CRANIAL NERVE NUCLEI AND THEIR CENTRAL

CONNECTIONS AND DISTRIBUTION General Visceral Motor Nuclei

 form the cranial outflow of the parasympathetic
12 CRANIAL NERVES portion of the autonomic nervous system
 There are 12 pairs of cranial nerves, which leave  They are the Edinger-Westphal nucleus of the
the brain and pass through foramina and fissures oculomotor nerve, the superior salivatory and
in the skull. All the nerves are distributed in the lacrimal nuclei of the facial nerve, the inferior
head and neck, except cranial nerve X, which also salivatory nucleus of the glossopharyngeal
supplies structures in the thorax and abdomen. nerve, and the dorsal motor nucleus of the
 The cranial nerves are named as follows: vagus.
1. Olfactory  receive numerous afferent fibers, including
2. Optic descending pathways from the hypothalamus.
3. Oculomotor
4. Trochlear Sensory Nuclei of the Cranial Nerves
5. Trigeminal  include somatic and visceral afferent nuclei.
6. Abducent  FIRST- ORDER NEURON- axons of nerve cells
7. Facial outside the brain and are situated in ganglia on
8. Vestibulocochlear the nerve trunks (equivalent to posterior root
9. Glossopharyngeal ganglion of a spinal nerve) or may be situated in a
10. Vagus sensory organ, such as the nose, eye, or ear.
11. Accessory  SECOND- ORDER NEURON- The central
12. Hypoglossal processes of these cells enter the brain and
Organization of the Cranial Nerves terminate by synapsing with cells forming the
 SENSORY sensory nuclei.
 olfactory, optic, and vestibulocochlear nerves  THIRD-ORDER NEURON- Axons from these
 MOTOR nuclear cells now cross the midline and ascend to
 oculomotor, trochlear, abducent, accessory, other sensory nuclei, such as the thalamus, where
hypoglossal nerves they synapse. Their axons terminate in the
 BOTH cerebral cortex
 trigeminal, facial, glossopharyngeal, and vagus
nerves The Letter Symbols Commonly Used to Indicate the
Functional Components of Each Cranial Nerve
Motor Nuclei of the Cranial Nerves COMPONENT FUNCTION LETTER
SOMATIC MOTOR and BRANCHIOMOTOR NERVE SYMBOLS
FIBERS AFFERENT SENSORY
-axons of nerve cells situated within the brain. FIBERS
-form motor nuclei and innervate striated muscle. SENSORY
General General sensations GSA
 LOW MOTOR NEURON somatic
 each nerve cell with its processes; afferent
equivalent to the motor cells in the
anterior gray columns of the spinal cord Special Hearing, balance, vision SSA
 CORTICONUCLEAR (corticobulbar) FIBERS somatic
 where motor nuclei of the cranial nerves afferent
receive impulses General Viscera VGA
 originate from the pyramidal cells in the visceral
inferior part of the precentral gyrus (area afferent
4) and from the adjacent part of the
postcentral gyrus. Special Smell, taste SVA
 descend through the corona radiata and visceral
the genu of the internal capsule. afferent
 pass through the midbrain just medial to
the corticospinal fibers in the basis EFFERENT
pedunculi and end by synapsing either FIBERS
directly with the lower motor neurons General Somatic striated muscles GSE
within the cranial nerve nuclei or somatic
indirectly through the internuncial efferent
neurons.
 Constitute the first-order neuron of the General Glands and smooth GVE
descending pathway, visceral muscles
 majority of the corticonuclear fibers to efferent (parasympathetic
the motor cranial nerve nuclei cross the innervation)
median plane before reaching the nuclei
 INTERNUNCIAL NEURON Special Branchial arch striated SVE
 Constitutes the second-order neuron visceral muscles
efferent
 LOWER MOTOR NEURON
 Constitutes the third-order neuron.

