BRAINSTEM

MIDBRAIN PONS MEDULLA

TECTUM: TECTUM NO TECTUM
- quadrigeminal plate (coprora quadrigemina) - not very prominent since 4 ventricle occupy a large area
th
- roof entirely formed by 4th ventricle and cerebellum (on top of 4th ventricle)
o superior colliculi (visual pathway) - superior medullary velum seen
o inferior colliculi (auditory pathway)
à (lateral lemniscus fibers à inferior colliculi à medial geniculate
nucleus/body of thalamus)
- Pretectal nuclei
o gets afferent fibers retina and gives efferent fibers to Edinger-Westphal Nuclei
o pupillary constriction
§ (lightà retinaà afferent fibers à pretectal nuclei à efferent fibers
à Edinger-Westphal Nuclei)
§ do not pass through occipital cortex
- Quadrigeminal Plate: reflex arcs
o auditory stimulus à inferior colliculi à superior colliculi
o makes you look towards (a sound) or make you close your eyes (from visual
stimulus) and look away
o efferent arms
§ tectospinal tract (cervical muscles) (aversion of head)
§ tectonuclear tract (orbicularis oculi) (eye closure/blink reflex)
- Periaqueductal gray
o surrounds the aqueduct
o descending autonomic tracts
à lesion: defensive behavior, reproductive behavior, aggression
o Endorphin-producing cells (sensitive to opioids for pain control)
o Micturition, penile erection
TEGMENTUM TEGMENTUM - Ascending Tracts
- Red nucleus (RN) - Medial lemniscus o Nucleus Cuneatus, nucleus gracilis, medial lemniscus
o ---à inferior olives - spinothalamic tract o Spinothalamic tract
o afferent input: emboliform and dentate nuclei - CN V, VI, VII, VIII nuclei o Spinocerebellar tract (A & P)
o efferent input: rubrospinal and ruboreticular tracts - PPRF, MLF - Descending Tracts : CST, Pyramids and decussation
o dentate-rubro-thalamic reflex: body posture - Lateral lemniscus – auditory pathway - Nuclei
(dentate nuclei à red nucleus à thalamus) - Superior olivary nucleus (pontomedullary junction) o CN IX, X, XI, XII nuclei
o rubrospinal tract - Central tegmental tract (RN---inferior olivary nucleus) o CN V spinal nucleus
§ flexion of upper extremities - Locus Coeruleus o nucleus of tractus solitarius
§ differentiate decorticate and decerebrate position o rostral pons to caudal midbrain o nucleus ambiguous
o Mollaret’s triangle: o Norepinephrine o olivary nuclear complex
§ red nucleus (midbrain) o -à entire CNS § inferior olive
§ inferior olive (medulla) o activated during stress • Sheet of gray matter
§ dentate nucleus (cerebellum) • afferent (via central tegmental tract): red
§ lesions: palatal myoclonus (involuntary jerky movements of soft nucleus, striatum, PAG, RF, cortex
palate) à popping in the ear • efferent: olivocerebellar tract
- Medial lemniscus [inferior cerebral peduncle à cerebellum
- Spinothalamic tract à neocerebellar cortex]
- CN V mesencephalic nucleus (sensory nucleus) (coordination of voluntary movement)
- CN III and IV nuclei § accessory olive – maintenance of balance
- Medial longitudinal fasciculus (MLF): gaze pathway - Area Postrema
(PPRF à MLF à contralateral CN III/ same side CN VIà medial rectus) o floor of the caudal 4th ventricle
- Substantia Nigra (SN): large motor nucleus o lacks blood brain barrier
o dopamine production o stimulation induced vomiting – emesis center
o Pars compacta- dorsal à melanin
o Pars reticulata – ventral à iron
o contains pirmented and non pigmented neurons
o movement disorders: Parkinson’s ALS, Huntington’s
- Reticular formation
o connections: SC, CN, Cerebellum, Cerebral Cortex
o part of ascending reticular activating system (ARAS)
à arousal/ wakefulness
- Ventral tegmental area
o rostral midbrain
o dopaminergic innervation
o activated by pleasure (reward, fear pathway)
BASE/ BASIS PONTIS BASE/ BASIS PONTIS
- Cerebral peduncles/ Crus cerebri - Corticospinal Tract (scattered): voluntary movement
o Corticospinal tract - Pontine nuclei: Corticopontocerebellar pathway
o Corticobulbar tract – facial muscle innervation o regulates smooth and precise coordination of voluntary
o Corticopontine fibers movement (corticospinal tract makes the movement itself)
- Raphe nuclei
o serotonin
o arousal, sleep-wake cycle, pain control
 MIDBRAIN
BLOOD SUPPLY:
• Posterior Cerebral Artery (PCA)
- Posterior choridal artery
- Interpeduncular branches
• Others: Superior cerebellar artery (SCA), Pcomm
• Landmark: CN III nuclei in the middle
SYNDROMES:
Wallenburg (Dorsolateral Medullary
Syndrome/ Lateral Medullary Syndrome)
Medial Medullary Syndrome (Dejerine
Syndrome)
Locked – In Syndrome
Cerebellopontine Angle Syndrome
Parinaud’s Syndrome
Weber Syndrome
CAUSE (area of
infarct/occlusion/embolism)
PICA or Vertebral artery
Vertebral artery or paramedian
branches of Basilar artery
Ventral Pons
no definitive cause
Pineal region tumors
hydrocephalus
Interpeduncular branches of PCA or
Posterior choroidal artery
BLOOD SUPPLY:
• Basilar Artery
- Paramedian branches (medial area)
- Short circumferential branches
- long circumferential branches (posterior portion)
AFFECTED AREA
lateral medullary areas
paramedian areas
CN XII (hypoglossal)
Bilateral Corticosponal
Corticobulbar tracts
CN VII, VIII, cerebellum
Dorsal midbrain
Pretectal area
Corticopontine tract
Substantia nigra
CN VII, IX-XII
PONS MEDULLA
BLOOD SUPPLY:
• Vertebral artery (VA)
- Posterior Inferior Cerebellar Artery (PICA)
o posterolateral portion
o infarct will NOT cause weakness on muscles supplied
by corticospinal tract (bc corticospinal tract is located
medially and supplied by anterior spinal artery)
- Others: anterior spinal artery, vertebral spinal artery, vertebral
paramedian artery
o medial portions of caudal medulla
CLINICAL FEATURES
• horner syndrome, nystagmus, dysarthia, dysphagia
• analgesia and thermanesthesia
• ataxia and aysngergia
• hypoglossal palsy
• nonspastic paralysis
• impairment of touch, position, and vibration sense (medial lemniscus,
contralateral)
absent motor function
intact sensation and cognition
Unilateral hearing loss
high frequency HL
decreased corneal reflex
facial weakness
Impairment of vertical gaze
large, irregular pupils
eyelid abnormalities (bilateral lid contraction to bilateral ptosis)
impaired convergence
Supranuclear facial and hypoglossal nerve palsies
oculomotor nerve palsy
spastic paralysis
rigidity, parkinsonism, rest tremor