The Midbrain and connections

Kiryowa Haruna Muhmood

 Objectives
• To outline the functions of the midbrain
• To describe the embryological development of
the midbrain.
• To describe the external and internal structure
of the midbrain
• To describe the connections of the midbrain
• To outline the blood supply of the midbrain
• To describe the disorders of the midbrain
Interpeduncular fossa
 Definition of the midbrain
• The brainstem is made up of the medulla
oblongata, the pons, and the midbrain and
occupies the posterior cranial fossa of the
skull. It is stalklike in shape and connects the
narrow spinal cord with the expanded
forebrain .
The brainstem has three broad functions: (1)
it serves as a conduit for the ascending tracts
and descending tracts connecting the spinal
cord to the different parts of the higher
centers in the forebrain; (2) it contains
important reflex centers associated with the
control of respiration and CVS and with the
control of consciousness; and (3) it contains
the important nuclei of cranial nerves III
through XII.
 Embryology
• CNS appears as a slipper shaped plate of
ectoderm in the 3rd week →neural plate ,in
the mid dorsal region infront of the primitive
node
• Lateral edges elevate to form neural folds.
• Folds eventually meet in midline and fuse to
form neural tube
• Fusion starts in cervical region and proceeds in
cranial and caudal directions.
 Embryology cont
• Once fusion is completed, the open ends of
the neurotube form the cranial and caudal
neuropores that communicate with amniotic
cavity overlying the neural plate
• Closure of the cranial pore occurs at the 18-20
somite stage(25th day)
• Closure of the caudal pore occurs 2 days later
 Embryology cont,
• The cephalic end of the neural tube shows 3
dilatations -primary brain vesicles:
1. Prosencephalon (forebrain)
2. Mesencephalon (midbrain)
3. Rhombencephalon (hindbrain)
Neuroepithelium, mantle and marginal
layers
• Following closure of neural tube, the cells lining the
neural tube are known as neuroepithelium
• These cells give rise to another type of cells called
neuroblasts characterized by a large round nucleus,
deeply staining nucleoli and scanty cytoplasm
• These form a layer around the neuroepithelium called
the mantle layer that eventually forms the gray mater
of the brain and spinal cord.
• The outermost layer containing nerve fibers emerging
from neuroblasts form marginal layer. Following
myelination of these nerve fibers, it becomes white
mater of brain and spinal cord.
 Basal, Alar, Roof and Floor plates
• Following addition of more neuroblasts to the mantal layer,
each side of the neurotube shows a ventral and dorsal
thickening.
• The ventral thickening, also called the basal plates contains
ventral motor horn cells(anterior gray horns)
• The dorsal thickening also called the alar plates forms the
posterior gray horns and contain sensory areas
• The dorsal and ventral midline areas form the roof and
floor plates respectively and lack neuroblasts (serve as
pathways for fibers running from one side to another)
• An intermedite horn(sympathetic portion of spinal cord) is
found in the thoracic and lumbar portions of the spinal cord
 Mesencephalon
• Unlike in rhomboncephalon and myencephalon,
basal plates contain only two types of nuclei:
medial efferent gp and a small general visceral
efferent
• Medial somatic efferent gp; motor nuclei of
oculomotor and trochlear nerves
• General visceral efferent gp: parasympathetic
nucleus of oculomotor nerve(edinger wesphal
nucleus) to sphincter pupillary muscles
• Marginal layer: enlarges to form crus cerebri
• Alar plates: form superior and inferior colliculi.
 External appearance.
• measures about 0.8 inch (2 cm) in length and
connects the pons and cerebellum with the
forebrain.
• Its long axis inclines anteriorly as it ascends
through the opening in the tentorium
cerebelli.
• It is traversed by a narrow channel, the
cerebral aqueduct, which is filled with
cerebrospinal fluid
 Anterior view
• has a deep depression in the midline, the
interpeduncular fossa, which is bounded on
either side by the crus cerebri.
• Many small blood vessels perforate the floor
of the interpeduncular fossa, and this region is
termed the posterior perforated substance
The oculomotor nerve emerges from a groove
on the medial side of the crus cerebri and
passes forward in the lateral wall of the
cavernous sinus.
• The interpeduncular fossa also contains the
mammilary bodies, the circle of willis and the
optic chiasm
Interpeduncular fossa
 Posterior view
• Shows the four colliculi (corpora
quadrigemina). These are rounded eminences
that are divided into superior and inferior
pairs by a vertical and a transverse groove.
• The superior colliculi are centers for visual
reflexes.
• The inferior colliculi are lower auditory
centers. In the midline below the inferior
colliculi, the trochlear nerves emerge.
• These nerves (trochlear) are small-diameter
nerves that wind around the lateral aspect of
the midbrain to enter the lateral wall of the
cavernous sinus.
• They exit the skull through the superior orbital
fissure and end by supplying the superior
oblique muscle
Extraocular muscles
