Clarifications from last lecture

Parasympathetic
Rest and digest
Sympathetic
Fight or flight
Steven Hawking does have ALS.
He’s had it most of his adult life.
Medulla – Ventral Surface
Anterior median sulcus
Continues from spinal
cord
Pyramids – corticospinal
tract
Pyramidal decussation
Anterior lateral sulcus
Inferior Olive
Medulla – Ventral Surface
Cranial Nerves (9-12)
Glossopharyngeal (IX)
Vagus (X)
Accessory (XI)
Hypoglossal (XII)
Medulla - Dorsal Surface
Posteromedian sulcus
Posterolateral sulcus
Clava
Gracile tract protuberance
Cuneate tubercle
Cuneate tract protuberance
Fourth Ventricle
Contains CSF
Choroid Plexus
Makes CSF
Space between
Medulla/Pons and
Cerebellum/medullary
velums
Velum – “veil”
Thin membrane
Internal Structure
3 levels
Motor (pyramidal) decussation
Sensory (lemniscal) decussation
Inferior olive
Motor Decussation Level
Pyramidal decussation
Corticospinal
Lower extremities
Lateral
Decussate last
Upper extremities
Medial
Decussate first
Corticobulbar
Cortex to cranial nerve
nuclei
Pyramidal Decussation
Bilateral upper
extremity paralysis
Rostral lesion
Hemiplegia cruciata
‘crossed’
Opposite arm/leg
Caudal lesion
Motor Decussation Level
Dorsal column nuclei
Cuneate
C1 to T7
Gracile
Below T7
Spinal trigeminal nucleus
Trigeminal nerve
Pain, temperature, light
touch
Ipsilateral face
Sensory Decussation Level
Medial lemniscus
DC-ML
Kinesthesia
Discriminative touch
Contralateral
Accessory cuneate
nucleus
Not part of DC-ML
Spinocerebellar system
Fibers from above C8
Projects to cerebellum
Hypertension activates
Bradycardyia
Hypotension
Inferior Olive Level
Inferior olivary
nuclear complex
Principal olive
Dorsal accessory
olive
Medial accessory
olive
Inputs to Inferior Olive
‘Relay station’
inputs from
Cortex
Basal ganglia
Spinal cord
Midbrain
Medulla
Cerebellum
Output to cerebellum
Olivocerebellar tract
Inferior Olive Level
Restiform body
Inferior cerebellar
peduncle
Foot
2 other cerebellar
peduncles
Middle
Pons
Superior
Midbrain
Tracts within Restiform Body
Olivocerebellar tract
Largest
Inferior olive and
cerebellum
Dorsal spinocerebellar
tract
Spinal cord to cerebellum
Reticulocerebellar tract
Reticular formation to
cerebellum
Medulla: Cranial Nerve Nuclei
Cranial Nerves 8-12
Vestibulochoclear (VIII)
Glossopharyngeal (IX)
Vagus (X)
Accessory (XI)
Hypoglossal (XII)
Hypoglossal (XII)
Hypoglossal
nucleus
Motor
Tongue
Nerve
Travels between
olive and pyramid
Hypoglossal Lesions (and
Surrounding Structures)
Nerve
Nerve and medial
lemniscus (DC-ML)
Nerve and pyramid
Accessory Nerve: Roots
Spinal
Spinal cord
Ventral horn C1-C6
Nucleus ambiguus
Cranial
Medulla
Accessory nucleus
Accessory Nerve: Output
Larynx
Recurrent laryngeal
nerve
Galen and the silent pig
Some neck muscles
Lesions
Winged scapula
Sagging shoulder
Weak turning head to
opposite side
Vagus Nerve
Dorsal
motor
nucleus
Vestibular
input
Motion
sickness
Nausea,
vomiting,
heart rate
Glossopharyngeal Nerve
Motor
Nucleus ambiguus
Pharynx
Swallowing
Speech
Inferior salivatory
nucleus
Dry mouth
Fear/anxiety
Salivation
Food odor
Glossopharyngeal Nerve
Sensory
Posterior 1/3 of
tongue
Carotid sinus nerve
Chemoreceptor/bar
oreptor
Increase pressure
activates it
It causes vagus
nerve to slow heart
rate
Nucleus Solitarius
2 zones
Taste
Facial nerve
Anterior 2/3 of tongue
Glossopharyngeal nerve
Posterior 1/3 of tongue
Vagus nerve
Epiglotts
Output to posterior thalamus
Then primary gustatory cortex
Nucleus Solitarius
2 zones
Cardio-respiratory (also
visceral)
Input
Glosspharyngeal
Vagus
Output
Nucleus ambiguus
Dorsal motor nucleus of Vagus
Medullary reticular formation
Parabrachial pontine nucleus
Visceral to amygdala &
hypothalamus
Medulla and Respiratory Function

Nucleus solitarius
Inspiration
Nucleus ambigguus
Inspiration
Expiration
Sleep apnea
Stop breathing when sleeping
Lesions of nucleus ambiguus & reticular formation
Sneezing
Nasal mucosa
Trigeminal nerve
Sneezing center
Medulla
2 phases
Nasal – nasal secretion
Respiratory – muscular output
Close eyes, deep breath, close pharynx, forceful expiration,
explosive air release through mouth and nose
You can’t sneeze with your eyes open ☺
Vomiting
Instinctive defensive reaction
Triggers
Motion
Adverse drug reactions
Trauma
Toxin ingestion
Chemoreceptor trigger zone in floor of fourth ventricle
[devoid of blood-brain barrier]
Taste receptors
Vestibular
Autonomic input from intestines
Medulla: Clinical Correlates
Medial Medullary Syndrome
Occlusion of anterior
spinal artery or
vertebral artery
Lateral Medullary Syndrome
Occlusion of
vertebral artery or
posterior inferior
cerebellar artery
Horner’s
Miosis – small pupil
Droopy eyelid –
ptosis
Lack of facial sweat -
anhidrosis
Lateral Medullary Syndrome:
Sensory Patterns

#1 – 26% #4 – 20%
#2 – 24% #5 – 8%
#3 – 18% #6 – 4%