Outline – midbrain looks like
A. Midbrain
Video → Medicosis Perfectionalis
Notes → Transcript of Medicosis Perfectionalis
Medulla Oblongata
ϫ ♪ nuclei of oculomotor → at level of superior
– Intro
♪ Midbrain → embryonic name mesencephalon.
♪ meso means → mid  mesencephalon → midbrain
– exists in middle between cerebrum upstairs and
pons and medulla downstairs.
– Communication
♪ communicates above with cerebrum → via cerebral
peduncle
† In other words → communicating between
midbrain and cerebrum.
♪ communicates posteriorly with cerebellum behind
via superior cerebellar peduncle.
– Cranial nerves
♪ 3 & 4 in midbrain.
♪ Most eye reflexes center in midbrain
♪ Both oculomotor and trochlear nerves responsible
for eye movement
♪ cornea reflex → center is in midbrain
♪ pupillary light reflex center → in midbrain.
♪ in case of a midbrain lesion→ loss of reflexes
– Rule
♪ followed by midbrain
† Anterior is motor
† posterior is sensory.
– Nuclei
♪ upper part of midbrain → nucleus for oculomotor
♪ lower half of midbrain → nucleus for trochlear
nerve.
ϫ Gross Appearance
♪ a pair of shorts (chadda) anteriorly
♪ four balls posteriorly + tectum
– Posterior Midbrain
♪ Balls are arranged in two pairs
† superior pair
† inferior pair
 superior pair → called superior colliculus
 inferior pair → called inferior colliculus.
colliculus
♪ nuclei of trochlear → at level of inferior colliculus.
♪ Tectum
† Mn → just like rectum is behind – tectum is in
posterior aspect of midbrain.
♪ Communications of Colliculi
† Superior colliculus communicates with lateral
geniculate body via superior brachium, (LGB
part of thalamus).
† Inferior colliculus communicates with medial
geniculate body via inferior brachium. (MGB
also part of thalamus.)
† lateral geniculate body is called lateral as it is
lateral to medial geniculate body.
 MGB closer to midline
 LGB lateral to midline.
† Recall superior colliculus has visual functions &
Inferior colliculus has auditory functions.
† LGB connects to
† Inferior colliculus + MGB → auditory functions.
† One additional fifth ball posteriorly in midbrain
→ pineal body.
† function of pineal body → secrete melatonin.
♪ Lateral geniculate body assists in vision since it
connects to optic tract & superior colliculus of
midbrain.
♪ medial geniculate body assists in auditory functions
as it connects to inferior colliculus of midbrain &
auditory nerve.
 †Mn → L for light – M is for music. ♪damage to periaqueductal gray area → increased
– Anterior Midbrain pain.
♪ pair of shorts called crus cerebri (aka cerebral – Ventricles
peduncles aka base of midbrain aka crura cerebri) ♪ No ventricles in midbrain

† Called Crus because it looks like a crus similar ♪ Only contains connecting cavity cerebral aqueduct

to crus of diaphragm. of Sylvius which connect third ventricle to 4th

† Called cerebral peduncle → midbrain ventricle.
communicates to cerebrum or cerebral cortex via ♪ Hindbrain posteriorly have covering upstairs and

crux cerebri. downstairs called

† Called base of midbrain because more broad † superior medullary velum

than posterior end. † inferior medullary velum.

 Similar case with pons → base of pons, basis ♪ velum is like a veil that covers the pons & medulla

pontis also anterior. posterior to 4th ventricle.

– Middle Midbrain
♪ Tegmentum → Between crus anteriorly and tectum

posteriorly.
♪ At border between tegmentum and tectum →

cerebral aqueduct of Sylvius.

†

♪ Around cerebral aqueduct → an area of grey matter

called → periaqueductal gray area
† abbreviated PAG.

† PAG has enkephalin → a natural painkiller.

♪ Substantia Niagara
† means black substance.

