Medulla Oblongata

Anatomy
lecture 4
Abbas A. A. Shawka
Medical student
2nd grade
 Subjects
• Introduction to Brainstem
• Medulla oblongata
 General overview
 Gross anatomy
 Internal organization
Introduction to Brainstem
Introduction
• Anatomy of the brainstem (
midbrain-pons-medulla ) is very
complicated !!

• What you will find in each

section through brainstem ?!

• 1- ascending an descending tracts that

connect brain to spinal cord.
• 2- cranial nerves nuclei and their
connections
• 3- Reticular formation
• 4- others ( do not classified as one of
the above ) e.g ( olivary nucleus in
MO , tapizus body in pons and red
nucleus in MB )
Cranial nerves and nuclei

• The cranial nerves are individually

named and numbered, using Roman
numerals, in a rostro–caudal
sequence, reflecting their order of
attachment to the brain.
• Cranial nerves III–X and XII are
associated with brainstem cell
groupings referred to collectively as
the cranial nerve nuclei
Cranial nerves and nuclei
1. A cranial nerve nuclei is a group of
cell ( gray matter ) participate in
formation of CN .. ( equal for dorsal
root ganglia of spinal nerves in
sensory CN and to anterior horn cells
of spinal nerves in motor CN )
2. Each nuclei have only ONE single
function ( sensory , motor , … )
3. A cranial nerve which have ONE
function is connected to ONE nuclei
that served that function.
4. A cranial nerve which have many
functions is connected to number of
nuclei equal the number of its
functions and each nuclei also served
only ONE function
5. There is shared nuclei ( two CN or
more can be share ONE nuclei .. )
Cranial nerves and nuclei
• Since we have 3 types of general
somatic sensation ( mentioned in
previous lecture ) .. Every type of
these sensations have an equal nuclei
in brainstem that give connections to
CNV !! “ IMPORTANT “

1. Spinal nucleus of V nerve ( in MO ) is

correspond to anteriorlatera system (
pain and temperature )
2. General sensory nucleus of V nerve
( in pons ) is correspond to DC-ML
system ( tactile sensation )
3. Mesencephalic nucleus of V nerve is
correspond to spinocerebellar tract
( proprioception )
•
Gross anatomy of medulla oblongata
Medulla oblongata
• The medulla oblongata is the part
of the brainstem between the
pons and spinal cord
• it extends through the foramen
magnum to the level of the atlas.
• Medullar is vital for our function,
without medulla we die.
• Above the foramen magnum it is
embraced dorsally by the
cerebellar hemispheres.
1. The lower end which contains
the upward continuation of the
central canal of the spinal cord is
the ‘closed part of the medulla’,
2
2. the upper end, where the canal
comes to the surface as the
lower part of the floor of the
fourth ventricle, is the ‘open 1
part’.
Medulla oblongata
• MO is about 3 cm ( lowest 3 cm of the
brainstem )

• it extend from the pronto-medullary Closed part

junction until plane below foramina
magnum for about 0.5 cm.

• Medulla spinalis have a central canal

which prolonged into its lower half to
open in the four ventricle at its upper
half.

• CSF is encircle the MO from outside

( subarachnoid space ) and inside
( central canal ). Open part

• MO is between the two lobes of

cerebellum ( anterior cerebellar
notch )
Medulla oblongata
• Ventrally the upper part of the
medulla is deeply grooved in the
midline, with a bold convexity on
either side, the pyramid (1) , due
to the contained corticospinal
fibres.

• Lateral to the pyramid is another

convexity, the olive (2) , due to the
underlying inferior olivary nucleus.
1
• Lateral to the olive the lateral 2
surface of the medulla is formed
by the inferior cerebellar
peduncle, which enters the
cerebellum medial to and below
the middle peduncle.
Cranial nerves
• 2 exit from the midbrain
• 4 exit from the bones
• 4 exit from the medulla

• From medulla
1. Glossopharyngeal nerve IX
2. Vagus nerve X IX
XII X
3. Spinal accessory nerve XI**
XI
4. Hypoglossal nerve XII

