Brain Stem

External features
 Intended Learning Outcomes
By the end of this lecture , the student will be able to :

1. Name parts of the brain stem

2. Describe gross morphology of brain stem &
attachments of cranial nerve nuclei.
3. Describe the communications & boundaries of 4 th
ventricle.

©
OVERVIEW
 Lateral
ventricle

Cerebral
Aqueduct of Sylvius

3rd
ventricle Central canal

4th
ventricle
Prof. Khaled Naiem
 Midbrain
Cerebral hemisphere

Pons

Cerebellum
Medulla
M.O

Prof. Khaled Naiem

 Diencephalon

Midbrain
Diencephalon

Midbrain
Pons

Pons
Cerebellum
Open medulla
Medulla

Closed medulla Open medulla

Spinal cord Closed medulla

6
Spinal cord
MEDULLA OBLONGATA
 Medulla Oblongata
M.O
• Is located in the posterior cranial
fossa. Its old name is bulb. Its anterior
surface is in contact with the clivus.
• Is cone- shaped, 3 cm length.
• It extends from the lower margin of
pons to the upper end of the spinal cord,
at the level of foramen magnum.
• Is divided into upper opened Medulla &
lower closed Medulla.
Ventral surface of medulla

Glossopharyngeal
Vagus
Cranial accessory
nerves
Olive
Pyramid
Hypoglossal N.

IX,X,XI.XII.= last 4 cranial nerves emerge from the medulla.

Lateral view

4th ventricle

Central
canal

Medulla
Anterior oblongata Posterior
 Antero-lateral surface of M.O: One fissure
Two sulcui
3 Elevations
4 cranial nerves

Pons

nt er
o -m
e d ia
n f is
sure

Antero-later Pyramid
al sulcus

Olive
ostero lateral sulcus

ICP
Prof. Khaled Naiem
One fissure, 2 sulci & 4 Cr. nerves

Antero-median fissure:
Lies in the midline anterior.

Antero-lateral sulcus:
Lies between pyramid & olive.
Gives exit to the rootlets of
the hypoglossal nerve.

Antero-lateral sulcus

Postero-lateral sulcus O P IX
XII X
Postero-lateral sulcus:
XI
Lies between olive & inferior
cerebellar peduncle.
Gives exit to the rootlets of:
9th, 10th & 11th Cranial ns. Prof. Khaled Naiem
A- Features of the Lower Part

13
terior surface of M.O:
A-closed medulla:

. Posterior median
sulcus:3 elevations on
each side
..Gracile tract: lies
medial & ends in gracile
tubercle (nucleus).
… Cuneate tract: lies
in the middle & ends in
cuneate tubercle
(nucleus). ICP
…. Inferior cerebellar
Cuneate
peduncle(ICP). tract &
tubercle Gracile tract
& tubercle
Posterior median sulcus
Dorsal surface
of Medulla

Pons
Stria medullaris
(Medullary stria)
Inferior fovea
I.C.P.
Cuneate
tubercle
Gracile tubercle
B- Features of the Upper Part

16
 Dorsal surface of M.O. Hypoglossal
trigone

Vestibular
Stria medullaris
trigone

Area postrema : at the

lower part of inferior fovea.
Vagal trigone
Is a chemoreceptive area
that triggers vomiting
PONS
 Diencephalon

Midbrain
Diencephalon

Midbrain
Pons

Pons
Cerebellum
Open medulla
Medulla

Closed medulla Open medulla

Spinal cord Closed medulla

19
Spinal cord
•The pons forms a bridge ,
• 2.5 cm length.
•It appears as a
protuberance above the
medulla and anterior to the
cerebellum.
• Connects the 2 cerebellar
hemispheres by Middle
Cerebellar Peduncle (MCP).
Ventral surface of Pons
Basis pontis
VI
Sulcus basilaris
VII
V VIII

M.C.P.