*Bilateral connections are present for all the cranial motor

nuclei except for part of the facial nucleus that supplies
the muscles of the lower part of the face and a part of the
hypoglossal nucleus that supplies the genioglossus muscle.
 1. LEFT SIDE APRAXIA
 Lesion of the anterior corpus callosum w/
interruption of the connections b/n R and L
association motor cortices
 Apraxia of left sided limb movements
2. PURE WORD BLINDNESS OR ALEXIA W/O AGRAPHIA
 Lesion of the posterior corpus callosum and
dominant occipital lobe w/ interruption of
connections b/n visual cortex and angular gyrus/
Wernicke’s area
 Inability to read, name colors, copy writing, but
w/ normal spontaneous writing and the ability to
HIGHER CORTICAL DYSFUNCTION identify colors
3. AGENESIS OF THE CORPUS CALLOSUM
APRAXIA- loss of ability to carry out skilled movement;  Developmental d/o w/ no connection b/n 2
adequate understanding of the task and normal motor hems.
Constructional Non-  Failure to name obj. presented visually or by touch
and Dressing dominant to the non-dominant hem. ( R and L visual fields
Apraxia parietal can’t match presented objects)
disease
Gait Apraxia Difficulty in Frontal lobe/ HIGHER CORTICAL FUNCTION MEMORY
initiating walking anterior NORMAL MEMORY- involves recognition, registering, and
corpus cataloguing of a stimulus (acquisition) + recall (retrieval)
callosum 1. VERBAL MEMORY- materials presented in a
disease verbal form
Oculomotor Impaired Parieto- 2. VISUAL MEMORY- material presented w/o words
Apraxia voluntary eye occipital or verbal mediation
movement disease 3. EPISODIC MEMORY
 SHORT TERM- immediate recall of a
Ideamotor Separation of idea Dominant
short message
Apraxia of movement from hemisphere
 LONG TERM- retrieval or remote events
execution- can’t
4. SEMANTIC MEMORY- long established factual
carry out motor
knowledge
command but can
ANATOMICAL BASIS OF MEMORY
perform the
required  Limbic system
movement  HIPPOCAMPUS- deep structure in temporal
Ideational Inability to carry Frontal lobe lobe, ridges the floor of the lateral ventricle
Apraxia out a sequence of disease  hippocampus-> fornix -> mamillary body-
movements > thalamus -> cingulate gyrus ->
hippocampus
power Mamil Thal Orbito Medial Forni
lary amus - Temporal x
DISCONNECTION SYNDROMES- recognizable syndromes; Bodie frontal Cortex/
lesions of connecting pathways that disorganize normal s cortex Hippocam
fxn pus
CONNECTING PATHWAYS Korsak + +
1. INTRAHEMISPHERIC – in the subcortical white matter off’s
and linking parts of the same hemispheric Head + + + +
2. INTERHEMISPHERIC- traversing corpus callosum and Traum
linking related parts of the two hemispheres a
Stroke + + +
INTRAHEMISPHERIC DISCONNECTION SYNDROMES
Enceph + +
1. CONDUCTION APHASIA
alitis
 Lesion of the arcuate fasciculus linking
Anoxia + +
Wernicke’s and Broca’s
 Fluent dysphasic speech, good comprehension of Metabo + +
written or spoken material, POOR REPETITION lic
2. PURE WORD DEAFNESS Tempo +
 Lesion of the connection b/n the primary ral
auditory cortex (heschl’s gyrus) and auditory Lobect
association cortex omy
 Impaired comprehension of spoken word, self- 3rd +
initiated language is normal, deaf but audiometry Ventric
is normal ular
3. BUCCAL LINGUAL AND SYMPATHETIC APRAXIA Operati
 Involves the links b/n L and R association motor ons
cortices in the subcortical region
 Right brachiofacial weakness and tongue, lip and
left limb apraxia AMNESIC SYNDROME
 intact retrieval of old info., intact intellectual fxn,
INTERHEMISPHERIC DISCONNECTION SYNDROMES intact personality, tendency to confabulate
  RETROGRADE AMNESIA- impairment of memory
for events that antedate illness or injury
 ANTEROGRADE AMNESIA (post-traumatic)-
inability to learn new non/verbal info. from onset
of the illness or injury
CAUSES
1. KORSAKOFF’S SYNDROME
 From: alcoholism, encephalitis and head injury
 Lesion occurs w/ thalamus and mamillary bodies
 Associated w/ CONFABULATION- false
rationalization of events and circumstances
2. POST TRAUMATIC AMNESIA
 After trauma, retrograde amnesia may span
several yrs., but w/ recovery this gradually
diminishes
 Duration of PTA remains fixed and relates directly
to the severity of the injury
3. AMNESIC STROKE
 Bilateral medial temporal lobe infarction from a
posterior circulation stroke
 Associated w/ hemiplegia and visual disturbance
or loss (Anton’s or Balint’s)
4. AMNESIA WITH TUMOURS
 Compress thalamic sx of the fornix may produce
amnesia (ex. Colloid cyst of the 3rd ventricle)
5. TEMPORAL LOBECTOMY
 Amnesia will only occur if fxn in the unoperated
temporal lobe is abnormal
 Pre-operative ax during a unilateral carotid
injection of sodium amytal minimizes risk
6. TRANSIENT GLOBAL AMNESIA
 Typically a single episode lasting b/n 1 and 10 hrs.
 Patient is bewildered, typically repeatedly asking
the same questions, but with clear consciousness
and often able to carry out complex such as
driving/ cooking
 Benign assoc. w/ migrane
 Triggered by stress or exercise
7. TRANSIENT EPILEPTIC AMNESIA
 Recurrent episodes of amnesia lasting 15 mins. to
1 hr. often on waking
8. PSYCHOGENIC AMNESIA
 Affects overlearned and personally relevant
aspects of memory (what is your name), while less
well learned remains unaffected
 Clinically evident acute mental stress may
precipitate this
 Inadequate defense mech. suggests a serious
underlying psychiatric or personality d/o
DISORDERS OF MEMORY RETRIEVAL
1. SENESCENCE
 Part of normal aging, rapid retrieval of stored
memory becomes defective
2. DEPRESSION
 Impaired memory is a common complaint in
depressive illness
 D/o is one of motivation and concentration
3. SUBCORTICAL DEMENTIA
 Slow response rate but right to q’s of memory fxn
4. NB DEMENTIA, TUMOURS, CEREBROVASCULAR
DISEASE
 Assoc. w/ memory loss combined w/ evidence of
more widespread disordered cognitive fxn
DISORDERS OF SPEECH AND LANGUAGE
LANGUAGE
 Fxn of the dominant cerebral hem. and maybe
divided into:
a) EMOTIONAL- instinctive expression of feelings
representing earliest forms of language acquired
in infancy
b) SYMBOLIC or PREPOSITIONAL- conveying
thoughts, opinion, and concepts; acquired over
20yr period and is dependent on culture, educ.,
and normal cerebral dev.
1. DYSARTHRIA
- Disturbance of articulation in which the content of
speech; Language is unaffected
- Diff. with articulation
MECHANISM OF ARTICULATION
1. Speech Initiated
2. Descending corticobulbar pathway from L hem.
to nuclei X and XII
3. Connection thru corpus callosum to motor
cortex of R hem.
4. Descending corticobulbar pathway from R he.
To nuclei X and XII
 NUCLEI X and XII – receive corticobulbar
pathway from both ipsilateral and contralateral
hem. ( bilateral innervation)
 This safety factor means that a lesion in one
corticobulbar pathway does not produce
symptoms
 Corticobulbar pathway, cerebellum,
Extrapyramidal system (modulate
articulatory mx action), Nuclei of lower motor
neurons of X (supply soft palate, larynx,
pharynx), XII CNs
DIAGNOSTIC APPROACH
 Listen to spontaneous speech and ask the patient
to read aloud
 Observe lingual consonants- “ta ta ta” , useful
phrase “yellow lorry”, “baby hippopotamus”
 Guttural consonants- “ ga ga ga” (laryngeal and
pharyngeal/ palatal) “good king”
A. Speech hoarse and strained; labial consonants
affected
 Middle cerebral artery occlusion,
neoplasm, bilateral small vessel occlusion
1. SPASTIC DYSARTHRIA (cortical origin)-
associated contralateral hemiparesis or dysphasia
2. SPASTIC DYSARTHRIA (corticobulbar origin)-
other signs of pseudobulbar palsy (impaired
chewing, swallowing)
B. Speech slow and monotonous w/ abnormal
separation of syllables; Scanning speech; at times
may sound explosive- ASSOCIATED SIGNS OF
CEREBELLAR DISEASE
 Motor neuron disease, multiple sclerosis,
hereditary ataxias, parkinson’s,
huntington’s
1. ATAXIC DYSARTHRIA- lesion in cerebellar
vermis and paravermis
C. Soft and monotonous w/ poor volume and little
inflection and short rushes of speech –
ASSOCIATED SIGNS OF EXTRAPYRAMIDAL
DISEASE (basal ganglia)
 Motor neuron disease, multiple sclerosis,
hereditary ataxias, parkinson’s,
huntington’s
1. HYPOKINETIC-slow
2. HYPERKINETIC- fast
 D. Labial consonants first affected, later gutturals, 2. RECEPTIVE AREAS
nasal speech and progression to total loss of  Spoken word is understood
articulation (anarthria)- ASSOCIATED SIGNS OF  Appropriate reply or action initiated
LOWER MOTOR NEURON WEAKNESS OF X AND  Lie at the posterior end of the Sylvian
XI fissure(frontal and parietal) on the lateral surface
 Motor neuron disease, bulbar of the hem.
poliomyelitis, cranial polyneuritis  TEMPORAL LOBE RECEPTIVE AREA- lies close
1. FLACCID DYSARTHRIA to the auditory cortex of the transverse gyrus of
the temporal lobe
2. DYSPHONIA  PARIETAL LOBE RECEPTIVE AREA- lies within
 Respiratory disease or vocal cord paralysis the angular gyrus
 APHONIA- complete inability to produce sound;
often coexist w/ dysarthria ARCUATE FASCICULUS
DIAGNOSTIC APPROACH  Links receptive and expressive areas
-INDIRECT LARYNGOSCOPY  A fiber tract which runs forward in the subcortical
1. PARALYSIS OF BOTH VOCAL CORDS white matter
 Patient speaks in whispers and inspiratory stridor
is present DIAGNOSTIC APPROACH DYSPHASIA
 Causative diseases  Listen to content and fluency of speech
 Medullary Damage  Test comprehension (simple to complex
 Infarction commands)
 Syringobulbia  CAUSATIVE DISEASES: vascular disease,
2. SPASTIC DYSPHONIA neoplasm, trauma, infective disease, degenerative
 Speaking while being strangled disease
 May be a functional d/o (psychological), form of  Assess:
focal dystonia (sabay ang antagonist at  Spontaneous speech
protagonist ; common in Ilonggos), occurs w/  Naming objects
essential tremor or hypothyroidism  Repetition
 Reading
3. PARALYSIS OF LEFT VOCAL CORD  Writing
 Which does not move w/ “Ahh” while right A. Broca’s Dysphasia (Motor or Expressive )
abducts  Non- fluent, hesistant speech
 When patient says “E” normal cord will move  May be confine to few repeated
towards paralysed cord utterances
 Voice is weak and breathy and the cough is  In less severe- telegraphic nature w/
‘bovine’ articles and conjunctions omitted
 Good comprehension
OTHER SPEECH DISORDERS  Poor handwriting
1. MUTISM  Look for coexisting right arm and face
 An absence of any attempt at oral weakness
communication  Face- arm trunk
 Associated w/ bilateral frontal lobe or third
ventricular pathology
2. ECHOLALIA B. Wernicke’s Dysphasia (Sensory or receptive)
 Constant repetition of words or sentences  Impaired comprehension and
heard in dementing illnesses Nonsensical speech but fluent
3. PALALIA  NEOLOGISMS- nonexistent words
 Repetition of last word/s of patient’s speech  PARAPHRASIA- half right words
 In extrapyramidal diseases- Parkinson’s,  Unaware and Poor handwriting
Huntington  Parietal, temporal
4. LOGORRHOEA C. Global Dysphasia
 Prolonged speech monologues  Non fluent speech and impaired
 Associated w/ Wernicke’s dysphasia comprehension
3. DYSPHASIA  Associated with hemiplegia/
 Acquired loss of production or comprehension of hemianesthesia and visual field deficit
spoken or written language secondary to brain  Damage involving a large area of the
damage dominant hemisphere
 APHASIA- inborn, neurodevelopmental delay D. Conduction Dysphasia
 HAND PREFERENCE- associated with ‘hemisphere  Nonsensical speech but fluent
dominance’  Normal comprehension but poor
 May develop as a result of vascular, neoplastic, repetition
traumatic, or degenerative disease of the  Frontal, temporal
cerebrum when language areas are involved
4. DEMENTIAS
DOMINANT HEMISPHERES- where cortical centers  Progressive deterioration of intellect, behavior
reside: and personality as a consequence of diffuse
1. BROCA’S AREA disease of the cerebral hemispheres, maximally
 Executive or motor area for the production of affecting the cerebral cortex and hippocampus
language  DELIRIUM- acute disturbance of cerebral function
 Lies in the inferior part of the frontal lobe on the w/ impaired conscious level, hallucinations, and
lateral surface of the cerebral hemisphere autonomic overactivity as a consequence of toxic,
abutting the mouth of the Sylvian fissure metabolic or infective conditions
  May occur at any age but is more common in the -CENTRAL SULCUS- its gyrus contains the motor cells that
elderly(1% at 60, 5% at 70, 15% at 80) initiate the movements of the opp. side of the body;
 A symptom of disease rather than a single disease indents the superior medial border of the hem. behind
entity midpoint; lies between 2 parallel gyri
 PRESENILE DEMENTIA- when occurring under -LATERAL SULCUS- deep cleft found mainly on the
age 65 inferior and later surfaces of cerebral hem.; consists of
short stem that divides into 3 rami- ante. hori. Rami, ante.
ascending rami, ascending ramus, posterior ramus ;
INSULA – lies at the bottom of the deep lateral sulcus and
CLINICAL COURSE:
cannot be seen from the surface unless the lips of the
Rate of progression depends upon the underlying cause.
 ACUTE: WEEK - encephalitis sulcus are separated
 SUBACUTE: MONTHS – Creutzfeldt-Jakob -PARIETO-OCCIPITAL SULCUS- begins on the superior
 CHRONIC: YEARS- Normal Pressure medial margin of the hem. Anterior to the occipital pole
Hydrocephalus, Alzheimer’s disease -CALACARINE SULCUS- found on the medial surface of the
hem.; It commences under the poste. end of the corpus
DEVELOPMENT OF SYMPTOMS callosum ; joined at an acute angle by parieto-occipital
sulcus
-consist of six lobes and the olfactory structures:
Difficulty in
Loss of
coping w/ Long term
Introspective insight, Mutism, a. Frontal lobe
work and care,
behavioural Incontinence,
Unsure of self ordinary - extends from the central sulcus to the frontal pole.
changes, loss cannot be left
routine DEATH
of inhibition unattended - anterior: central sulcus ; superior: lateral sulcus
(retained
insight)
-3 sulci; 4 gyri
-PRECENTRAL SULCUS- runs parallel to central sulcus
SUPERIOR AND INFERIOR SULCI- anterior from the
precentral sulcus
BRAIN -contains the following gyri:
-part of the central nervous system (CNS) that lies within (1) Precentral gyrus-consists of the motor
the cranial vault, the encephalon. Its hemispheric surface area (area 4). ; lies between prefentral sulcus
is convoluted (i.e., gyrencephalic) and has gyri and sulci.
(2) Superior frontal gyrus -contains the
-consists of the cerebrum (cerebral supplementary motor cortex on the medial
hemispheres/telencephalon and diencephalon/central surface(area 6) ; lies superior to superior frontal
core; largest part of the brain; in ante. and middle cranial sulci
fossae of the skull), the brainstem (midbrain, pons, and
medulla), and the cerebellum. (3) Middle frontal gyrus- contains the frontal
eye field (area 8) ; lies between superior and
-weighs 350 g in the newborn and 1400 g in the adult. inferior sulci
(4) Inferior frontal gyrus- contains the Broca speech area
-covered by three connective tissue membranes, the in the dominant hemisphere (areas 44& 45) ; lie inferior to
meninges. inferior frontal sulcus; invaded by anterior and ascending
rami of lateral sulcus
-surrounded by cerebrospinal fluid (CSF), which
supports it and protects it from trauma. (5) Gyrus rectus and orbital gyri- separated by the
olfactory sulcus.
BRAIN DIVISIONS
(6) Anterior paracentral lobule- found on the medial
-The brain is classified into six postembryonic divisions: surface between the superior frontal gyrus (paracentral
telencephalon, diencephalon, mesencephalon, pons, sulcus) and the central sulcus.
medulla oblongata, and cerebellum. -represents a continuation of the precentral gyrus on the
medial hemispheric surface.
A. TELENCEPHALON