**although it exit through medulla it have NO

nuclei in it ( note : cranial accessory nerve is
consideres as part of vagus )
Cranial nerves
• From the 4 cranial nerves that
exit through medulla
• 1 exit between pyramid and
olive  XII
• The other 3 exit between olive
and ICP  IX,X,XI
IX
XII X
XI
Medulla oblongata
• Dorsally the lower part of the floor of
the fourth ventricle forms the upper
part of the medulla , here the roof of
the ventricle is ependyma and pia
mater.
• At the lower corner of the diamond-
shaped floor the hypoglossal trigone
(1) is adjacent to the midline, with the
vagal trigone (2) lateral to it. Higher
up and at the lateral corners of the
diamond is the vestibular area and 1
the medullary striae.
2 CC
• In the lower or closed part of the 4
medulla, the fourth ventricle has 3
become narrowed to the tiny central
canal, and the external dorsal surface
shows small elevations, the gracile (3)
and cuneate (4) tubercles, the former
being medial to the latter.
Internal structure
 NOTE
We will study cross section
firstly in closed part then in
open part !!
Closed part of medulla
 Closed part of
medulla

Gray mater White mater

Spinal nucleus of V. nerve

Spinal accessory nucleus
Nucleus graciles
Nucleus cuneatus
Motor Sensory
Spinal tract of V nerve
Pyramidal decuss.
Lateral ST tract
Anterior & posterior SC tract

Internal arcuate fibers*

*internal arcuate fibers = DC-ML system Medial lemniscus begining
spinal nucleus of the trigeminal nerve
• Arrow !!
• Extend from pons to C2
• Pain, temperature and crude
touch from the ipsilateral H&N
• general somatic sensation
corresponding to anteriolateral
system !!!
• V, VII, IX,X have connections
with it.

Spinal accessory nucleus

• Only nuclei of spinal accessory

nerve XI
• Reach lower medullary levels
gracile and cuneate nuclei
• The gracile and cuneate nuclei Brain stem
underlie the corresponding tubercles
of the dorsal surface of the lower
medulla.
• They contain the cell bodies on which
the incoming fibres of the gracile and
cuneate tracts of the spinal cord
Spinal cord
terminate,
• the nuclei give origin to the medial
lemniscus.

G ALT
C STT

DC-MLT
White mater – pyramidal decussation level
White mater – medial Leminscus decussation level
open part of medulla
 open part of
medulla

Gray mater

Inferior olivary nucleus Spinal nucleus of V nerve

Arcuate nucleus Nucleus ambiguius
Will be studied in cerebellum !! Nuclei of solitary tract
Inferior salivatory nucleus
Dorsal nucleus of vagus n.
Lateral vestibular nuclei
Nucleus of hypoglossal n.
Cochlear nuclei
Will be studied in pons !! CN IX,X,XII nuclei
Open medulla – inferior peduncle level
Modalities of CN ?
• 1- motor :-
• A- to skeletal muscle
- General : muscle of somite origin GSE
- Special : muscle of branchial origin SVE
• B- to viscera ( parasympathetic ) GVE
- To glands ( secretomotor )
- To smooth muscle

• 2- sensory
• A- From body
- General : 3 types of sensation GSA
- Special : vision, hear & balance SSA
• B- From viscera
- General : visceral pain and spasm GVA
- Special : test and smell SVA
Parasympathetic CN and their nuclei and ganglion

Parasympathetic CN Nuclei Ganglion

Oculomotor nerve III Acessory oculomotor Ciliary gangliom
nucleus
Fascial nerve VII Superior salivatory nucleus Ptrygopalatine ganglia
+
Submandibular ganglia
Glossopharyngeal nerve Inferior salivatory nucleus Otic ganglion
IX
Vagus nerve X Dorsal nucleus of vagus Superior and inferior
nerve ganglion of vagus nerve
Glossopharyngeal nerve IX
Nerve Modality Nucleus Position Distribution
SVE Nucleus Medulla Motor to stylopharyngeus
ambigius that assists with
swallowing
GVE Inferior Medulla Parasympathetic
salivatory innervation to parotid
nucleus gland
GVA Visceral sensation from
Glosso- parotid gland, carotid
pharyngeal body and sinus,
nerve Solitary nucleus pharynx, and middle ear
Lower
SVA medulla Taste from posterior 1/3
of tongue
GSA sensory nucleus Pons – C2 Cutaneous sensation from
of trigeminal external ear
nerve Common sensation from
posterior 1/3 of tongue
Glossopharyngeal nerve IX
Nerve Modality Nucleus Position Distribution
Nucleus ambigius Medulla Motor to constrictor muscles of
pharynx, intrinsic muscles of
SVE** larynx, muscles of palate (except
tensor veli palatini), and striated
muscle in superior two thirds of
esophagus
Vagus GVE Dorsal vagus nuclei Medulla Smooth muscle of trachea,
nerve bronchi, and digestive
tract,cardiac
muscle
Visceral sensation from base of
tongue, pharynx, larynx, trachea,
GVA Solitary nucleus Lower bronchi, heart, esophagus,
medulla stomach, and intestine
SVA Taste from epiglottis and palate

