Outline † brain

A. Medulla Oblongata † spinal cord.

♪ brain →

† forebrain
Video → Medicosis Perfectionalis
† midbrain
Notes → Transcript of Medicosis Perfectionalis
† hindbrain hind brain

♪ Hind brain

† cerebellum
Medulla Oblongata
† pons
ϫ † medulla
– Brain stem → made of – ventricles inside brain
♪ Midbrain ♪ ventricle of forebrain
♪ pons
† lateral ventricle
♪ medulla
† third ventricle
† like a stem. ♪ ventricle of midbrain
♪ we call it medulla because medulla means core.
† just a duct → cerebral aqueduct of Sylvius.
† Core of what? Core of foramen magnum. ♪ Ventricle for hindbrain
♪ Another word to describe core → myelo.
† fourth ventricle
† hence myelencephalon. † looks like a pyramid
♪ oblong means → rectangle
– Embryology
– brain is divided into ♪ Three primary vesicles of brain →
† four brain † Prosencephalon
† midbrain † Mesencephalon
† hindbrain. † Rhombencephalon
♪ medulla part of → hindbrain
♪ Prosencephalon → give rise to
† hindbrain consists of † telencephalon on outside
 pons † diencephalon on inside.
 medulla ♪ Mesencephalon give rise to →
 cerebellum. † Mid brain,
– Medulla has ♪ Rhombencephalon give rise to →
♪ descending efferent fibers → motor fibers
† metencephalon
♪ ascending efferent fibers → sensory fibers
 metencephalon give rise to →
– Medulla follows the rule ž Pons
♪ drawing line in center
ž Cerebellum
† Front is motor † Myelencephalon give rise to medulla
† Behind is Sensory ♪ Telencephalon give rise to →
♪ Therefore →
† cerebral hemisphere and
† motor decussation → anterior of medulla † slightly inner basal
† sensory decussation → in posterior medulla ♪ diencephalon, give rise to →

– central nervous system →

 † any word that has thalamus  Note → Nucleus ambiguus → motor nucleus
 thalamus of basically vagus nerve but shared with
 hypothalamus cranial nerves CN 9 11
 epithalamus  Purely motor nucleus
 subthalamus  M in ambiguus M in motor
 meta thalamus, † Motor nucleus

♪ Ventricle of telencephalon → lateral ventricles. † Mn → nucleus ambiguous has M

† ventricle of diencephalon → Third ventricle.  located in medulla → M.

♪ Ventricle of midbrain → not a ventricle → cerebral  function is somatic motor → M.
aqueduct of Sylvius. † supplies skeletal muscle → stylopharyngeus,

♪ Ventricle of hindbrain → fourth ventricle. ♪ Spinal trigeminal nucleus aka trigeminal sensory

† fourth ventricle related to nucleus

 Pons † general sensations

 medulla ♪ Solitary nucleus (aka Nucleus of Tractus Solitarius)

 cerebellum † Chemoreceptors in carotid body

♪ Medulla and 4th ventricle † baroreceptors in carotid sinus

† Upper portion of medulla has relation with † Taste sensation → from posterior tongue

fourth ventricle posteriorly.  Mn → S for solitary S for sensory

– cerebrospinal fluid † Note

♪ secreted by ependymal cells lining choroid plexus  Nucleus of Tractus solitarius shared nucleus,
which lines lateral ventricles. has fibers from →
– Origin of Cranial nerves ž CN 7 9 10

♪ from forebrain. ž Mn → NTS → 9 10 7

† Cranial nerves 1 and 2 ♪ Inferior Salivatory nucleus

 CN 1 → telencephalon † Parasympathetic Nucleus

 CN 2 → diencephalon. † Secretomotor (PANS) fibers to parotid gland via

♪ from midbrain. otic ganglion.

† Cranial nerves 3 and 4 → † Note

♪ from pons  Secretomotor (PANS) fibers to sub lingual +

† Cranial nerves 5, 6, 7, 8 → sub mandibular gland from Superior

♪ From Medulla. Salivatory nucleus
† Cranial Nerves 9, 10, 11, 12 →  Sup Salivatory nucleus → CN 7

 This is about superficial attachment of cranial  Inferior Salivatory Nucleus → CN 9

nerves, not about deep nuclei. ž Mn → CN 7 superior to CN 9

– Cranial nerves with Autonomic activity ž superior is for seven inferior is for nine

♪ CN III – Vagus nerve → mcq fav

♪ CN VII ♪ Nucleus Ambiguus

♪ CN IX † SVE → mcq

♪ CN X  efferent nerve fibers that provide motor

ϫ Cranial Nerves of Medulla innervation to the muscles of the pharyngeal
– Glossopharyngeal nerve arches in humans
♪ Many nuclei in medulla † supply →

♪ Both nerve →  All muscles of pharynx except

† Sensory stylopharyngeus (CN 9)

† Motor  all muscles of palate except tensor verli

♪ Also part of parasympathetic NS palatini (CN V3)

– Nuclei of CN IX  all muscles of larynx – no exception

♪ Nucleus ambiguous.  some muscles of oesophagus.