• They are the only cranial nerves that emerge
from the dorsal aspect of the brainstem
• They are also the most slender and the most
commonly injured cranial nerves.
 Lateral view
• On the lateral aspect of the midbrain, the
superior and inferior brachia ascend in an
anterolateral direction.
• The superior brachium passes from the
superior colliculus to the lateral geniculate
body and the optic tract.
• The inferior brachium connects the inferior
colliculus to the medial geniculate body.
 Internal view
• The midbrain comprises two lateral halves,
called the cerebral peduncles; each of these is
divided into an anterior part, the crus cerebri,
and a posterior part, the tegmentum, by a
pigmented band of gray matter, the substantia
nigra.
• The narrow cavity of the midbrain is the
cerebral aqueduct, which connects the third
and fourth ventricles.
• The tectum is the part of the midbrain posterior to
the cerebral aqueduct; it has four small surface
swellings; these are the two superior and two
inferior colliculi.
• The cerebral aqueduct is lined by ependyma and is
surrounded by the central gray matter. On transverse
sections of the midbrain, the interpeduncular fossa
can be seen to separate the crura cerebri, whereas
the tegmentum is continuous across the median
plane
 Section through inferior colliculus
-visible:
Nuclei: Inferior colliculus, Trochler nucleus,
mesencephalic nucleus of CN V, Substancia nigra
Motor Tracts: Corticospinal and corticonuclear tracts,
temporopontine, frontopontine, medial longitudinal
fasciculus
Sensory Tracts: Lateral, trigeminal, spinal, and medial
lemnisci; decussation of superior cerebellar peduncles
 Inferior colliculi
• consists of a large nucleus of gray matter.
• lies beneath the corresponding surface
elevation and forms part of the auditory
pathway .
• It receives many of the terminal fibers of the
lateral lemniscus. The pathway then continues
through the inferior brachium to the medial
geniculate body (thalamus). It ends in the
auditory cortex
 Trochlear nucleus
• Located in the central gray matter close to the
median plane just posterior to the medial
longitudinal fasciculus.
• The emerging fibers of the trochlear nucleus
pass laterally and posteriorly around the
central gray matter and leave the midbrain
just below the inferior colliculi. The fibers of
the trochlear nerve now decussate completely
in the superior medullary velum
 Mesencephalic nucleus of
trigerminal nerve
• The two nuclei are lateral to the cerebral
aqueduct.
• Lies in central grey mater lateral to Aqueduct
thru out whole length of midbrain receives
proprioceptive fibres from muscles supplied
by CN V(mandibular div),muscles of orbit
+face, tongue muscles.
 Superior cerebellar peduncles
• The decussation of the superior cerebellar
peduncles occupies the central part of the
tegmentum anterior to the cerebral aqueduct.
• It contains anterior spinocerebellar tracts and
conveys muscle joint information from muscle
spindles, tenodn organs and joint receptors of
the trunk, upper and lower limbs.
• Also conveys information from skin and
superficial fascia to cerebellum.
• .
• The reticular formation is smaller than that of
the pons and is situated lateral to the
decussation. The term itself derives from the
characteristic appearance of loosely packed
cells of varying sizes and shapes that are
embedded in a dense meshwork of cell
processes, including dendrites and axons.
• It plays a crucial role in maintaining behavioral
arousal and consciousness.
An outline of the human brain stem (black) extending from the caudal end of the medulla to
the dorsal thalami. The principal nuclear derivatives of the brain stem RF are indicated in
approximate outline. Those from the median and paramedian nuclear column are in
magenta; medial column derivatives are purple, lateral column derivatives blue.
 Medial, trigerminal and spinal
lemnisci
• The medial lemniscus ascends posterior to the
substantia nigra; the spinal and trigeminal
lemnisci are situated lateral to the medial
lemniscus. The lateral lemniscus is located
posterior to the trigeminal lemniscus.
 Substantia niagra
• a large motor nucleus situated between the
tegmentum, and the crus cerebri and is found
throughout the midbrain.
• Composed of medium-size multipolar neurons
that possess inclusion granules of melanin
pigment within their cytoplasm(hence dark
appearence).
• concerned with muscle tone and is connected
to the cerebral cortex, spinal cord,
hypothalamus, and basal nuclei
• Main pathways both afferent & efferent are to
corpus striatum(caudate nucleus & putamen)-
nigrostriatal fibres which are dopaminergic.
• Loss of 80% of these leads to Parkinsonism
Crus cerebri
o consists of descending fibres from the cerebral cortex
• Medial 1/6 contains corticopontine fibres from the
frontal lobe
• Lateral 1/6 contains fibres from
temporal,frontal,occipital
• Intermediate 2/3 contains corticospinal &
corticonuclear fibres
• Note: fibres from leg -most lateral & from head most
medial
 Section through midbrain at level
of superior colliculi
Visible
• Superior colliculi
• Motor nuclei
• Lemnsci
• Red nucleus
 Section through Superior colliculus