-consists of the cerebral hemispheres (which comprise b. Parietal lobe

both cerebral cortex and white matter) and the basal
ganglia. The cerebral hemispheres contain the lateral
ventricles.
1. Cerebral hemispheres
- separated by the longitudinal cerebral fissure and the
falx cerebri.
-contains the sickle-shaped fold of dura matter- falx
cerebri and anterior cerebral arteries
-interconnected by the corpus callosum.
-covered with a layer of gray matter- CEREBRAL CORTEX
-TENTORIUM CEREBELLI- second horizontal fold of dura
mater that separates the cerebral hemispheres from
cerebellum
-extends from the central sulcus to the occipital lobe and
lies superior to the temporal lobe.
-posterior to: central sulcus; superior to: lateral sulcus
-2 sulci; 3 gyri
-POSTCENTRAL SULCUS- runs parallel to central sulcus
and postcentral gyrus lies between them
-INTRAPARIETAL SULCUS- running posteriorly from the
middle of the postcentral sulcus
-SUPERIOR PARIETAL LOBULE/ GYRUS- superior to
intraparietal sulcus ; INFERIOR PARIETAL GYRUS- inferior
to intraparietal sulcus
-contains the following lobules and gyri:
(1)Postcentral gyrus- primary somatosensory area
of the cerebral cortex (areas 3, 1, 2).

