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BRAINSTEM

Lecturer: Emmaruth B. Bautista, PTRP

MEDULLA OBLONGATA
 Upper half- cavity of 4th ventricle
 Lower half- central canal of SC

 ANTERIOR SURFACE OF MEDULLA:
 AMF- anterior median fissure of SC
 PYRAMIDS- one ach side of AMF of SC
 Swelling

 Tapers inferiorly: bundles of nerve fibers,
corticospinal tracts
 DECUSSATION OF PYRAMIDS

 1. Anterior
median fissure
 2. Olive
 3. Pyramids
 4.Cerebellum

MEDULLA OBLONGATA
 OLIVES- posterolateral to pyramids
 Groove between PYRAMIDS & OLIVE:
 Rootlets of HYPOGLOSSAL N.

 INFERIOR CEREBELLAR PEDUNCLES-
 Posterior to olives

 Connects MO-cerebellum

 Groove between OLIVES & INFERIOR
CEREBELLAR PEDUNCLES:
 Rootlets of GLOSSOPHARYNGEAL, VAGUS &
CRANIAL ROOTS OF ACCESSORY N.

 1.Glossopharyngeal
nerve
 2.Vagus nerve
 3.Hypoglossal nerve
 4.Accessory nerve
 5.First cervical spinal
nerve
 6.Spinal root of accessory
nerve

continuous with SC & possesses posterior median sulcus  GRACILE TUBERCLE.forms lower part of floor of 4th ventricle  Inferior half. MEDULLA OBLONGATA  POSTERIOR SURFACE OF Medulla Oblongata:  Superior half.on each side of posterior median sulcus  Elongated swelling  Produced by GRACILE NUCLEUS .

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olives  4. just inferior to pons . pyramids  2.lateral to gracile nucleus  Produced by underlying: CUNEATE  Internal Structure:  Considered at 4 levels:  1. MEDULLA OBLONGATA  CUNEATE TUBERCLE. lemnisci  3.

 1.Floor of fourth ventricle .Dentate nucleus  4.Superior cerebellar peduncle  3.Median sulcus  2.

LEVEL OF DECUSSATION OF PYRAMIDS  Great motor decussation  Superior part of MO: corticospinal fibers occupy & form the pyramid  Inferiorly: about ¾ of fibers cross median plane & continue down the SC in the lateral white column as LATERAL CORTICOSPINAL TRACT ( crosses midline ) .

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. FASCICULUS GRACILLIS &  Continue CUNEATUS to ascend superiorly posterior to central gray matter  Appears as posterior extensions of central gray matter  Substantia gelatinosa in posterior gray column becomes continuous with inferior end of NUCLEUS OF SPINAL TRACT OF TRIGEMINAL N.

LEVEL OF DECUSSATION OF LEMNISCI  Great sensory decussation  Takes place anterior to central gray matter & posterior to pyramids  Have bee formed from: INTERNAL ARCUATE FIBERS Which has emerged from the anterior aspect of the NUCLEUS GRACILIS & NUCLEUS CUNEATUS .

-  lies lateral to internal arcuate fibers  SPINAL TRACT OF TRIGEMINAL N. LEVEL OF DECUSSATION OF LEMNISCI  NUCLEUS OF SPINAL TRACT OF TRIGEMINAL N.-  Lies lateral to nucleus  LATERAL & ANTERIOR SPINOTHALAMIC TRACTS & TECTAL TRACTS  Lateral to decussation of lemnisci  Collectively known as: SPINAL LEMNISCUS .

VESTIBULOSPINAL & RUBROSPINAL TRACTS-  Situated anterolateral region of Medulla Oblongata . LEVEL OF DECUSSATION OF LEMNISCI  SPINOCEREBELLAR.

LEVEL OF OLIVES  Transverse section passes across inferior part of 4th ventricle  Amount of gray matter has increased at this level  OLIVARY NUCLEAR COMPLEX:  INFERIOR OLIVARY NUCLEUS  Largest nucleus of this complex  Gray matter shaped-bag. mouth directed medially  Responsible for elevation on surface of medulla called OLIVES .