Recognisable:
Nuclei: occulomotor nucleus, red nucleus,
substancia nigra, Edinger-westphal nucleus,
mesencephalic nucleus of CN V
Motor Tracts: Corticospinal and corticonuclear
tracts, temporopontine, frontopontine, medial
longitudinal fasciculus, decussation of rubrospinal
tract
Sensory Tracts: Trigeminal, spinal, and medial
lemnisci
 Superior colliculus
• a large nucleus of gray matter that lies
beneath the corresponding surface elevation,
forms part of the visual reflexes.
• connected to the lateral geniculate body by
the superior brachium. It receives afferent
fibers from the optic nerve, the visual cortex,
and the spinotectal tract.
•
• After relaying in the pretectal nucleus, the
fibers pass to the parasympathetic nucleus of
the oculomotor nerve (Edinger-Westphal
nucleus). The emerging fibers then pass to the
oculomotor nerve.
 Oculomotor nucleus
• The oculomotor nucleus is situated in the
central gray matter close to the median plane,
just posterior to the medial longitudinal
fasciculus.
• The fibers of the oculomotor nucleus pass
anteriorly through the red nucleus to emerge
on the medial side of the crus cerebri in the
interpeduncular fossa. The nucleus of the
oculomotor nerve is divisible into a number of
cell groups.
• The nerve passes through the lateral wall of
the carvenous sinus, exits the skull through
the superior orbital fissue and ends by
supplying all the extraocular muscles except
superior oblique and lateral rectus
Extraocular muscles
 Lemnisci
• The medial, spinal, and trigeminal lemnisci
form a curved band posterior to the
substantia nigra, but the lateral lemniscus
does not extend superiorly to this level
 Crus cerebri
• The crus cerebri contains the identical
important descending tracts—the
corticospinal, corticonuclear, and
corticopontine fibers—that are present at the
level of the inferior colliculus
 Medial longitudinal fasciculus
• Located in the posterior part of the
tegmentum
• Receives fibres of cranial nerves 4, 6 and 8
connecting them to the oculomotor nucleus.
 Red nucleus
• a rounded mass of gray matter situated
between the cerebral aqueduct and the
substantia nigra. Its reddish hue, seen in fresh
specimens, is due to its vascularity and the
presence of an iron-containing pigment in the
cytoplasm of many of its neurons.
• Afferent fibers reach the red nucleus from (1)
the cerebral cortex through the corticospinal
fibers, (2) the cerebellum through the superior
cerebellar peduncle, and (3) the lentiform
nucleus, subthalamic and hypothalamic
nuclei, substantia nigra, and spinal cord.
• Efferent fibers leave the red nucleus and pass
to (1) the spinal cord through the rubrospinal
tract (as this tract descends, it decussates), (2)
the reticular formation through the
rubroreticular tract, (3) the thalamus, and (4)
the substantia nigra.
 Reticular formation
:
Not anatomically distinct nuclei
 Located in tegmentum of brain stem, consisting
of a diffuse mixture of nerve fibers and small
groups of nerve cells, extends throughout the
length of brainstem (inf olivary nucleus to pons).