(2)Superior parietal lobule- comprises association
areas involved in somatosensory functions (areas 5
and 7)
(3) Inferior parietal lobule
(a) Supramarginal gyrus- interrelates
somatosensory, auditory, and visual input (area 40).
(b) Angular gyrus (area 39)- receives impulses
from primary visual cortex.
(4) Precuneus- located between the paracentral
lobule and the cuneus.
(5) Posterior paracentral lobule- located on the
medial surface between the central sulcus and the
precuneus.
-represents a continuation of the postcentral gyrus
on the medial hemispheric surface.
c. Temporal lobe
-inferior to: lateral sulcus
-3gyri, 2 sulci
-SUPERIOR AND MIDDLE TEMPROAL SULCI- run parallel
to the posterior ramus of the lateral sulcus
-contains the following gyri:
(1) Transverse temporal gyri of Heschl
-lie buried within the lateral sulcus.
-extend from the superior temporal gyrus toward the
medial geniculate body
-primary auditory areas of the cerebral cortex (areas
41 and 42).
(2) Superior temporal gyrus -associated with
auditory functions.
-contains the Wernicke speech area in the dominant
hemisphere (area 22).
-contains the planum temporale on its superior hidden
surface.
(3) Middle temporal gyrus
(4) Inferior temporal gyrus
(5) Lateral occipitotemporal gyrus (fusiform
gyrus)- lies between the inferior temporal sulcus and
the collateral sulcus.
d. OCCIPITAL LOBE
-lies posterior to a line connecting the parieto-occipital
sulcus and the preoccipital notch.
-contains two structures:
(1)Cuneus
-a triangular area of cortex bounded above by the
parieto-occipital sulcus, inferiorly by the calcarine
sulcus and posteriorly by the superior medial margin
- lies between the parieto-occipital sulcus and the
calcarine sulcus.
- contains the visual cortex (areas 17, 18, and 19).
(2) Lingual gyrus (medial occipitotemporal
gyrus)
- extends from the occi. pole to temporal pole
-bounded medially by the collateral and rhinal sulci and
laterally by occipitotemporal sulcus
- lies below the calcarine sulcus.
-contains the visual cortex (areas 17, 18, and 19)
-OCCIPITOTEMPORAL GYRUS-lies lateral to the sulcus
and is continuous w/ inferior temporal gyrus
*PRECUNEUS- an area of cortex bounded by the
upturned posterior end of the cingulate sulcus and
post3eriroly by the parieto-occipital sulcus
*COLLATERAL SULCUS-situated on the infe. of hemi.;
runs anteriorly below the calcarine sulcus
LINGUAL GYRUS- between calcarine sulcus and
collateral sulcus
PARAHIPPOCAMPAL GYRUS-anterior to lingual gyrus
*OLFACTORY SULCUS- overlie on the inferior surface of
the frontal lobe, olfactory bulb and tract
e. INSULAR LOBE (INSULA)
• lies buried within the lateral sulcus.
• has short and long gyri.
f. LIMBIC LOBE
- C-shaped structure of the medial hemispheric surface
that encircles the corpus callosum and the lateral
aspect of the midbrain.
-includes the following structures:
(1) Paraterminal gyrus and subcallosal area- are
located anterior to the lamina terminalis and ventral
to the rostrum of the corpus callosum.
(2) Cingulate gyrus- begins beneath the anterior end
of the corpus callosum and continues above the
corpus callosum til reaches its posterior end
-separated from the corpus callosum by:
CALLOSAL SULCUS
-separated from the superior frontal gyrus by:
CALLOSAL SULCUS
-merges with the parahippocampal gyrus at the
isthmus.
(3) Parahippocampal gyrus- lies between the
hippocampal and collateral sulci and terminates in the
uncus.
(4) Hippocampal formation-lies between the
choroidal and hippocampal fissures.
-jelly-rolled into the parahippocampal gyrus.
-connected to the hypothalamus and septal area
via the fornix.
- includes the following three structures:
(a) Dentate gyrus
(b) Hippocampus
(c) Subiculum
*PARACENTRAL LOBULE- area of the cerebral cortex
that surrounds the indentation produced by the central
sulcus on the superior border; anterior- continuation of
the precentral gyrus on the superior lateral surface ;
posterior- continuation of postcentral gyrus
g. OLFACTORY STRUCTURES
-found on the orbital surface of the brain and
include:
(1) Olfactory bulb and tract- outpouching of
the telencephalon.
(2) Olfactory bulb- receives the olfactory
nerve (cranial nerve [CN] I).
(3) Olfactory trigone and striae
(4)Anterior perforated substance- created
by penetrating striate arteries.
 (5) Diagonal band of Broca- interconnects
the amygdaloid nucleus and the septal area.
2. BASAL GANGLIA (BASAL NUCLEI)
-collection of masses of gray matter situated within each
cerebral hem- corpus striatum, amygdaloid nucleus,
claustrum
- subcortical nuclei of the telencephalon.
- include the following structures:
a. Caudate nucleus- part of the striatum, together
with the putamen; a large C-shaped mass of gray
matter that is closely related to lateral ventricle
-lies lateral to: thalamus
-internal capsule- separates nucleus from lentiform
nucleus
b. Putamen- part of the striatum, together with the
caudate nucleus.
-part of the lentiform nucleus, together with the
globus pallidus.
c. Globus pallidus- part of the lentiform nucleus,
together with the putamen.
d. Amygdaloid nuclear complex (amygdala)-
situated in the temporal lobe close to the uncus;
considered part of the limbic system
*CORPUS STRIATUM- lateral to thalamus; almost
completely divided by aband of nerve fibers. Internal
capsule, into the caudate nucles and the lentiform
nucleus; receives afferent fibers from diff. areas of the
cerebral cortex, thalamus, subthalamus and
brainstem; function is concerned with muscular
movement
*LENTIFORM NUCLEUS- a wedge-shaped mass of gray
matter whose broad convex base is directed laterally
and its blade medially; Buried deep in the white
matter of the cerebral hem. And related medially to
the internal capsule –which separates it from the
caudate nucleus and thalamus; continuous with
caudate nucleus
*EXTERNAL CAPSULE- separates lentiform nucleus
from claustrum
*CLAUSTRUM- separates the external capsule from the
subcortical white matter of the insula
-separated from lateral surface of lentriform by ext.
capsule
-lateral to the claustrum: subcortical white matter of
the insula
3. LATERAL VENTRICLES
-in the interior of the cerebral hem- masses of gray
matter, basal nuclei and nerve fibers
-ependyma-lined cavities of the cerebral hemispheres.
-contain CSF and choroid plexus
-communicate with the third ventricle via the two
interventricular foramina of Monro
-separated from each other by the septa pellucida.
There are 2 lateral ventricles
-each ventricle is roughly C-shaped cavity lined with
ependymal and filled w/ CSF
-LT may be divided into a body- occupies the parietal
lobe, and from which anterior, posterior and inferior
horns extend into the frontal, occipital and temporal
lobes
-communicates with the cavity of the 3rd ventricle thru
INTERVENTRICULAR FORAMEN- lies in the anterior
of the medial wall of the lateral ventricle, bounded
anteriorly by the anterior column of the fornix and
posteriorly by the anterior end of the thalamus
4. CEREBRAL CORTEX
- consists of a thin layer or mantle of gray substance.
-covers the surface of each cerebral hemisphere.
- folded into gyri that are separated by sulci.
5. WHITE MATTER
-composed of myelinated nerve fibers supported by
neuroglia
-nerve fibers classified into 3 grps. According to their
connection: commissural fibers (corpus
callosum,anterior and posterior commissure, fornix,
habenular commissure), association fibers, projection
fibers
-includes the cerebral commissures and the internal
capsule.
a. Cerebral commissures- interconnect the cerebral
hemispheres and include:
(1) Corpus callosum-largest commissure of the
brain.
-interconnects the two hemispheres.
-lies at the bottom of the longitudinal fissure
-has four parts:
(a) Rostrum-thin part of the anterior end of
the corpus callosum-prolonged to be
continuous with upper end of lamina
terminalis
(b) Genu- curved anterior end of the corpus
callosum that bends inferiorly in front of the
septum pellucidum
(c) Body – arches posteriorly and ends as
the thickened posterior portion-splenium
(d) Splenium
*FORCEPS MINOR- formed by the fibers of the genu curve
forward into the frontal lobes
*RADIATION OF CORPUS CALLOSUM- fibers of the body
extend laterally; intersect w/ bundles of assoc. and
projection fibers as they pass to the cerebral cortex
*TAPETUM- some fibers form the roof and the lateral wall
of the posterior horn of the lateral ventricle and the lateral
wall of the inferior horn of the lateral ventricle
*FORCEPS MAJOR- formed by the fibers in the splenium
arch backward into the occipital lobes
(2) Anterior commissure
- located in the midsagittal section between the lamina
terminalis and the column of the fornix.
- a small bundle of nerve fibers that crosses the midline in
the lamina terminalis
-interconnects the olfactory bulbs and the middle and
inferior temporal lobes.
(3) Hippocampal commissure (commissure of
the fornix)- located between the fornices and ventral
to the splenium of the corpus callosum.
-consists of transverse fibers that cross the
midline from one column to another just before the
formation of the body of the fornix
-connect hippocampal formations of the two sides
 * POSTERIOR COMMISSURE- bundle of nerve fibers
that crosses the midline immediately above the opening
of the cerebral aqueduct into the third ventricle
*FORNIX- composed of myelinated nerve fibers and
constitutes the efferent system of the hippocampus that
passes to the mammillary bodies of the hypothalamus;
ALVEUS- thin layer of white matter covering the
ventricular surface of the hippocampus, and then
converge to form FIMBRIA
*ASSOCIATION FIBERS- nerve fibers that essentially
connect various cortical regions within the same hem.
and maybe divided into short and long grps.
SHORT ASSOCIATION FIBERS-s lie immediately
beneath the cortex and connect adjacent gyri; these
fibers run transversely to the long axis of the sulci
LONG ASSOCIATION FIBERS-collected into
named bundles that can be dissected in a formalin-
hardened brain
UNCINATE FASCICULUS-connects the first motor
speech area and the gyri on the inferior surface of the
frontal lobe with the cortex of the pole of the temporal
lobe.
CINGULUM-a long, curved fasciculus lying within
the white matter of the cingulate gyrus; t connects the
frontal and parietal lobes with parahippocampal and
adjacent temporal cortical regions
SUPERIOR LONGITUDINAL FASCICULUS-largest
bundle of nerve fibers; connects the anterior part of the
frontal lobe to the occipital and temporal lobes
INFERIOR LONGITUDINAL FASCICULUS- runs
anteriorly from the occipital lobe, passing lateral to the
optic radiation, and is distributed to the temporal lobe
