APPEARANCE:
Convex anterior surface
Transverse fibers converge to form MCP
BASILAR GROOVE
lodges basilar artery
On anterolat side: emerges CN V on each side
Motor root: smaller, medial part
Sensory root: larger, lateral part
Groove between PONS & MO ( M-L )
CN VI, VII, VIII
1.Cerebral peduncle
2.Basilar groove
3.Olive
4.Pyramid
5.Trigeminal nerve
6.Abducent nerve
POSTERIOR SURFACE:
1.Substantia ferruginea
2.Facial colliculus
3.Striae medullares
4.Vestibular area
5.Hypoglossal triangle
6.Vagal triangle
7.Calamus scriptorius
into:
TRANSVERSE
PART:
Medial
Lemniscus
Facial Nucleus
Nucleus of abducent nerve
Facial colliculus
Medial longitudinal fasciculus
Medial vestibular nucleus
Posterior & anterior cochlear nuclei
Spinal nucleus of CN V
TRAPEZOID
BODY
BASILAR
PART OF PONS:
Contains small masses of nerve cells: PONTINE
NUCLEI
CORTICOPONTINE FIBERS of crus cerebri
terminate in pontine nuclei
TRANSVERSE FIBERS enter middle cerebellar
peduncle
MIDBRAIN
CEREBRAL
AQUEDUCT
Narrow channel traversing midbrain
Filled with CSF
POSTERIOR
COLLICULI
SURFACE OF MIDBRAIN:
( Corpora Quadrigemina )
Rounded
SUPERIOR
reflexes
INFERIOR COLLICULI- lower auditory centers
TROCHLEAR-
LATERAL ASPECT
SUPERIOR
OF MIDBRAIN:
BRACHIUM
Passes from superior colliculus to lateral
geniculate body & optic tract
INFERIOR BRACHIUM
Connects inferior colliculus to:
MEDIAL GENICULATE BODY
FOSSA
Deep depression in the midline, bound on each
side by:
CRUS CEREBRI
POSTERIOR PERFORATED SUBSTANCE
Many small blood vessels that perforate the floor
of the interpendicular fossa
OCCULOMOTOR NERVE emerges from a
groove on medial side of crus cerebri & passes
forward in lateral wall of cavernous sinus
TRANSVERSE SECTION OF MB AT
LEVEL OF INFERIOR COLLICULI
INFERIOR
COLLICULUS
TROCHLEAR NUCLEUS
Situated in gray matter close to median plane just
posterior to the: MEDIAL LONGITUDINAL
FASCICULUS
MESENCEPHALIC
to cerebral aqueduct
DECUSSATION OF SUPERIOR CEREBELLAR
PEDUNCLES
Occupies central part of tegmentum anterior to
cerebral aqueduct
RETICULAR
FORMATION
MEDIAL LEMNISCUS
SPINAL
LATERAL
LEMNISCUS
SUBSTANTIA NIGRA
CRUS
CEREBRI
TRANSVERSE SECTION OF MB AT
LEVEL OF SUPERIOR COLLICULI
SUPERIOR
COLLICULUS
LIGHT REFLEX- PRETECTAL NUCLEUS
OCCULOMOTOR NUCLEUS situated in central
gray matter close to median plane, just posterior to
MEDIAL LONGITUDINAL FASCICULUS
MEDIAL,
1.Pineal gland
2.superior colliculus
3.Inferior colliculus
4.Trochlear nerve
5.Fourth ventricle
6.Pulvinar of thalamus
7.Superior cerebellar
peduncle
RED
NUCLEUS
Rounded mass of gray matter situated between
cerebral aqueduct & substantia nigra
Redish hue is due to its vascularity & presence
of iron containing pigment in cytoplasm ot its
neurons.
RETICULAR FORMATION
Situated in tegmentum lateral & posterior to red
nucleus
CRUS CEREBRI
CORTICOSPINAL,
CORTICONUCLEAR,
CORTICOPONTINE fibers
BRAINSTEM STROKE
SYNDROMES
TWO
GENERAL MANIFESTATIONS
EXPECTED OF A BRAINSTEM STROKE:
1.
Contralateral hemiplegia
2. Ipsilateral Cranial Nerve Palsy
Also
WEBERS SYNDROME
MEDIAL
BASAL MIDBRAIN
Contralateral Hemiplegia
Ipsilateral CN 3 Palsy
( Ipsilateral Ptosis )
BENEDIKTS SYNDROME
TEGMENTUM
OF MIDBRAIN
CONTRALATERAL:
Pain
3 palsy
PONS
Contralateral Hemiplegia
Ipsilateral 6th & 7th nerve palsy
LOCKED IN SYNDROME
BILATERAL
PONS
Bilateral Hemiplegia
Bilateral CN Palsy
WALLENBERGS or LATERAL
MEDULLARY SYNDROME
LATERAL
MEDULLA
IPSILATERAL:
Loss
of FACIAL SENSATION
Hemiataxia
Horners syndrome
Nystagmus
dysphagia
CONTRALATERAL
Loss
BRAIN FUNCTIONS
Language/Communications
Higher
skill
logic
RIGHT
BRAIN FUNCTIONS
Perception
Imagination
Memory
The
CVA a.k.a :
Left
hemispheric lesion
Dominant hemispheric lesion or CVA
Right hemiplegic
RIGHT
Right
CVA a.k.a :
hemispheric lesion
Non-dominant Hemispheric lesion or CVA
Left hemiplegic