• Involved in control of respiration & CVS fxns
(Autonomic), states of consciousness, sleep &
Alertness,fine movt/somatomotor (as part of extra
pyramidal sys) & somatosensory(modifying sensory
input to the thalamus),Circadian rhythm & endocrine
secretion (Hypothalamus)
• Has numerous connections, Directly or indirectly.
Involved pathways are complex both ascending &
descending, crossed & uncrossed ,somatic & visceral
 Tracts in the brain stem
Descending tracts
• Corticonuclear tracts (upper motor neurons
synapse with lower motor neurons in ventral
and intermediate horn of the spinal cord) and
corticospinal. All located in the crus cerebri
• Rubral spinal
 CORTICAL SPINAL TRACT
• 1st order neuron in motor cortex sends axon
through corona radiata, int.capsule.
• Desend thro middle 3/5 of midbrain as basis
pedunculi
• Descend thro pons where they are boken into
many bundles by transverse ponto cerebellar
fibers.
• Grouped together in anterior part of the
medulla as pyramids.
• Majority cross to the opposite side
(decussation of pyramids) and descend as lat.
Corticospinal tract. These descend the entire
length of the spinal cord and terminal in ant
gray columns at all levels( 2nd order neurones)
• The 2nd order neurones then synapse with
motor neurons (3rd order). 3rd order pass
through anterior root of spinal nerve and
supply muscles.
• Remaining do not cross at the decussation but
remain on same side descending as ant.
Cortical spinal tract. They eventually cross
midline
• These terminate in ant gray horns of spinal
segments in cervical and upper thoracic
regions
• These tracts confer speed and agility to
voluntary movements, used to perform rapid
skilled movements
 Rubrospinal Tract
1st order neuron begins in red nucleus situated in mid
brain.
Its axon decussates in midbrain.
Descends through pons and medulla oblongata and
enters lateral column of spinal cord.
Synapses with an internuncial neuron (2nd order) of ant.
Gray horn of spinal cord.
2nd order synapses with 3rd order which innervates
muscles.
 Cont..
 NB: the red nucleus receives neurons from
cerebellum and cortex. Hence these two parts
control mov’t indirectly through red nucleus.
 Function; facilitates the activity of flexor
muscles and inhibits activity of extensor
(antigravity) muscles.
 Descending tracts
Tract Function
Coricospinal tracts Confers speed and agility to voluntary
movements, used to perform rapid skilled
movements
Reticulospinal Provide a pathway by which
hypothalamus can control ANS
Tectospinal Reflex postural movements in response to
visual stimuli
Rubrospinal Facilitates activity of flexors and inhibits
activity of extensors
Vestibulospinal Facilitates activity of extensors and
inhibits flexors
 Ascending tracts
• Spinal lemniscus (ant and lateral
spinothalamic tracts)
• Medial lemniscus (dorsal columns:fasciculus
gracilis and cuneatus.
• Spinoreticular
• Superior cerebellar peduncles: anterior
spinocerebellar
 Ascending tracts
Tract Sensory modality
Lateral spinothalamic Pain and temperature