FRONTO-OCCIPITAL FASCICULUS-connects the
frontal lobe to the occipital and temporal lobes;
situated deep within the cerebral hemisphere and is
related to the lateral border of the caudate nucleus.
b. Internal capsule- consists of the white matter
located between the basal ganglia and the thalamus
- upper part of the brainstem, compact band; flanked
medially by the caudate nucleus and the thalamus and
laterally by the lentiform nucleus
-has three parts:
(1) Anterior limb- located between the
caudate nucleus and putamen.
(2) Genu- located between the anterior and
posterior limbs.
-contains corticobulbar fibers.
(3) Posterior limb- located between the
thalamus and lentiform nucleus (which is made
up of the putamen and the globus pallidus).
-contains corticospinal fibers
*CORONA RADIATA-radiating projection fibers
*OPTIC RADIATION-nerve fibers lying within the most
posterior part of the posterior limb of the internal capsule
radiate toward the calcarine sulcus
B. DIENCEPHALON
-located between the telencephalon and
mesencephalon and between the interventricular
foramen and the posterior commissure.
-continuous with the cerebral aqueduct and anterior=
interventricular foramina
--receives the optic nerve (CN II).
-INFERIOR SURFACE (HYPOTHALAMUS)- only area
exposed to the surface in the brain
-SUPERIOR SURFACE- concealed by FORNIX- thick
bundle of fibers that originates in the hippocampus of
the temporal lobe and arches posterior over thalamus
to join the mammillary body
-roof of the third ventricle- superior wall of the
diencephalon; consists of ependymal layers
-LATERAL SURFACE- bounded by INTERNAL
CAPSULE- consists of nerve fibers that connect the
cerebral cortex w/ other parts of the brainstem and
spinal cord
-MEDIAL SURFACE- lateral wall of the third ventricle;
superior: medial of thalamus; inferior: hypothalamus;
HYPOTHALAMIC SULCUS- separates superior and
inferior of medial surface
- STRIA MEDULLARIS THALAMI- bundle of nerve
fibers, which afferent fibers to the habenular nucleus,
forms a ridge along the superior margin of the medial
surface of the diencephalon
-consists of the epithalamus, thalamus, hypothalamus,
subthalamus, and the third ventricle and associated
structures.
1. EPITHALAMUS
a. Pineal body / gland(epiphysis cerebri)
-small, conical structure by the pineal stalk to the
diencephalon; projects backwardlies poste. to the
midbrain
-superior; habenular commissure; base- posterior
commissure
-2 cells: pinealocytes and glial cells
-BRAIN SAND-concretion of calcified material;
progressively accumulate within the pineal gland w/
age
-no nerve cells, but adrenergic sympathetic fibers
derived from the superior cervical sympathetic ganglia
enter the gland and run in assoc. w/ the blood vessels
and pinealocytes
- no blood-brain barrier; active during darkness
Actions- mainly inhibitory-prod. Of hormones/
indirectly inhibit the secretion of releasing factors by
the hypothalamus
b. Habenular trigone / nucleus
-small grp. Of neurons situated just medial to the poste.
Of thalamus; center for integration of olfactory, visceral
and somatic afferent pathways
c. Medullary stria of the thalamus
d. Posterior commissure- mediates the
consensual reaction of the pupillary light reflex.
e. Tela choroidea and choroid plexus of the
third ventricle
2. THALAMUS- separated from the hypothalamus by
the hypothalamic sulcus.
- large ovoid mass of gray matter that forms the major
part of the diencephalon
-region of great functional importance and serves as a
cell station to all the main sensory system (except:
olfactory)
-situated on: each side of the third ventricle
-anterior end: narrow and rouded and forms the poste.
Boundary of the interventricular foramen
-TELA CHOROIDEA AND FORNIX- covers medially and
laterally the superior surface of the thalamus; covered
by ependymal and forms part of the floor of the lateral
ventricle
-lateral part: partially hidden by the choroid plexus of
the lateral ventricle
-Inferior surface: continuous with the tegmentum of the
midbrain
-Medial surface- forms the superior part of the lateral
wall of the third ventricle and connected to the
opposite thalamus by a band of gray matter-
INTERTHALAMIC ADHESION
-Regarded as a station where much of the info. Is
integrated and relayed to the cerebral cortex and many
other subcortical regions
-It plays a key role in the integration of visceral and
somatic functions
-consists of the following surface structures:
a. Pulvinar- overhangs the superior colliculus
and superior brachium
b. Metathalamus
(1) Medial geniculate body (auditory
system)
(2) Lateral geniculate body (visual system)-
forms a small elevation on the under aspect of the
lateral portion of the pulvinar
c. Anterior tubercle
d. Interthalamic adhesion (massa intermedia)
3. HYPOTHALAMUS-extends from the region of the
optic chiasm to the caudal border of the mammiliary
bodies
-below: hypothalamic sulcus on the lateral wall of the
third ventricle
-relatively small area of the brain; maintain
homeostatis- regulation of body tem, body fluids, drives
to eat and drink, sexual behavior, and emotion
-PREOPTIC AREA- anterior to the hypothalamus;
extends from the optic chiasm to the lamina terminalis
and ante. Commissure
-thalamus lies superior the HT; subthalamic-
inferolaterally to HT
a. Optic chiasm- flattened bundle of nerve
fibers situated at the junction of the ante. wall and floor
of the third ventricle; superior: attached to the lamina
terminalis; inferiorly: hypophysis cerebri =both
separated by: diaphragm sellae; posterolateral corners
are continuous w/ OPTIC TRACTS
-OPTIC RECESS OF THE 3RD VENTRICLE- in the
superior surface
b. Mamillary body- two small hemispherical
bodies situated side by side poste. to tuber cinereum ;
possess a central core of gray matter invested by a
capsule of myelinated nerve fibers
c. Infundibulum- hollow and continuous w/
poste. lobe of hyophysis cerebri
d. Tuber cinereum- convex mass of gray
matter; continuous inferiorly w/ infundibulum
-MEDIAN EMINENCE- raised part of TC, and the
posterior lobe of hypophysis cerebri = form
NEUROPHYSIS
4. SUBTHALAMUS (ventral thalamus)
-lies ventral to the thalamus and lateral to the
hypothalamus.
-lies inferior to the thalamys; between the thalamus and
the tegmentum of the midbrain
-related to hypothalamus
-not visible on midsagittal sections through the third
ventricle.
-consists of:
a. Subthalamic nucleus- has the shape of
biconvex lens; involved in the control of muscle
activity( connection witth corpus striatum); contains
many impt. Tracts that pass up from the regmentum to
the thalamic nucles (eg. Cranial ends of the medial,
spinal and trigeminal lemnisci)
b. Zona incerta and fields of Forel
5. Third ventricle and associated structures
-derived from the forebrain vesicle; slittlike cleft
between the two thalami
-communicates anter. w/ lateral ventricles thru
INTERVENTRICULAR FORAMINA (FORAMINA OF
MONRO)
-communicates poste. w/ fourth ventricle thru
CEREBRAL ACQUEDUCT
-anterior wall : lamina terminalis
-Posterior wall: opening of cerebral acqueduct:
superior to acqueduct-POSTERIOR COMMISSURE;
superior to commissure- PINEAL RECESS;
HABENULAR COMMISSURE-superior to pineal recess
-lateral wall: medial surface of thalamus superiorly;
hypothalamus –superiorly ; separated by:
HYPOTHALAMIC SULCUS ; lateral wall is limited
superiorly by: stria medullaris thalami ; joined by:
interthalamic adhesion
-superior wall/ roof: formed by ependyma;
TELA CHOROIDEA- 2 layered fold of pia mater,
superior to ependymal, invaginate to form choroid
plexus
-Inferior wall: formed by OPTIC CHIASMA, TUBER
CINEREUM, INFUNDIBULUM, MAMILLARY BODIES; =
posterior: tegementum of cerebral peduncles
-HYPOPHYSIS- attached to infundibulum
a. Lamina terminalis- results from closure of the
anterior neuropore.; thin sheet of gray matter that
forms the anterior wall ; across which runs the
ANTERIOR COMMISSURE- round bundle of nerve
fibers that are situated ante. to anterior columns of
the fornix; connect the right and left temporal lobes
b. Tela choroidea
c. Choroid plexus
d. Interventricular foramen of Monro- interconnects
the lateral ventricle and the third ventricle.
e. Optic recess
f. Infundibular recess
g. Suprapineal recess
h. Pineal recess
C. MESENCEPHALON (midbrain)
-located between the diencephalon and the pons.
-extends from the posterior commissure to the
frenulum of the superior medullary velum.
-contains the cerebral aqueduct, which interconnects
the third and fourth ventricles.
1. Ventral surface
a. Cerebral peduncle
b. Interpeduncular fossa
(1) Oculomotor nerve (CN III)
(2) Posterior perforated substance-
created by penetrating branches of the
 posterior cerebral and posterior
communicating arteries.
2. Dorsal surface
a. Superior colliculus (visual system)
b. Brachium of the superior colliculus
c. Inferior colliculus (auditory
system)
d. Brachium of the inferior colliculus
e. Trochlear nerve (CN IV)- only cranial
nerve to exit the brainstem from the
dorsal aspect.
D. PONS- located between the midbrain and the
medulla.
-extends from the inferior pontine sulcus to the
superior pontine sulcus.
1. Ventral surface
a. Base of the pons
b. Cranial nerves
(1) Trigeminal nerve (CN V)
(2) Abducent nerve (CN VI)
(3) Facial nerve (CN VII)
(4) Vestibulocochlear nerve
(CN VIII)
2. Dorsal surface (rhomboid fossa)
a. Locus ceruleus- contains the largest
collection of norepinephrinergic neurons in
the CNS.
b. Facial colliculus - contains the abducent
nucleus and internal genu of the facial nerve.
c. Sulcus limitans- separates the alar plate from the
basal plate.
d. Striae medullares of the rhomboid fossa-
divide the rhomboid fossa into the superior pontine
portion and the inferior medullary portion.
E. MEDULLA OBLONGATA (myelencephalon)
-located between the pons and the spinal cord.
-extends from the first cervical nerve (C1) to the inferior
pontine sulcus (also called the pontobulbar sulcus).
1. Ventral surface
a. Pyramid- contains the corticospinal tract.
b. Olive- contains the inferior olivary nucleus.
c. Cranial nerves
(1) Glossopharyngeal nerve (CN IX)
(2) Vagal nerve (CN X)
(3) Accessory nerve (CN XI)
(4) Hypoglossal nerve (CN XII)
2. Dorsal surface
a. Gracile tubercle
b. Cuneate tubercle
c. Rhomboid fossa
(1) Striae medullares of the rhomboid
fossa
(2) Vagal trigone
(3) Hypoglossal trigone
(4) Sulcus limitans
(5) Area postrema (vomiting center)
F. Cerebellum
-located in the posterior cranial fossa.
-attached to the brainstem by three cerebellar peduncles.
-forms the roof of the fourth ventricle.
-separated from the occipital and temporal lobes by the
tentorium cerebelli.
-consists of folia and fissures on its surface.
-contains the following surface structures:
