MEDULLA OBLONGATA

Upper

half- cavity of 4th ventricle

Lower half- central canal of SC
ANTERIOR
AMF-

SURFACE OF MEDULLA:

anterior median fissure of SC

PYRAMIDS-

one ach side of AMF of SC

Swelling
Tapers

inferiorly: bundles of nerve fibers,

corticospinal tracts
DECUSSATION OF PYRAMIDS

 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

SURFACE OF Medulla Oblongata:

Superior half- forms lower part of floor of 4th
ventricle
Inferior half- continuous with SC & possesses
posterior median sulcus
GRACILE TUBERCLE- on each side of posterior
median sulcus
Elongated swelling
Produced by GRACILE NUCLEUS

MEDULLA OBLONGATA
CUNEATE

TUBERCLE- lateral to gracile nucleus

Produced by underlying: 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 )

FASCICULUS GRACILLIS &

CUNEATUS

Continue

to ascend superiorly posterior to central

gray matter
Appears as posterior extensions of central gray
matter
Substantia

gelatinosa in posterior gray column

becomes continuous with inferior end of NUCLEUS
OF SPINAL TRACT OF TRIGEMINAL N.

LEVEL OF DECUSSATION OF
LEMNISCI
Great

sensory decussation
Takes place anterior to central gray matter &
posterior to pyramids
Have

bee formed from: INTERNAL ARCUATE

FIBERS
Which has emerged from the anterior aspect of
the NUCLEUS GRACILIS & NUCLEUS
CUNEATUS

LEVEL OF DECUSSATION OF
LEMNISCI
NUCLEUS

OF SPINAL TRACT OF TRIGEMINAL

N. lies lateral to internal arcuate fibers

SPINAL TRACT OF TRIGEMINAL N. Lies lateral to nucleus
LATERAL & ANTERIOR SPINOTHALAMIC
TRACTS & TECTAL TRACTS
Lateral to decussation of lemnisci
Collectively

known as: SPINAL LEMNISCUS

LEVEL OF DECUSSATION OF
LEMNISCI
SPINOCEREBELLAR,

VESTIBULOSPINAL &
RUBROSPINAL TRACTS Situated anterolateral region of Medulla Oblongata

LEVEL OF OLIVES
Transverse

section passes across inferior part of 4 th

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

OLIVARY NUCLEAR COMPLEX

Smaller

dorsal & medial accessory olivary nuclei

are also present
Send fibers medially across midline to enter
cerebellum
SPINO-OLIVARY TRACTS
Function is associated with voluntary movement

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

CORTICOSPINAL & CORTICONUCLEAR FIBERS

MEDIAL

LEMNISCUS

Flattened tracts on each side of midline posterior to pyramid

Emerge from decussation of lemnisci
Convey sensory information to thalamus

MEDIAL LONGITUDINAL FASCICULUS

Forms small tract of fibers situated on each side of
midline posterior to medial lemniscus & anterior to
hypoglossal nucleus
INFERIOR CEREBELLAR PEDUNCLES

In posterolateral corner on lateral side of 4th ventricle

SPINAL

TRACT OF CN V & ITS NUCLEUS

On antermedial aspect of ICP

ANTERTIOR

Between inferior olivary & nucleusof spinal tract of CN V

RETICULAR

SPINOCEREBELLAR TRACT
FORMATION

Deep posterior to olivary nucleus

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

IX, X & Cranial part of Accessory N.

can be seen running forward & lateral through
reticular formation
HYPOGLOSSAL N.
Run anterior & lateral through reticular
LEVEL
No

JUST INFERIOR TO PONS

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:

Limited laterally by SCP

MEDIAN SULCUS- divides pons symmetrically
MEDIAL EMINENCE-

Bounded by sulcus limitans

Lateral to sulcus
FACIAL COLLICULUS
Slight expansion on inferior end of medial eminence
SUBSTANTIA FERRUGINEA
Bluish gray in superior part of sulcus limitans
AREA VESTIBULI
Lateral to sulcus limitans
Underlying vestibular nuclei

1.Substantia ferruginea
2.Facial colliculus
3.Striae medullares
4.Vestibular area
5.Hypoglossal triangle
6.Vagal triangle
7.Calamus scriptorius

INTERNAL STRUCTURE OF PONS:

Divided

into:

TEGMENTUM- posterior part

BASAL PART- anterior part
TRAPEZOID BODY- divides tegmentum & basal part

TRANSVERSE

PART:

