Internal features of midbrain

• It is traversed by the cerebral aqueduct of Sylvius which divides it into tectum (dorsally)
and 2 cerebral peduncles (ventrally).

• Each cerebral peduncle is divided by a pigmented sheet of grey matter called

substantia nigra into tegmentum (dorsally) and crus cerebri (ventrally).

Internal features of midbrain

1. Crus cerebri: (SEQ - give short account about crus cerebri )

• Is the most anterior part.

• Contains descending fibers from the internal capsule arranged as follows:

- medial 1/5: fronto-pontine

- lateral 1/5: parieto-temporo- & occipito pontine

- middle 3/5: cortico-spinal & cortico-nuclear

*(MCQ) medial part contine Which of following fiber?

2. Substantia nigra:(features)

• A pigmented sheet of grey matter between the crus cerebri and tegmentum.

• It is formed of neurons containing melanin pigment.

• IT SECRETS DOPAMIN, their lesion leads to Parkinsonism.

3-Tegmentum of midbrain

• Contains:

-White matter:

- Longitudinal fibers:

4 lemnisci (lateral, spinal, trigeminal & medial)

DECUSSATIONS

• 2 at the level of inferior colliculus: decussation of superior cerebellar peduncle

(dentatothalamic fibers) & decussation of trochlear nerve.

• 2 at the level of superior colliculus: ventral tegmental decussation (rubro-spinal tract) &

dorsal tegmental decussation (tecto-spinal tract).

Grey matter of tegmentum of midbrain:

• 3 Cranial nerve nuclei: oculomotor nucleus (at level of superior colliculus),

trochlear nucleus (at level of inferior colliculus)

& mesencephalic nucleus of trigeminal (extending upwards from the pons to both levels).

• 2 Other nuclei at level of superior colliculus: red nucleus & pretectal nucleus

1- Red Nucleus :

A large nucleus in the midbrain tegmentum at the level of superior colliculus

Appears red in fresh histological sections due to rich iron content.

2- Pretectal nucleus: (concerned with light reflex)

4-Tectum of midbrain

• Inferior colliculus: Function: relays auditory pathway & auditory reflexes

• Superior colliculus: Function: reflex turning of eyes & neck in response to visual, stimuli.

MCQ : which of the following nuclei of midbrain is concerned to light reflexe?

A: pretectal nucleus

MCQ : which of the following nuclei of midbrain has a high iron content?

A: red nucleus .

MCQ : mention the nuclei present in midbrain at the level of inferior colliculus?

trochlear Nerve

SEQ : mention the nuclei present in midbrain at the level of superior colliculus?

1-Red Nucleus

2-oculomotor nucleus

3-mesencephalic nucleus

SEQ : mention nuclei of cranial and non cranial present midbrain?

1- oculomotor nucleus

2-trochlear nucleus

3-mesencephalic nucleus Of trigemenal

The pons is divided into an anterior part (basis pontis) & a posterior part (tegmentum).

1-THE BASIS PONTIS:

* Descending pyramidal fibers:

collect into separate bundles that include:

a- Cortico-spinal fibers to the AHCs

b- Cortico-nuclear fibers to the cranial nerve nuclei

c- Cortico-pontine fibers to the pontine nuclei.

2- Pontine nuclei (pontine nuclei).

(Table for revision)

The rest of the pons is made up of tracts passing through the pons including:

• Descending corticospinal tracts – responsible for voluntary motor control of the body.

• Descending corticobulbar tracts – responsible for voluntary motor control of face, head and
neck.

• Ascending medial lemniscus tracts – responsible for fine touch, vibration and proprioception.

• Ascending spinothalamic tracts – responsible for pain and temperature sensation

Case: patient with lestion loss pain sensation with thermoanasthesia?

A-spinothalamic tract

Case: patient with lestion in fine touch with sensory positions?

A-medial lemniscus tract



CORTICO-PONTO-CEREBELLAR PATHWAY

Afferent Part [cortico-ponto-cerebellar pathway] includes:

• 1. Cortico-pontine fibers: arise from the 4 lobes of cerebral cortex & thus

include fronto, parieto, temporo & occipito-pontine fibers.

All descend in internal capsule, then the crus cerebri to end on the apontine nuclei.

• 2. Ponto-cerebellar fibers: the axons of the pontine nuclei form the transverse

pontine fibers which pass via the MCP to the contralateral cerebellum

Efferent Part [dentato-rubro-thalamo-cortical pathway] includes:

• 1. Dentato-thalamic fibers: Arise from the dentate nucleus of cerebellum & pass

via the SCP decussate & end on the lateral anterior nucleus of thalamus either

directly or after relaying on the red nucleus

• 2. Thalamo-cortical fibers: projects to the cerebral cortex.

Clinical notes (pontine hemorrhage )

if the hemorrhage occurs from one of the arteries and is unilateral will be:

1- facial paralysis on side of the lesion (involvement of the facial nerve nucleus

And therefore , results in lower motor neuron palsy )

2- paralysis of the limbs on the opposite side (involvement of the corticospinal fiber as they

Pass through the pons ).

3-there is often paralysis of conjugate ocular deviation (involvement of the abducent nerve

Nucleus and medial longitudainal fasciculus

Internal features of medulla oblangata

-internal structure of the medulla

considered at 4 levels:

1-level of decussation of pyramids

2-level of decussation of lemnisci

3-level of the olives

4-level just inferior to the pons

Decussation of pyramids represents the crossing of the?

A-corticospinal tracts

PYRAMIDAL DECUSSATION

• It is motor decussation .

• Formed by pyramidal fibers (75%)Cross to opposite side .

• They descend in the lateral white column of the spinal cord

as thr lateral corticosinal tract

• uncrossed fibers form the ventral corticospinal tract

SENSORY DECUSSATION

Formed by the crossed internal arcuate fibers .

Medial leminiscus :

• composed of the ascending internal arcuate fibers after their crossing

• Lies adjacent to the middle line ventral to central canal

• Terminatetes in thalamus.

OLIVARY NUCLEI

SEQ : give short account olivary nuclei

• (4 in number: inferior, superior, dorsal accessory & medial accessory olives).

• The superior olive: lies in the pons & forms part of the auditory pathway

• The inferior olive: is the largest . It lies in the open medulla, lateral to the pyramid.

Function of inferior olive:

• 1. Relays proprioception to cerebellum

• 2. Relays newly performed motor information to the cerebellum

• 3.The dorsal & medial accessory olives: Lie posterior & medial to the inferior
olive. Both send proprioceptive fibers to the cerebellum

Lateral medullary syndrome?

• lateral part of the medulla oblongata is supply by the posterior inferior artery ,

Which is usually a branch of the vertebral artery.

• Thrombosis of either of these arteries produce of the following signs and

symptoms:

1- dysphasia and dysarthria due to paralysis of the ipsilateral palatl and laryngeal
muscle ( innvervated by the nucleus ambiguous )

2- analgesia and thermoanesthesia on the ispsilateral side of the face

(Nucleus and spinal tract of the trigemenal nerve )

4-vertigo ,nausea , vomiting and nystagmus (vestibular nuclei)

5- lpsilateral horner syndrome (descending sympathetic fibers )

6- lpsilateral cerebellar signs - gait and limb ataxia ( cerebellar or inferior cerebellar
peduncle )

7- contralateral loss of sensation of pain and temperature (spinothalmic tract).