 ♪ Nucleus of Tractus Solitarius † spinal nucleus → in medulla + spinal cord.
† chemoreceptors & bare receptors in aortic arch ♪ sensory nucleus of trigeminal nerve
(GVA) † pain and temperature sensation from face.

† Taste from epiglottis (SVA) † is the trigeminal nucleus from which

♪ Trigeminal sensory nucleus  glossopharyngeal borrows

† general sensations of  vagus nerve borrows
 trachea 
 oesophagus – Peduncles
 pharynx ♪ brainstem communicate with cerebrum in front →
 larynx Via cerebral peduncles.
 part of auricle ♪ brainstem communicate with cerebellum behind →

 external auditory nucleus. Via cerebellar peduncles.

♪ Dorsal motor nucleus of vagus † midbrain to cerebellum→ superior cerebellar

† GVE fibers → mcq peduncle

 Def → efferent nerve fibers of the autonomic † pons to cerebellum → middle cerebellar

nervous system (also known as the visceral peduncle

efferent nervous system) that provide motor † medulla to cerebellum → inferior cerebellar

innervation to smooth muscle, cardiac muscle, peduncle.

and glands. – Medulla posterior View
† Parasympathetic → mcq ♪ Superior medullary velum is visible.

† PANS fibers to ♪ we'll see inferior medullary velum.

 Smooth muscles of bronchi – Superficial attachment of cranial nerves.

 Thorax → Heart ♪ Only important points mentioned

 Abdomen → GI tract ♪

 Glands – anterior aspect of medulla

– Accessory nerve ♪ In anterior midline → anterior median fissure
♪ 2 parts ♪ Lateral to midline on either sides → pyramid
† cranial part (root) ♪ Lateral to pyramids on either sides → anterolateral

† spinal part (root) sulcus

♪ Cranial root from medulla. ♪ Lateral to anterolateral sulcus on either sides →

♪ Nucleus Ambiguous olives

† accessory nerve help vagus innervations in head ♪ Lateral to olives on either sides → posterolateral

and neck sulcus

– hypoglossal nerve CN 12 ♪ Lateral to posterolateral sulcus → inferior

♪ hypoglossal nucleus cerebellar peduncle

† Cn 12 begins from HG nucleus ♪ nerve that emerges from anterolateral sulcus →

† supply all muscles of tongue except one 12th nerve

palatoglossus muscle (CN 10) ♪ nerves that emerge from posterolateral sulcus →

– trigeminal nerve cranial nerves 9 10 and 11

♪ trigeminal mixed → † Rule → if a nerve is motor → nuclei will lie

† sensory → majorly close to midline → hence the CN 12 nucleus

† motor → minorly † If nerve is sensory or mixed → nuclei will lie

♪ trigeminal nerve emerges from pons as nuclei are in more laterally → hence the CN 9 10 11 nucleus.
pons. ♪ Pyramids → major pathway for motor tracts

♪ Sensory nucleus of trigeminal nerve has three † Pass via internal capsule to cerebral cortex →

pieces mcq.
† principal sensory nucleus → in pons – Posterior aspect of medulla.
† mesencephalic nucleus → in midbrain
 ♪ In posterior midline → posterior median fissure
(not very evident in diagram)
♪ Below floor of 4th ventricle → 2 Longitudinal
elevations on each side → Counterparts of pyramid
and olive posteriorly →
† Fasciculus gracilis → medial
† Fasciculus cuneatus → lateral
 These are ascending tracts
 Belong to dorsal column medial lemniscus
pathway.
 Fibers are 1st order sensory neuron.
♪ On inside deep to tract →
† gracilis nucleus
† cuneatus nucleus
 These are sensory nuclei
 both → Fasciculi gracilis + Fasciculi cuneatus
tracts synapse onto cell bodies of 2nd order
neurons gracilis nucleus & cuneatus nucleus
 Nuclei gracilis & nuclei cuneatus give out
fibers → internal arcuate fibers.
 Bundle of internal arcuate fibers →
collectively called medial lemniscus tract.
 Medial lemniscus tract decussate & then
ascends upwards.
♪ fourth ventricle
† floor of fourth ventricle → looks like a diamond
† superior medullary velum
† inferior medullary velum
† horizontal fibers called medullary stria.
† Triangular structures
 hypoglossal trigone → closest to midline
 vagus trigone → triangle for vagus nerve,
 auditory trigone → triangle for auditory nerve
ϫ Transverse Sections of Medulla
– TS Through Upper Part Of Medulla Passing Through
Floor Of 4th Ventricle
♪ upper medulla, also known as rostral medulla,
♪ also known as open medulla → because opens onto
fourth ventricle.
♪ Pyramids in diagram identify anterior part
♪ posterior opens onto fourth ventricle,
♪ anteriorly visible
† pyramids
† olives.
♪ Posteriorly visible →
† Gracilis tract → medial
† cuneatus tract → lateral.
† more lateral→ inferior cerebellar peduncles,
♪ nucleus visible
† cranial nerve 8 nuclei
 originally lies in pons
 Some part extends to medulla
† cranial nerve 10 nuclei
 Nucleus ambiguous
ž Nuclei of CN 10 but shared by CN 9 & 11
 Nucleus solitarius
ž Shared nucleus of 7 9 10
† Spinal nucleus and spinal tract of trigeminal
nerve
 Part of sensory nucleus of trigeminal nerve.
♪ Other Imp Structures
† From posterior to anterior
 medial longitudinal fasciculus or MLF
ž Function → makes your eye look medially,
closer to nose.
 tectospinal tract
ž from tectum of midbrain to spinal cord.
ž one of extra pyramidal tracts.
 Medial lemniscus
ž dorsal column medial lemniscus system
ž a Pyramidal tract
ž Pyramidal tract runs in pyramid of medulla.
ž Always motor.
ž includes
‫ ؞‬corticospinal → cortex to spinal nerves
‫ ؞‬corticobulbar → brainstem to cranial
nerves.
– TS Through Middle of Medulla Passing Through
Sensory Decussation
♪ sensory decussation is in middle of medulla
† Mn → common sense – word common → middle
 Sensory decussation – middle.
♪ Sensory decussation → means sensory crossing.
♪ Decussation includes fibers of
† dorsal column medial lemniscus system,
† tractus gracilis → medial
† tractus cuneatus → lateral
 Gracilis → from lower extremities.
 Cuneatus from → upper extremities.
ž Mn 1 → When one do something cunning
they do it with their hands.
ž Mn 2 → if one stands anatomical position
→ upper extremities are more lateral to
your lower extremities.
ž Thus, cuneatus more lateral to gracilis.
† Gracilis nucleus
 Cuneatus nucleus
† ϫ Pearls
– TS of Lower Part Of Medulla → level of Pyramidal – In brainstem
Decussation. ♪ motor nuclei are medially → CN 3 4 6 12 (all that