† Appears black → important

† contains dopaminergic neurons → synthesize

dopamine.
† Lack of dopamine in substantia nigra → SN will
†
be pale due to lack of dopamine.
†
† In Parkinson's disease
– Blood supply of midbrain
 About 80 % loss of dopaminergic neurons in
♪Posterior cerebral artery → last branch of basilar
substantia nigra.
artery
 Pt presents with
♪ Superior cerebellar artery → another branch of
ž loss of inhibitory control.
basilar artery
ž Bradykinesia
ϫ Cranial nerves
ž Jerky movements
– CN 3
 substantia nigra becomes pale
♪ leaves midbrain through anterior aspect close to
ž this is only evident on autopsy.
midline.
♪ in middle of tegmentum, at midline, → Raphe.
♪ Nuclei at level of Superior colliculus.
† Raphe secrete serotonin.
♪ two nuclei
† Serotonin sort of anti depressant (MP did not tell
† oculomotor nucleus → for movement of extra
exact function+ google did not confirm the one
ocular muscles → GSE
he told)
 supply all extra ocular muscles except
♪ Lesion in neurotransmitter areas of midbrain.
superior oblique & Lateral rectus.
† Damage to raphe → depression0
† Edinger Westphal nucleus → parasympathetic
† damage to substantia nigra → movement
nucleus of CN 3 (recall 3 7 9 10 are PANS)
disorders like Parkinson's disease.
 Supply two muscles.
 – posterior cerebral artery
ž ciliary muscle to accommodate lens ♪ A stroke in posterior cerebral artery →
ž sphincter pupillae or constrictor pupillae † oculomotor nerve palsy.

muscle to constrict pupils (miosis) † cerebral peduncle palsy

♪ Red nucleus → also located in midbrain.  If stroke in left Posterior cerebral artery →
† Nucleus for extra pyramidal tract. since CP motor → corticospinal tract in it →
– CN 4 hemiplegia.
♪ Nuclei at level of inferior colliculus → lower † Damage to substantia nigra → get movement

midbrain – caudal midbrain. problems.

♪ Nucleus → Trochlea nucleus ♪ if a patient presents with
† One of the nerve for Motor activity to † oculomotor nerve palsy

extraocular muscles (3 4 6) → GSE † hemiplegia,

† Inferior movement of eye ball.  → homonymous hemianopia.

† Mn → for Obliques – Dr Nikita ♪ special name for posterior cerebral artery stroke →

 Obliques are → Op + Ab Weber disease or Weber stroke or Weber syndrome

 Op → movement will be opposite to name or midbrain stroke syndrome.
 Ab → only Abduction. – Lateral aspect of midbrain
♪ Trochlear nerve only cranial nerve that exits CNS ♪ Midbrain + pons+ medulla → together look like a

posteriorly. stem → hence called brain stem.

† All other cranial nerves leave anteriorly ♪ Red nucleus

 Either anteromedially † Appears red as it contains an iron containing

 Either anterolaterally pigment.

♪ Only nerve whose fibers cross and exit † Just like haemoglobin is red because it has iron

contralaterally. ♪ medial lemniscus + trigeminal lemniscus + spinal

† Fibers from left nucleus exit from right lemniscus + lateral lemniscus exist in brainstem.
† Fibers from right nucleus exit from left ♪ Lemniscus Def → group of nerve fibers that exists

♪ After exit winds around midbrain and also comes in brainstem + carries sensory fibers to thalamus
anteriorly. † thalamus is secretary of sensation.

♪ Damage to trochlear nucleus or trochlear nerve → † Thalamus → grey matter between brainstem and

eyeball everted up. cerebrum

♪ † talk to secretory first, thalamus, before talk to big

ϫ Midbrain Superior View boss, cerebrum.

– Anteriorly ϫ If you're sensory, you're ascending. While ascending, you

♪ Cerebral peduncles (aka crus cerebri aka crura will meet secretory, diencephalon. before you can meet
cerebri) big boss, telencephalon.
♪ They start at a base → Basis pedunculi. ♪

♪ space between two cerebral peduncles → ϫ

interpeduncular fossa. ϫ
† cranial nerves 3 exit from interpeduncular fossa. ϫ
† CN 4 exit lateral to cerebral peduncles. ϫ
† ϫ
♪ Anterior to Crus cerebri → ϫ
† optic nerves ϫ
† optic chiasm ϫ
† optic tracts. ϫ
– Posteriorly ϫ
♪ Between Tegmentum and tectum → cerebral ϫ
aqueduct of Sylvius. ϫ
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ϫ Rough
Efferent fibers (out of cerebellum)
Middle cerebellar peduncles

Pathways associated with Cerebellum

† H2O2 Catalase O2 and H2O

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