Posterior spinothalamic Crude touch and pressure

Posterior white columns Vibration, position, two point

discrimination
Anterior and Posterior spinocerebellar Unconscious information from joints, skin
, muscles and subcutaneous tissues
Spinotectal Spinovisual reflexes

Spinoreticular Levels of conciousness

 Pain and temperature
• By lateral spinothalamic tract
• Pain and sensory receptors are free nerve
endings in skin. Pain carried by two types of
neurones, fast conducting delta type A (sharp
pain) and slow conducting delta C(prolonged
burning and arching pain)
• 1st order neuron to post gray horn
• Synapse with 2o neurons in post gray horn
• 2o order neuron axons cross obliquely to
opposite side.
• Ascend at lat. Spino thalamic tract.
• In medulla, its accompanied by ant
spinothalamic tract and spinotectal tract
(spinoleminiscus)
• Ascends to post part of pons, tegmentum of
mid brain
• Most synapse with 3o neuron in ventral
postrolateral nucleus of thalamus. (Here
crude pain and temp. are appreciated).
 Cont..
• 3rd order neuron gives rise to projection fibres
which pass through posterior limb of internal
capsule and corona radiata to sensory cortex
(postcentral gyrus)
• Contralateral half of the body is inverted, with
the head and hands inferiorly, the leg
superiorly, the foot and perineum medially
 Light (Crude) Touch and Pressure
• By anterior spinothalamic tract
• Pathway same as lat. Spino that tract but
ascend in anterolateral white column
• Crude awareness of touch and pressure is
believed to be appreciated at the thalamus.
 Disciminative Touch, Vibratory Sense and
Conscious Muscle (Joint Sensory)
• In posterior white column: through fasciculi
gracilis and cuneatus
• Fasciculus gracilis is present throughout the
whole length of the spinal cord. Receives
fibres from sacral, lumbar and lower 6 thoracic
spinal nerves
• Fasciculus cuneatusis only in upper six and
cervical segments of spinal cord.receives
fibers from spinal nerves in this region.
• Axons of 1o neuron enter spinal cord from
post root ganglion.
• Pass directly to post.white column ipsilaterally
 Cont …
• Terminate with 2o neuron in nucleus gracilis
and nucleus cuneatus of medulla oblongata.
• 2o neuron axons(internal arcuate fibers) cross
median plane decussating with those of the
opposite side.
• Fibres ascend contralaterally as medial
lemniscus (it is medial to spinal lemniscus)
 Anterior Spinocerebellar tract
• Same as for post. Spinocerebellar tract.
• BUT; majority of fibers of 2o neurons cross to
opposite side and ascend as ant.
Spinocerebellar tracts in contralateral white
column.
• Fibers pass through medulla and pons and
enter cerebellum through superior cerebellar
peduncle.
• Those that crossed, cross back.
• Conveys muscle joint information from muscle
spindles, tendon organs and joint receptors of
the trunk, upper and lower limbs.
• Also conveys information from skin and
superficial fascia to cerebellum.
 Spinotectal Tract
• Axons at 1o neuron enter spinal cord from post root
ganglion.
• Synapse with 2 order neuron in gray matter.
• 2o neuron cross to opposite side.
• Ascend as spinotectal tract in anterelateral white
column.
• Pass through medulla oblongata and pons.
• Synapse with neurons of the superior colliculus in
mid brain.
• Pathway provides afferent information for
spinovisual reflex and brings about mov’t of eyes and
head towards the source of stimuli.
 Spinoreticular tract
• Axons enter spinal cord from post root ganglion
• Synapse with 2o neurons in gray matter
• 2o neuron axons ascend as spinoreticular tract
• Majority are uncrossed and terminate as neurons of
reticular formation in medulla , pons and mid brain.
• Provides afferent pathway for reticular formation
which plays an important role in influencing levels of
consciousness.
•Blood supply: Basilar, Posterior cerebral &
superior cerebellar Arteries.