OLIVARY NUCLEAR COMPLEX  Smaller dorsal & medial accessory olivary nuclei are also present  Send fibers medially across midline to enter cerebellum  SPINO-OLIVARY TRACTS  Function is associated with voluntary movement .

lateral vestibular nucleus  4. medial vestibular nucleus  2. VESTIBULOCOCHLEAR NUCLEI  VESTIBULAR COMPLEX:  1. superior vestibular nucleus 2 COCHLEAR NUCLEI:  1. inferior vestibular nucleus  3. posterior cochlear ( post of ICP ) . anterior cochlear ( anterolat of ICP )  2.

medial & inferior vestibular nuclei . dorsal nucleus of vagus  3. nucleus of tractus solitarius  4. X. NUCLEUS AMBIGUUS  Large motor neurons  Situated deep w/in reticular formation  Joins CN IX. hypoglossal nucleus  2. XI ( cranial part ) distributed to voluntary muscles  CENTRAL GRAY MATTER  Lies beneath floor of 4th ventricle ( M-L )  1.

EXTERNAL ARCUATE FIBERS  PYRAMIDS  CORTICOSPINAL & CORTICONUCLEAR FIBERS  MEDIAL LEMNISCUS  Flattened tracts on each side of midline posterior to pyramid  Emerge from decussation of lemnisci  Convey sensory information to thalamus . ARCUATE NUCLEI  Inferior displaced pontine nuclei  Efferent fibers to cerebellum.

MEDIAL LONGITUDINAL FASCICULUS  Forms small tract of fibers situated on each side of midline posterior to medial lemniscus & anterior to hypoglossal nucleus  INFERIOR CEREBELLAR PEDUNCLES  In posterolateral corner on lateral side of 4th ventricle  SPINAL TRACT OF CN V & ITS NUCLEUS  On antermedial aspect of ICP  ANTERTIOR SPINOCEREBELLAR TRACT  Between inferior olivary & nucleusof spinal tract of CN V  RETICULAR FORMATION  Deep posterior to olivary nucleus .

Pons  4.Fourth ventricle  5.Nuclei of oculomotor nerve  2.Medial longitudinal fasciculus .Abducent nucleus  6. 1.Trochlear nucleus  3.Vestibular nucleus  7.

Reticular formation  6.Medial lemniscus  7.Inferior olivary nucleus  9.Inferior cerebellar peduncle  2.Pyramids .Arcuate nuclei  8.Floor of fourth ventricle  3.Hypoglossal nucleus  4.Medial longitudinal fasciculus  5. 1.

 can be seen running forward & lateral through reticular formation  HYPOGLOSSAL N. Run anterior & lateral through reticular  LEVEL JUST INFERIOR TO PONS No major changes Lateral vestibular nucleus has replaced inferior vestibular nucleus Cochlear nucleus now are visible on anterior & posterior surface of ICP .IX. X & Cranial part of Accessory N.

VIII . PONS  GROSS APPEARANCE:  Convex anterior surface  Transverse fibers converge to form MCP  BASILAR GROOVE  lodges basilar artery  On anterolat side: emerges CN V on each side  Motor root: smaller. VII. lateral part  Groove between PONS & MO ( M-L ) CN VI. medial part  Sensory root: larger.

Olive  4.Basilar groove  3.Abducent nerve .Trigeminal nerve  6.Pyramid  5.Cerebral peduncle  2. 1.

divides pons symmetrically  MEDIAL EMINENCE-  Bounded by sulcus limitans  Lateral to sulcus  FACIAL COLLICULUS  Slight expansion on inferior end of medial eminence  SUBSTANTIA FERRUGINEA  Bluish gray in superior part of sulcus limitans  AREA VESTIBULI  Lateral to sulcus limitans  Underlying vestibular nuclei .POSTERIOR SURFACE:  Limited laterally by SCP  MEDIAN SULCUS.