1.Hemispheres- made up of two lateral lobes.
2. Vermis- midline structure.
3. Flocculus and vermal nodulus- form the
flocculonodular lobule.
4. Tonsil- rounded lobule on the inferior
surface of each cerebellar hemisphere.
-may herniate, with increased intracranial
pressure, through the foramen magnum.
5. Superior cerebellar peduncle- connects
the cerebellum to the pons and midbrain.
6. Middle cerebellar peduncle- connects the
cerebellum to the pons.
7. Inferior cerebellar peduncle- connects the
cerebellum to the medulla.
8. Anterior lobe- lies anterior to the primary
fissure.
9. Posterior lobe- located between the
primary and posterolateral fissures.
10. Flocculonodular lobe- lies posterior to the
posterolateral fissure
*nerve fibers are embedded in neuroglia and constitute the
white matter
SEPTUM PELLUCIDUM- a thin vertical sheet of nervous
tissue consisting of white and gray matter covered on
either side by ependymal; between the fornix and the
corpus callosum; double membrane with a closed, slitlike
cavity between the membranes; forms a partition between
the anterior horns of the lateral ventricles.
TELA CHORIDEA-a two-layered fold of pia mater; situated
between the fornix superiorly and the roof of the third
ventricle and the upper surfaces of the two thalami
inferiorly; covered by ependyma and form the choroid
plexuses of the lateral ventricle; derived from the
choroidal branches of the internal carotid and basilar
arteries.
THE BRAINSTEM
Introduction
 Made up of the medulla oblongata, the pons, and
the midbrain
 3 broad functions of the brainstem:
 Serves a conduit for the ascending tracts
and the descending tracts connecting the
spinal cord to the different parts of the
higher centers in the forebrain
 Contains important reflex centers
associated with the control of respiration
and the cardiovascular system and with
the control of consciousness
 Contains the important nuclei of cranial
nerves III through XII
Gross Appearance of the Medulla Oblongata
 Connects the pons superiorly with the spinal cord
inferiorly
Gross Appearance of the Pons
 Anterior to the cerebellum
 Connects the medulla oblongata to the midbrain
  Bridge connecting the right and left cerebellar
hemispheres
Gross Appearance of the Midbrain
 Connects the pons and the cerebellum with the
forebrain
 Its long axis inclines anteriorly as it ascends
through the opening in the tentorium cerebelli
 Traversed by a narrow channel—the cerebral
aqueduct, which is filled with cerebrospinal fluid.
It also connects the 3rd and 4th ventricles.
Transverse Section of the Midbrain at the Level of the
Superior Colliculi
 Superior colliculus
 Large nucleus of gray matter that lies
beneath the corresponding surface
elevation and forms part of the visual
reflexes
 Receives afferent fibers from the optic
nerve. The visual cortex, and the
spinotectal tract
 The efferent fibers form the tectospinal
and tectobulbar tracts
o Responsible for reflex
movements of the eye, head, and
neck in response to visual stimuli
 Crus Cerebri
 Contains important descending tracts and
is separated by the tegmentum by the
substantia nigra
 The corticopinal and corticonuclear fibers
occupy the middle 2/3 of the crus
 The corticopontine fibers are also present
here
LESIONS OF THE BRAINSTEM
Vascular Lesions of the Medulla
 Medial Medullary Syndrome
 Results from the occlusion of the anterior
spinal artery
 Affected structures and resultant deficits:
o Corticospinal tract – contralateral
hemiparesis of the trunk and
extremities
o Medial Lemniscus- contralateral
loss of proprioception,
discriminative tactile sensation,
and vibration sensation from the
trunk and extremities
o Hypoglossal nerve roots (intra-
axial fibers) – ipsilateral flaccid
paralysis of the tongue
 Lateral Medullary Syndrome (PICA syndrome)
 “Wallenburg Syndrome”
 Results from occlusion of the vertebral
artery or one of its medullary branches
 Affected structures and resultant deficits:
o Vestibular nuclei (medial &
inferior) – nystagmus, nausea,
vomiting, and vertigo
o Inferior cerebellar peduncle –
ipsilateral cerebellar signs
(dystaxia, dysmetria,
dysdiadochokinesia)
o Nucleus ambiguus of CN IX, X, and
XI- ipsilateral laryngeal,
pharyngeal, and palatal paralysis
(loss of gag reflex [efferent limb],
dysarthria, dysphagia, and
dysphonia)
o Glossopharyngeal nerve roots
(intra-axial fibers)- loss of the gag
reflex (afferent limb)
o Vagal nerve roots (intra-axial
fibers) - neurologic deficits as
those seen in the lesion of the
nucleus ambiguus
o Spinothalamic tracts –
contralateral loss of pain and
temperature sensation from the
trunk and extremities
o Spinal trigeminal nucleus and
tract- ipsilateral loss of pain and
temperature sensation from the
face
o Descending sympathetic tract-
ipsilateral Horner syndrome
(ptosis, miosis, hemianhidrosis,
vasodilation, and apparent
enophthalmos)
Vascular Lesions of the Pons
 Results from occlusion of the basilar artery or its
branches (the anterior inferior cerebellar artery
[AICA], transverse pontine arteries, and superior
cerebellar artery)
 Medial Inferior Pontine Syndrome
 Results from occlusion of the paramedian
branches of the basilar artery
 Affected structures and resultant deficits:
o Abducent nerve roots (intra-axial
fibers) – ipsilateral rectus
paralysis
o Corticobulbar tracts-
contralateral weakness of the
lower face
o Corticospinal tracts- contralateral
hemiparesis of the trunk and
extremities
o Base of the pons (middle
cerebellar peduncle)- ipsilateral
limp and gait ataxia
o Medial lemniscus- contralateral
loss of proprioception,
discriminative tactile sensation,
and vibration sensation from the
trunk and extremities
 Lateral Inferior Pontine Syndrome (AICA
Syndrome)
 Results from occlusion of a long
circumferential branch of the basilar
artery—AICA
 Affected structures and resultant deficits:
o Facial nucleus and the intra-axial
nerve fibers- ipsilateral facial
nerve paralysis, loss of taste from
the anterior 2/3 of the tongue,
and loss of the corneal and
stapedial reflexes
 o Cochlear nuclei and intra-axial
nerve fibers- unilateral central
nerve deafness
o Vestibular nuclei and intra-axial
nerve fibers- nystagmus, nausea,
vomiting, and vertigo
o Spinal trigeminal nucleus and
tract- ipsilateral loss of pain and
temperature sensation from the
face
o Middle and inferior cerebellar
peduncles- ipsilateral limb and
gait dystaxia
o Spinothalamic tracts-
contralateral loss of pain and
temperature sensation from the
trunk and extremities
o Descending sympathetic tract-
ipsilateral Horner syndrome
(ptosis, miosis, hemianhidrosis,
vasodilation, and apparent
enophthalmos)
 Lateral Midpontine Syndrome
 Results from occlusion of a short
cirumferential branch of the basilar
artery
 Affected structures and resultant deficits:
o Trigeminal nuclei and nerve root
(motor and principal sensory
nuclei) – complete ipsilateral
trigeminal paralysis including:
a. Paralysis of the
muscles of
mastication
b. Jaw deviation of the
paretic side (due to
unopposed action of
the intact lateral
pterygoid muscle)
c. Facial
hemianesthesia
(pain, temperature,
touch, and
proprioception)
d. Loss of the corneal
reflex (Afferent limn
of CN V-1)
o Middle cerebellar peduncle (base
of the pons) – ipsilateral limb and
gait ataxia
 Lateral Superior Pontine Syndrome
 Results from occlusion of a long
circumferential branch of the basilar
artery, the superior cerebellar artery.
 Affected structures and resultant deficits:
o Superior and middle cerebellar
peduncles – ipsilateral limb and
trunk dystaxia
o Dentate nucleus – signs similar to
those seen with damage to
superior cerebellar peduncle
(dystaxia, dysmetria, and
intention tremor)
o Spinothalamic and
trigeminothalamic tracts – trunk and extremities
contralateral loss of pain and
temperature sensation from the
trunk extremities and face
o Descending sympathetic tracts –
ipsilateral Horner syndrome
(ptosis, miosis, hemihidrosis, and
apparent enophthalmos)
o Medial lemniscus (lateral division
[graciis])—contralateral loss of
proprioception, discriminative
tactile sensation, and vibration
sensation from the trunk and
lower extremity
 Locked-in Syndrome (pseudocoma)
 Results from infarction of the base of the
superior pons, infarcted structures
include corticobulbar and corticospinal
tracts, resulting in quadriplegia and
paralysis of the lower cranial nerves
 Also may result from central pontine
myelinolysis
 Communication occurs only by blinking
or moving eyes vertically
Lesions of the Midbrain
 Result from vascular occlusion of the
mesencephalic branches of the posterior cerebral
artery
 May result from aneurysm of the posterior circle
of Willis
 May result from tumors of the pineal region
 May result from hydrocephalus
 Dorsal Midbrain (Parinaud syndrome)
 Frequently the result of a pinealoma or
germinoma of the pineal region
 Affected structures and resultant deficits:
o Superior colliculus and pretectal
area – paralysis of upward and
downward gaze, pupillary
disturbances, and absence of
convergence
o Cerebral aqueduct –
noncommunicating
hydrocephalus (as a result of
compression from a pineal
tumor)
 Paremedian Midbrain (Benedikt Syndrome)
 Results from occlusion or hemorrhage of
the paramedian midbrain branches of the
posterior cerebral artery
 Affected structures and resultant deficits:
o Oculomotor nerve roots (intra-
axial fibers) – complete ipsilateral
oculomotor nerve paralysis; eye
abduction and depression; severe
ptosis; ipsilateral fixed and
dilated pupil
o Red nucleus and
dentatorubrothalamic tract –
contralateral cerebellar dystaxia
with intention tremor
o Medial lemniscus – contralateral
loss of proprioception,
discriminative tactile sensation,
and vibration sensation from
 Medial Midbrain (Weber Syndrome)
  Results from occlusion of midbrain
branches of the posterior cerebral artery
and aneurysms of the circle of Willis
 Affected structures and resultant deficits:
o Oculomotor nerve roots (intra-
axial fibers)
o Corticobulbar tracts
contralateral weakness of the
lower face (CN VII), tongue (CN
XII), and palate (CN X)
o Corticospinal tracts
contralateral hemiparesis of the
trunk and extremities
Acoustic Neuroma (Schwannoma)
o Accessory nerve (CN XI) – weakness of the
sternocleidomastoid and upper trapezius
muscles (the shoulder droops)
Subclavian Steal Syndrome
 Results from thrombosis of the left subclavian
– artery proximal to the vertebral artery. Blood is
shunted retrograde down the vertebral artery into
the left subclavian artery
 Leads to the following clinical signs:
– o Transient weakness and claudication of
the left arm on exercise
o Vertebrobasilar insufficiency (Vertigo,
dizziness)