♪ Motor Decussation is in lower medulla come in table of 12 )

† Mn → movements is via lower limbs ♪ Nuclei of 5 7 8 → laterally

  → decussation – Lower medulla. – Centres in Medulla →

♪ Fibers after decussation in pyramids of medulla are ♪ 4 centres

called pyramidal tracts → mcq. † Two vital centres → cannot survive without.
♪ Motor tracts include † Two non vital centres → survive without.
† Pyramidal tracts ♪ Vitals (together called cardio pulmonary)

† Extra pyramidal tracts † Cardiovascular center → essential for heartbeat.

 Only pyramidal tracts decussate † Respiratory center → essential to breathe.
 ♪ Two non vital.

♪ These lovely sensory fibers that belong to dorsal † Swallowing centre

column medial lemniscus system will cross like † Vomiting centres
this. I'm crossing to opposite side. left will become – Vomiting Center →
right and right will become left. Since these are ♪ Nucleus of tractus Solitarius

sensory fibers we call this crossing sensory – Vertigo with nausea and vomiting associated with
decastation. In middle part of medulla we call them Dorsal vagus nucleus.
dorsal column medial lemniscus system because ♪ Location Dorsal Vagus nucleus → lateral to

they leave dorsal column and they go towards rhomboid fossa

medial lemniscus which is medial in anatomical ♪ Rhomboid fossa → depression in anterior part of

location. Let me remind you that interior we have 4th ventricle.

pyramids and then olives, posteriorly we have – Lost of taste sensation →
gracilis then cuneatus. spinal tract of trigeminal ♪ Nucleus of tractus solitarius CN 7 9 10

nerve and spinal nucleus of trigeminal are located – Lesion to Nucleus gracilis + cuneatus →
here for pain and temperature sensation from your ♪ Astrogenesis → inability to judge shape & form of

face. I still have spinocerebellar tract from spinal objects.

cord to cerebellum Hashtag equilibrium and this is – Superior Olivary nucleus →
second slice of medulla Let's go downstairs lower ♪ SON of medulla involved in auditory pathway

or caudal medulla at level of motor decastation ♪ Lesion in SON → pt cannot figure out direction

who's crossing here Well form where sound is coming from.

– – Thyroidectomy
♪ pyramidal tract Include ♪ → damage to vocal cords → development of

† corticospinal hoarseness in voice

† corticobulbar ♪ Nerve associated – CN X

♪ Extra pyramidal tract ♪

† Only one extra pyramidal tract → Rubro spinal – Blood Supply →

tract decussate
† Red nucleus of midbrain to spinal cord.
♪ Other Structures
† Gracilis tract & nucleus → medial
† cuneatus tract & nucleus → lateral.
♪ Note →
† sensory decussation → more posterior
† motor decussation → more anterior. ϫ
ϫ ϫ
ϫ ϫ
♪ Vertebral Artery gives rise to →
† ASA
† PICA
† Medullary Arteries
♪ ASA → spinal cord + ventromedial part of medulla
♪ PICA → cerebellum + dorsolateral part of medulla
♪ Medullary Artery → Medulla.
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† H2O2 Catalase
→
O2 and H2O