GSA Sensory nucleus of Pons – C2 Sensation from auricle, external

trigeminal nerve acoustic meatus, and dura mater
of posterior cranial fossa
**Cranial part of accessory nerve XI
Spinal accessory nerve
• Two parts

1. Cranial part ( from N ambigius )  X

2. Spinal part
- Ascend from upper cervical cord
- Enter F. magnum to join the cranial
part.
- Separate just below the Jagular
foramina.
- PCT  supply platysma and SCM !!
Hypoglossal n.

• Hypoglossal nucleus
lies in lower medulla
• Give XII nerve fibers
Medullary autonomic centers
• Cardiovascular centers :-
• 1- cardioinhibitary and
cardiostimulatory centers affect the
rate and force of cardiac contraction.
• 2- vasomotor centers affect the
smooth muscle fibers tone.

• Respiratory centers :-
• Recive input from pons

• Others :-
• Emesis
• Deglutition
• Coughing
• Hiccupping
• Sneezing
Blood supply of medulla
• The medulla is supplied
ventrally by branches of the
vertebral and basilar arteries,
and laterally and dorsally by Posterior
the posterior inferior cerebellar inferior
cerebellar a.
artery.

• The veins drain dorsally to the

occipital sinus and ventrally
into the basilar plexus of veins
and the inferior petrosal sinus.
• The medullary veins
communicate with the spinal
veins.
Blood supply of medulla
Aertery distribution Loss of supply lead
to

supply the region next

Anterior to the midline i.e. the
spinal artery part containing the medial medullary
( branch of pyramid, medial syndrome
vertebral a. ) lemniscus
and hypoglossal nucleus

Posterior lateral medullary

inferior Lateral and dorsal sides syndrome
cerebellar a. of the MO ‘syndrome of the
( branch of posterior inferior
vertebral a. ) cerebellar artery’.
Medial medullary syndrome
• Due to loss of blood supply to ventral
side of MO … ( by anterior spinal a. )
• Structures will be affected :-
1. Pyramid
2. Medial lemniscus
3. Hypoglossal nucleus
• It will lead to :-
• IPSILATERALLY
• paralysis of the tongue on the same
side ( due to damaged hypoglossal
nuclei  hypoglossal nerve )

• CONTRALATERALY
• hemiplegia ( crossed pyramid Which side is affected ?!
damage)
• loss of touch and kinaesthetic sense
on the opposite side ( medial
lemniscus damage )
Lateral medullary syndrome
• Due to loss of blood supply to lateral
area of MO ( posterior inferior
cerebellar a. )

• Structures will be affected :-

1. Nucleus ambiguus
2. Spinal tract of trigeminal n. (
uncrossed )
3. Spinal lemniscus ( crossed ) :-
upper continuation of
anteriolateral system
4. Hypothalamospinal fibres of
the sympathetic system
5. Vestibular nuclei
• The loss of nucleus ambiguus function
paralyses laryngeal, palatal and
pharyngeal muscles on that side,
causing dysphonia and dysphagia.

• Loss of the uncrossed spinal tract of

the trigeminal and of the crossed
spinal lemniscus results in loss of pain
and temperature sensation on the
same side of the face and opposite
side of the body.
• There will also be a Horner’s
syndrome on the ipsilateral side due
to interruption of descending
hypothalamospinal fibres of the
sympathetic pathway.

• Involvement of the vestibular nuclei

causes vertigo and nystagmus with
nausea and vomiting.
Thank you