 Is a benign tumor of the Schwann cells affecting THE CEREBRUM

the vestibulocochlear nerve (CN VIII)
 Is a posterior fossa tumor of the internal auditory
meatus and the cerebellopontine angle
 Frequently compresses the facial nerve (CN VII),
which accompanies CN VIII in the CP angle and the
internal auditory meatus
 May impinge on the pons and affect the spinal
trigeminal tract (CN V)
 Affected structures and resultant deficits:
o Cochlear nerve of CN VIII – unilateral
nerve deafness and tinnitus
o Vestibular nerve of CN VIII- vertigo,
nystagmus, nausea, vomiting, and
unsteadiness of gait
o Facial nerve (CN VII) – facial weakness
and loss of corneal reflect (Efferent limb)
o Spinal trigeminal tract (CN V) –
paresthesias and anesthesia of ipsilateral
face; loss of corneal reflec (Afferent limb)
o Abducent nerve (CN VI) – diplopia
o Corticospinal tract—contralateral spastic
paresis
Internuclear Ophthalmoplegia (INO)
 Also known as medial longitudinal fasciculus
(MLF) syndrome, which results from a lesion of
the MLF. Lesions occur in the dorsomedial pontine
tegmentum and may affect one or both MLFs.
 Frequent sign of multiple sclerosis
 Results in medial rectus palsy on attempted lateral
gaze and monocular nystagmus in the abducting
eye with normal convergence
 Lesions of the abducent nucleus of CN VI result in
all MLF signs and a lateral rectus paralysis with
internal strabismus
Jugular Foramen (Vernet) Syndrome
 Affects CN IX, CN X, and CN XI
 Affected structures and resultant deficits:
o Glossopharyngeal nerve (CN IX) – lose of
gag reflex (afferent limb); loss of taste
sensation in the posterior third of the
tongue; unilateral loss of carotid sinus
reflex
o Vagal nerve (CN X) – laryngeal paralysis
with dysarthria, dysphagia, and
dysphonia; palatal paralysis with loss of
gag reflect (efferent limb)
Cerebrum
 Largest part of the brain situated in the anterior
and middle cranial fossae of the skull
 Subdivisions of the Cerebrum: diencephalon and
telencephalon
Diencephalon
 Can be divided into four major parts: thalamus,
subthalamus, epithalamus, and hypothalamus
 Thalamus
 Large ovoid mass of gray matter
 Forms the major part of the diencephalon
 Serves as a cell station to all the main
sensory systems (Except the olfactory
pathway)
 Situated on each side of the third
ventricle
 Cell station where much of the
information is integrated and relayed to
the cerebral cortex
 Plays a key role in the integration of
visceral and somatic functions
 Subthalamus
 Lies inferior to the thalamus and is
situated between the thalamus and the
tegmentum of the midbrain
 Among the collection of nerve cells found
in the subthalamus are the cranial nerve
ends of the red nuclei and the substantia
nigra.
 Epithalamus
 Habenular Nuclei
o Small group of neurons situated
just medial to the posterior
surface of the thalamus
o Believed to be the center for
integration of olfactory, visceral,
and somatic afferent pathways
 Pineal Gland (Body)
o Small conical structure that is
attached by the pineal stalk to the
diencephalon
o Recognized as an important
endocrine gland capable of
influencing activities of the
pituitary gland, the islets of
Langerhans of the pancreas, the
parathyroids, the adrenal cortex
and the adrenal medulla, and the
gonads.
 o Their actions are mainly o Claustrum – between the lentiform nucleus
inhibitory and either directly and the insular cortex; has reciprocal
inhibit the production of connections between the sensory cortices;
hormones or indirectly inhibit separates the external capsule from the
the secretion of releasing factors subcortical white matter of the insula
by the hypothalamus.
 Hypothalamus Connections of the Corpus Striatum
 Part of the diencephalon that extends Afferent Corticostriate All parts of the cerebral
from the region of the optic chiasma to Fibers cortex send axons to the
the caudal border of the mammillary caudate nucleus and
bodies the putamen. The
 The hypothalamus controls and largest input is from the
integrates the functions of the autonomic sensorimotor cortex.
nervous system and the endocrine Glutamate is the
systems and plays a vital role in neurotransmitter.
maintaining body homeostasis. Thalamostriate Intralaminar nuclei of
 Involved in activities such as regulation of Fibers the thalamus send
body temperature, body fluids, drives to axons to the caudate
nucleus and putamen.
eat and drink, sexual behavior, and
Nigrostriate Neurons in the
emotion.
Fibers substantia nigra send
axons to the caudate
nucleus and the
putamen. It liberates
dopamine at their
terminals as the
neurotransmitter.
BASAL GANGLIA
Brainstem Ascending fibers from
- Collection of masses of gray matter situated Striatal Fibers the brainstem end in
within each cerebral hemisphere the caudate nucleus
and putamen.
 Components
Efferent Striatopallidal Pass from the caudate
o Caudate Nucleus – gray matter closely related Fibers nucleus and putamen
to the lateral ventricle; lateral to the internal to the globus pallidus.
capsule GABA (gamma-
 Internal capsule – separates the aminobutyric acid) is the
caudate nucleus from the lentiform neurotransmitter.
Striatonigral Pass from the caudate
nucleus
Fibers nucleus and putamen to
o Putamen the substantia nigra.
o Globus Pallidus Some use GABA or
 Grouping of the Basal Nuclei/Ganglia acetylcholine as
o Striatum – consists of caudate nucleus and neurotransmitter.
putamen
Connections of the Globus Pallidus
o Lentiform nucleus – globus pallidus and
Afferent Striatopallidal Pass from the caudate
putamen; buried deep in the white matter of Fibers nucleus and the putamen
the cerebral hemisphere and is related to the globus pallidus.
medially to the internal capsule, and laterally Efferent Pallidofugal (1) ansa lenticularis –
to the eternal capsule; continuous with the Fibers pass to the thalamic nuclei
caudate nucleus (2) fasciculus lenticularis
o External capsule – separates the – pass to the subthalamus
(3) pallidotegmental
lentiform nucleus from the claustrum
fibers – terminate in the
o Corpus striatum – lentiform nucleus and caudal tegmentum of the
caudate nucleus; situated lateral to the midbrain
thalamus; divided by a band of nerve fibers, (4) pallidosubthalamic
internal capsule fibers – pass to the
o Amygdaloid Nucleus – in the temporal lobe subthalamic nuclei
close to the uncus; considered part of the
limbic system
o Substantia Nigra – found in the midbrain; its
neurons are dopaminergic (containing
dopamine), inhibitory, and have many
connections to the corpus striatum
o Subthalamic Nuclei – found in the
diencephalon; glutamiergic, and excitatory
and have many connections to the globus
pallidus and substantia nigra
  Internal medullary lamina nerve fibers
 Anterosuperiorly, it splits and forms a “Y”