•Venous drainage: Basal vein, great cerebral vein

• .
 Clinicals of midbrain
• possesses two important cranial nerve nuclei
(oculomotor and trochlear), reflex centers
(the colliculi), and the red nucleus and
substantia nigra, which greatly influence
motor function, and the midbrain serves as a
conduit for many important ascending and
descending tracts. As in other parts of the
brainstem, it is a site for tumors, hemorrhage,
or infarcts that will produce a wide variety of
symptoms and signs.
 Clinicals:
Trauma to the Midbrain:
• sudden lateral movement of the head, brain
lobes moves at diff. velocities may result in the
midbrain being bent, stretched, twisted, or
torn.
• Involvement of CN 3 nucleus will produce
ipsilateral paralysis of the levator palpebrae
superioris; the superior, inferior, and medial
rectus muscles; and the inferior oblique
muscle
•
• Malfunction of the parasympathetic nucleus
of the CN 3 nerve produces a dilated pupil
that is insensitive to light and does not
constrict on accommodation
• CN 4 nucleus will produce contralateral
paralysis of the superior oblique muscle of the
eyeball.
• both of these nuclei, or the corticonuclear
fibers that converge on them, will cause
impairment of ocular movements.
Extraocular muscles
 Clinicals:
Blockage of the Cerebral Aqueduct
• the cerebral aqueduct, narrower part of the
ventricular system, its conduit for CSF from 3rd to
4th ventricle
• congenital hydrocephalus, its blocked or replaced
by numerous small tubular passages that are
insufficient for the normal flow of cerebrospinal
fluid.

• .
• tumor of the midbrain or pressure on the
midbrain from a tumor arising outside the
midbrain may compress the aqueduct and
produce hydrocephalus
• accumulating CSF within the 3rd and lateral
ventricles produces lesions in the midbrain
esp of the CN 3 &CN 4 nuclei, together with
the important descending corticospinal and
corticonuclear tracts, will provide symptoms
and signs that are helpful in accurately
localizing a lesion in the brainstem
A: Tumor of the midbrain blocking the cerebral aqueduct.
B: Weber syndrome involving the oculomotor nerve and the crus cerebri following occlusion of the
blood supply to the midbrain.
C: Benedikt syndrome involving the red nucleus and the medial lemniscus following occlusion of the
blood supply to the midbrain.
 Vascular Lesions of the Midbrain
Weber Syndrome:
• occlusion of a branch of the posterior cerebral artery
that supplies the midbrain, necrosis of brain tissue
involving the CN 3 & crus cerebri.
• ipsilateral ophthalmoplegia and contralateral paralysis
of the lower part of the face, the tongue, and the arm
and leg.
• 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
• Benedikt syndrome 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
 MCQs
1. The following statements concern the midbrain:
(a) The oculomotor nucleus is found within it at the level of the inferior colliculus.
(b) The trochlear nerve emerges on the anterior surface of the midbrain and
decussates completely in the superior medullary velum.
(c) The trochlear nucleus is situated in the central gray matter at the level of the
inferior colliculus.
(d) The lemnisci are situated medial to the central gray matter.
(e) The trigeminal lemniscus lies anterior to the medial lemniscus.

2. The following statements concern the internal structures of the midbrain:

(a) The tectum is the part situated posterior to the cerebral aqueduct.
(b) The crus cerebri on each side lies posterior to the substantia nigra.
(c) The tegmentum lies anterior to the substantia nigra.
(d) The central gray matter encircles the red nuclei.
(e) The reticular formation is limited to the lower part of the midbrain
“ A brain finds it difficult
to understand another
brain’’
THE END