Calamus scriptorius .Substantia ferruginea  2.Vagal triangle  7.Striae medullares  4.Facial colliculus  3.Hypoglossal triangle  6. 1.Vestibular area  5.

divides tegmentum & basal part  TRANSVERSE SECTION THROUGH CAUDAL PART:  Medial Lemniscus  Facial Nucleus  Nucleus of abducent nerve  Facial colliculus  Medial longitudinal fasciculus  Medial vestibular nucleus  Posterior & anterior cochlear nuclei  Spinal nucleus of CN V .anterior part  TRAPEZOID BODY.posterior part  BASAL PART. INTERNAL STRUCTURE OF PONS:  Divided into:  TEGMENTUM.

 TRAPEZOID BODY  Fibers derived from cochlear nuclei & nuclei of trapezoid body  BASILAR PART OF PONS:  Contains small masses of nerve cells: PONTINE NUCLEI  CORTICOPONTINE FIBERS of crus cerebri terminate in pontine nuclei  TRANSVERSE FIBERS enter middle cerebellar peduncle .

TRANSVERSE SECTION THROUGH CRANIAL PART  Motor nucleus of trigeminal nerve  Principal sensory nucleus of trigeminal nerve  Superior cerebellar peduncle  Anterior cerebellar tract  Trapezoid body .

lower auditory centers .  SUPERIOR COLLICULI. MIDBRAIN  CEREBRAL AQUEDUCT  Narrow channel traversing midbrain  Filled with CSF  POSTERIOR SURFACE OF MIDBRAIN:  COLLICULI ( Corpora Quadrigemina )  Rounded eminences divided into superior & inferior pairs by a vertical & transverse groove.centers for visual reflexes  INFERIOR COLLICULI.

emerges in the midline below inferior colliculi  LATERAL ASPECT OF MIDBRAIN:  SUPERIOR BRACHIUM  Passes from superior colliculus to lateral geniculate body & optic tract  INFERIOR BRACHIUM  Connects inferior colliculus to:  MEDIAL GENICULATE BODY . TROCHLEAR.

ANTERIOR ASPECT OF MIDBRAIN:  INTERPENDICULAR FOSSA  Deep depression in the midline. bound on each side by:  CRUS CEREBRI  POSTERIOR PERFORATED SUBSTANCE  Many small blood vessels that perforate the floor of the interpendicular fossa  OCCULOMOTOR NERVE emerges from a groove on medial side of crus cerebri & passes forward in lateral wall of cavernous sinus .

part of midbrain posterior to cerebral aqueduct & has 4 swellings:  2 SUPERIOR COLLICULI  2 INFERIOR COLLICULI . each divided into:  CRUS CEREBRI.narrow cavity w/c connects 3rd & 4th ventricle  TECTUM.pigmented band of gray matter  CEREBRAL AQUEDUCT.anterior part &  TEGMENTUM.posterior part by:  SUBSTANTIA NIGRA. INTERNAL STRUCTURE OF MIDBRAIN:  Midbrain comprises 2 lateral halves:  CEREBRAL PEDUNCLES.

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TRANSVERSE SECTION OF MB AT LEVEL OF INFERIOR COLLICULI  INFERIOR COLLICULUS  TROCHLEAR NUCLEUS  Situated in gray matter close to median plane just posterior to the: MEDIAL LONGITUDINAL FASCICULUS  MESENCEPHALIC NUCLEI OF CN V are lateral to cerebral aqueduct  DECUSSATION OF SUPERIOR CEREBELLAR PEDUNCLES  Occupies central part of tegmentum anterior to cerebral aqueduct .