ANTERIOR PART

 Contains anterior thalamic nuclei which receive

the mamillothalamic tract from mamillary nuclei
 Also receive reciprocal connections with cingulate
and hypothalamus
 Emotional tone and mechanisms of recent
memory (6 mos.) hippocampus

MEDIAL PART

 Large dorsomedial nuclei and several smaller

nuclei

LATERAL PART (DORSAL)

 Dorsal tier includes lateral dorsal nucleus and

lateral posterior nucleus and pulvinar
 Interconnections with other thalamic nuclei;
parietal, cingulate, occipital and temporal lobes

LATERAL PART (VENTRAL)

 Craniocaudal
 Ventral anterior
 Connected to reticular formation, substantia
nigra, corpus striatum, premotor cortex and
other
 Produce abnormal movements
 Lies in pathway between corpus striatum and
motor of frontal cortex affecting movement
 Feed info to the motor areas
 Ventral lateral
 Major input from cerebellum and minor from
red nucleus
 Main projections pass to motor and premotor
regions of the cerebral cortex
 Ventral posterior

ARTERIES OF THE BRAIN

- Internal carotid artery

- Vertebral arteries
- Circle of Willis

1. INTERNAL CAROTID ARTERY

THALAMUS
 Rostral end of the brainstem
 Important relay and integrative station for
information
 Lateral borders of 3rd ventricle
 Lateral to thalamus is internal capsule
 Large egg-shaped mass of gray matter that forms
major part of diencephalon
 Anterior end is narrow, rounded; forms posterior
boundary of interventricular foramen
 Forms part of pulvinar
 Inferior part continuous with tegmentum of
 Cerebral Portion:
midbrain; connected to corpora quadrigemina by
superior and inferior brachium
 Medial surface of thalamus part of lateral wall of
3rd ventricle and usually connected to opposite
thalamus by gray matter (masa intermedia)
interthalamic adhesion/connection
- Bifurcation off common carotid artery
- Localized dilation: carotid SINUS
(chemoreceptors)
- Goes into the brain
- Ascends neck and perforates base of skull
by passing through carotid canal of the
temporal bone
- Runs horizontally forward through the
cavernous sinus, medial of the anterior
clinoid process by perforating dura mater
- Subarachnoid space  Subarachnoid
mater posterior to region of the medial
end of lateral cerebral sulcus
a) Ophthalmic artery
- Emerges from cavernous sinus
- Enters orbit through opticalcanal
below and lateral to the optic nerve
 - Supplies the eye and other orbital
structures, and its terminal branches  Cranial Portion
supply the frontal area of the scalp, a) Meningeal
ethmoidal & frontal sinus, and b) Posterior inferior cerebellar artery
dorsum of the nose - LARGEST branch of VA, irregular
b) Posterior communicating artery - Inferior surface of cerebellar vermis,
- Connects ant. And post. Circulation central nuclei of cerebellum and
(cerebral artery) undersurface of medulla and choroid
- Originates from ICA, close to of the 4th ventricle
terminal bifurcation c) Medullary
- *aneurysm compresses on CN 3  d) Basilar
dilated pupils, head and neck pain - Ends of basilar artery from 2
- Posterior above CN 3 to join PCA posterior cerebral artery
forming part of the Circle of Willis 1. Pontine – substance of
c) Choroidal artery pons
- Originates from internal carotid 2. Labyrinthine
artery to its terminal bifurcation - Accompanies 7
- Closely posterior to optic tract, and 8 CN into
enters inferior horn of lateral internal acoustic
ventricle and ends in choroid plexus meatus and
- Crus cerebri, lateral geniculate body, supplies internal
optic tract and internal capsule ear
d) Ant. Cerebral artery - Often arises
- Forward and medial superior to from anterior
optic nerve, and enters longitudinal inferior
fissure cerebellar artery
- Joined to the artery of the opposite (*anatomical
side by the anterior communicating variation)
artery 3. Anterior Inferior
- Backward over the corpus callosum Cerebellar Artery
and ___ with posterior cerebral artery - Posterior and
- CORTICAL BRANCHES: Supplying lateral, supplies
surfaces, medial surface of cerebral anterior and
cortex inferior
- Lesion: Leg weakness contralateral; cerebellum
precentral gyrus – bowel and bladder - Pass to pons and
control upper medulla
- CENTRAL BRANCHES: Anterior (*Labyrinthine)
perforated substance, and helps 4. Superior Cerebellar
supply lentiform, caudate, and Artery
internal capsule - Termination of
e) Middle cerebral artery basilar artery
- LARGEST branch of the ICA - Around cerebral
- Laterally in cerebral sulcus peduncle and
- CORTICAL BRANCHES: lateral surface supplies the
of hemisphere except the narrow superior surface
strip supplied by anterior cerebral of cerebellum
artery - Pons, pineal
- Motor area except leg gland, and
- CENTRAL BRANCHES: Enter anterior superior
perforated substance, supply medullary
lentiform, caudate and int. capsule velum
- *A1 segment of ICA  A2 5. Posterior Cerebral
Artery
2. VERTEBRAL ARTERY - Lateral and back
- First part of Subclavian Artery to midbrain,
- Ascends neck passing through foramina posterior
in transverse process of upper 6 cervical communicating
- *Basilar Artery – 2 vertebral arteries but branches of ICA
flow is separate (L & R) - CORTICAL:
- Foramen magnum with spinomedullary inferolateral and
medial temporal
junction
- Lower border of pons
 and occipital
lobe
- Lesion: VISION
 can have
language
problems
- CENTRAL:
thalamus,
lentiform,
midbrain,
pineal, medial
geniculate
bodies (*VISION
and HEARING)
- CHOROIDAL:
inferior horn of
lateral ventricle,
supplies choroid  Primary Somatosensory – 3, 1, 2
of 3rd ventricle  Vestibular Cortex – 2
 Primary Motor Cortex – 4
 Somatosensory Association Cortex – 5, 7, 40
 Frontal eye field – 8
 Prefrontal Cortex – 9, 10, 11, 12 (*Inhibition)
 Broca’s – 44, 45
 Primary Auditory Cortex – 41, 42
 Cingulate gyrus – 24
 Premotor Cortex – 6
 Visual Association Cortex – 18, 19
 Primary Visual Cortex – 17
 Uncus- 28
 Parahippocampal -20
 Primary Olfactory -34

 Circle of Willis

 Brain Caps
- Greater in gray matter
- Greater metabolic activity in neuronal cell
bodies of gray matter
- Blood-brain barrier
- Venous Circulation  Venous Arteries
- Fat cells  Atherosclerotic plaques
- Autoregulation; compensatory at least 70%
damage in blood flow – contralateral weakness
- Mean arterial pressure: 60-160

BRODMANN’S AREAS