Medial

SECTION THROUGH CAUDAL

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

Fibers derived from cochlear nuclei & nuclei of 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

TRANSVERSE SECTION THROUGH

CRANIAL PART
Motor

nucleus of trigeminal nerve

Principal sensory nucleus of trigeminal nerve
Superior cerebellar peduncle
Anterior cerebellar tract
Trapezoid body

MIDBRAIN
CEREBRAL

AQUEDUCT
Narrow channel traversing midbrain
Filled with CSF
POSTERIOR
COLLICULI

SURFACE OF MIDBRAIN:

( Corpora Quadrigemina )

Rounded

eminences divided into superior &

inferior pairs by a vertical & transverse groove.

SUPERIOR

COLLICULI- centers for visual

reflexes
INFERIOR COLLICULI- lower auditory centers

 TROCHLEAR-

emerges in the midline below

inferior colliculi

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

ANTERIOR ASPECT OF MIDBRAIN:

INTERPENDICULAR

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

INTERNAL STRUCTURE OF MIDBRAIN:

Midbrain

comprises 2 lateral halves:

CEREBRAL PEDUNCLES, each divided into:
CRUS CEREBRI- anterior part &
TEGMENTUM- posterior part by:
SUBSTANTIA NIGRA- pigmented band of gray
matter
CEREBRAL AQUEDUCT- narrow cavity w/c
connects 3rd & 4th ventricle
TECTUM- part of midbrain posterior to cerebral
aqueduct & has 4 swellings:
2 SUPERIOR COLLICULI
2 INFERIOR COLLICULI

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

NUCLEI OF CN V are lateral

to cerebral aqueduct
DECUSSATION OF SUPERIOR CEREBELLAR
PEDUNCLES
Occupies central part of tegmentum anterior to
cerebral aqueduct

 RETICULAR

FORMATION
MEDIAL LEMNISCUS

Ascends posterior to substantia nigra

SPINAL

& TRIGEMINAL LEMNISCI

Situated lateral to medial lemniscus

LATERAL

LEMNISCUS

Posterior to trigeminal lemniscus

SUBSTANTIA NIGRA

Large motor nucleus situated between tegmentum & crus

cerebri
Concerned w/ mm tone, connected to Cerebral cortex, SC,
hypothalamus & basal nuclei

CRUS

CEREBRI

Coticospinal & corticonuclear occupy middle 2/3of crus

Frontopontine fibers on lateral part

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,

SPINAL & TRIGEMINAL LEMNISCI

Form a curved band posterior to substantia nigra but

LATERAL LEMNISCUS does not extend superiorly to this
level

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

Contains identical, important descending tracts:

CORTICOSPINAL,

CORTICONUCLEAR,
CORTICOPONTINE fibers

BRAINSTEM STROKE
SYNDROMES
TWO

GENERAL MANIFESTATIONS
EXPECTED OF A BRAINSTEM STROKE:
1.

Contralateral hemiplegia
2. Ipsilateral Cranial Nerve Palsy
Also

known as ALTERNATING/ CROSSED

HEMIPLEGIA

WEBERS SYNDROME
MEDIAL

BASAL MIDBRAIN
Contralateral Hemiplegia
Ipsilateral CN 3 Palsy
( Ipsilateral Ptosis )

BENEDIKTS SYNDROME
TEGMENTUM

OF MIDBRAIN
CONTRALATERAL:
Pain

& temperature loss

Joint position loss
Ataxia
Chorea
IPSILATERAL:
CN

3 palsy

MILLARD GUBLER SYNDROME

LATERAL

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

of pain & temperature

LEFT VS. RIGHT CVA

LEFT

BRAIN FUNCTIONS

Language/Communications
Higher

skill

logic

RIGHT

BRAIN FUNCTIONS

Perception
Imagination
Memory
The

arts & music

LEFT VS. RIGHT CVA

LEFT

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

Analyze if it belongs to or (L) CVA?

Visuomotor perception & memory intact

Visuomotor or perceptual deficits
Loss of visual memory
Left sided neglect
Impulsive/quick/unorganized/over estimates capabilities &
underestimates their problems
Eliminates the use of words
Poor judgment
Cautious, slow, hesitant, insecure
Distorted body image
Learns from mistakes
Gives feedback
Aphasia
Unable to communicate effectively
Vocabulary & auditory retention span decreased