SC. RETICULAR FORMATION  MEDIAL LEMNISCUS  Ascends posterior to substantia nigra  SPINAL & TRIGEMINAL LEMNISCI  Situated lateral to medial lemniscus  LATERAL LEMNISCUS  Posterior to trigeminal lemniscus  SUBSTANTIA NIGRA  Large motor nucleus situated between tegmentum & crus cerebri  Concerned w/ mm tone. hypothalamus & basal nuclei  CRUS CEREBRI  Coticospinal & corticonuclear occupy middle 2/3of crus  Frontopontine fibers on lateral part . connected to Cerebral cortex.

SPINAL & TRIGEMINAL LEMNISCI  Form a curved band posterior to substantia nigra but LATERAL LEMNISCUS does not extend superiorly to this level .PRETECTAL NUCLEUS  OCCULOMOTOR NUCLEUS situated in central gray matter close to median plane. just posterior to MEDIAL LONGITUDINAL FASCICULUS  MEDIAL. TRANSVERSE SECTION OF MB AT LEVEL OF SUPERIOR COLLICULI  SUPERIOR COLLICULUS  LIGHT REFLEX.

Pulvinar of thalamus  7. 1.Inferior colliculus  4.superior colliculus  3.Trochlear nerve  5.Fourth ventricle  6.Superior cerebellar peduncle .Pineal gland  2.

CORTICONUCLEAR. CORTICOPONTINE fibers .  RETICULAR FORMATION  Situated in tegmentum lateral & posterior to red nucleus  CRUS CEREBRI  Contains identical. important descending tracts:  CORTICOSPINAL. RED NUCLEUS  Rounded mass of gray matter situated between cerebral aqueduct & substantia nigra  Redish hue is due to its vascularity & presence of iron containing pigment in cytoplasm ot its neurons.

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Contralateral hemiplegia  2. BRAINSTEM STROKE SYNDROMES  TWOGENERAL MANIFESTATIONS EXPECTED OF A BRAINSTEM STROKE:  1. Ipsilateral Cranial Nerve Palsy  Alsoknown as ALTERNATING/ CROSSED HEMIPLEGIA .

WEBER’S SYNDROME  MEDIAL BASAL MIDBRAIN  Contralateral Hemiplegia  Ipsilateral CN 3 Palsy  ( Ipsilateral Ptosis ) .

BENEDIKT’S SYNDROME  TEGMENTUM OF MIDBRAIN  CONTRALATERAL:  Pain & temperature loss  Joint position loss  Ataxia  Chorea  IPSILATERAL:  CN 3 palsy .

MILLARD GUBLER SYNDROME  LATERAL PONS  Contralateral Hemiplegia  Ipsilateral 6th & 7th nerve palsy .

LOCKED IN SYNDROME  BILATERAL PONS  Bilateral Hemiplegia  Bilateral CN Palsy .

WALLENBERG’S or LATERAL MEDULLARY SYNDROME  LATERAL MEDULLA  IPSILATERAL:  Loss of FACIAL SENSATION  Hemiataxia  Horner’s syndrome  Nystagmus  dysphagia  CONTRALATERAL  Loss of pain & temperature .

RIGHT CVA  LEFT BRAIN FUNCTIONS  Language/Communications  Higher skill  logic  RIGHT BRAIN FUNCTIONS  Perception  Imagination  Memory  The arts & music . LEFT VS.

LEFT VS.k.k. RIGHT CVA  LEFT CVA a.a :  Right hemispheric lesion  Non-dominant Hemispheric lesion or CVA  Left hemiplegic .a :  Lefthemispheric lesion  Dominant hemispheric lesion or CVA  Right hemiplegic  RIGHT CVA a.

Analyze if it belongs to ® or (L) CVA?  Visuomotor perception & memory intact  Visuomotor or perceptual deficits  Loss of visual memory  Left sided neglect  Impulsive/quick/unorganized/over estimates capabilities & underestimates their problems  Eliminates the use of words  Poor judgment  Cautious. insecure  Distorted body image  Learns from mistakes  Gives feedback  Aphasia  Unable to communicate effectively  Vocabulary & auditory retention span decreased . slow. hesitant.

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