P
Cerebellum

V,VI,VII,VIII = Middle 4 cranial nerves emerge from the

Pons.
Dorsal surface of Pons

Facial colliculus

Medial eminence Sup.fovea

Stria medullaris Vestibular area
Ventral aspect 0f Pons:

Trigeminal (5th) nerve:

Is attached at the
junction between basilar
part & MCP.
Basilar

Abducent (6 ) nerve: part M

th S
V
Is attached to the MCP VI
M
CP
I
junction between II

II
V

V
M
S

pyramid & pons. P

Facial (7th) & vestibulo-

cochlear (8th) nerves:
Emerge at the cerebello-
pontine angle.
Dorsal aspect of Pons:

Forms the upper

part of floor of 4th
.ventricle

It is triangular ; Apex

continuous above
with Cerebral
aqueduct of Sylvius Medullary
(=superior Angle of Stria

4th ventricle) and a

Base below formed
by Medullary stria
Dorsal aspect of Pons:
THE FLOOR SHOWS:
1- Medullary stria forms the
base of the triangle (below).
2- Median sulcus
3-Medial eminence on each
Side of the median sulcus;
4- Facial colliculus: Lies at

Median Sulcus
Medial eminence

the lower part of the Facial colliculus Superior

Fovea
medial eminence. It is Vestibular
formed by abducent nucleus area

with facial nerve fibres

around it.
5-Vestibular area.
Medullary
6-Superior fovea Stria
It is a depression
between facial
colliculus
& vestibular area. Prof. Khaled Naiem
MIDBRAIN
 Diencephalon

Midbrain
Diencephalon

Midbrain
Pons

Pons
Cerebellum
Open medulla
Medulla

Closed medulla Open medulla

Spinal cord Closed medulla

27
Spinal cord
 Midbrain:
Extension:
from the diencephalon
above to upper border of
the pons below. Cerebral Aqueduct Of Sylvius
Site:
it occupies the tentorial
notch
Length: diencephalon
Tetcum
2 cm Cerebral
Cavity: Peduncle
Cerebral aqueduct of
mid brain. Pons Cerebellum

Parts:
it is divided by its cavity
into cerebral peduncle in
front & tectum behind.
erebral peduncles: Inter Peduncular Fossa

Two diverging cord like 1-Optic

enclosing the inter Tract

peduncular fossa. They

extend from the pons to the
cerebral hemisphere. 2 III
3
Each cosists of: crus IV
IV

cerebri (ant.),substantia Cerebral Peduncle

nigra, tegmentum (post.)

The oculomotor nerve

emerges from the medial side
of the cerebral peduncle.
Is related to:
1-Optic tract
Lateral 2-Basal vein
Aspect:4 3-Post. cerebral A.
4-Trochlear nerve.
Brachia of SC & IC.
Tectum of Midbrain:
LGB
4 Colliculli SC MGB

(corpora quadrigemina) Brachium

IC Brachium
Separated by of SC
of IC
IV
Cruciform Sulcus. Sup.
Medullary
Velum
SCP
Two Superior colliculli (SC):
Are visual reflex centers.
Each one is connected to
lateral geniculate body (LGB)
by Superior Brachium

Two Inferior collicullus (IC):

Are auditory reflex centers.
Each one is connected to medial
geniculate body (MGB) by
Inferior Brachium.
Tectum: Brachium
of SC

Superior Cerebellar Peduncles

(SCP): LGB
MGB
Emerge from the posterior surface SC
of the MB & run downwards,
backwards & laterally along the IC Brachium
of IC
IV
sides of the 4th ventricle to enter Superior Medullary Velum
the cerebellar hemisphere.
SC
Superior medullary velum SC
P P

(SMV): Floor of th
vent
4

a membrane stretching
between the medial borders
of SCPs
Trochlear (4th ) nerve:
Emerges just below the inferior Posterolateral
collicullus & pierces the SMV & curve view
arround the lateral side of the MB.
Tectum

32
Floor

Is diamond in shape
(rhomboidal fossa).
Is divided into 2 triangles Apex
Medullar
y
by the stria medullaris: Stria

upper pontine triangle

& lower medullary triangle Apex
 -Roof
SMV
Upper part Formed by:
Superior Medullary Velum
(SMV)

Lower part Formed by: Inferior

Medullary Velum (IMV)

•It shows: Choroid

Choroid plexus of 4th ventricle. plexus
Foramen of Magendie in the IMV
lower part. choroid plexus:
Foramen of Magendie
pia mater+ ependyma+blood vessels.
Foramina
Median aperture of Magendie lies at the lower part of the roof.
Lateral aperture of Luschka lies at the lateral end of the lateral recess
CRANIAL NERVE NUCLEI
 Cranial Nerve Nuclei

False cranial nerves CN-I — CN-II True cranial nerves CN-III — CN-XII
Have nuclei
No nuclei
Emerge from the mesencephalon &
Emerge from the rhombencephalon
prosencephalon
Motor nuclei involve the perikarya of motor

axons Sensory nuclei receive information from

primary sensory axons

 Functional columns in the brain stem:

Q.Do you know the regions of distribution of the cranial nerves?

-Head and neck ( note the vagus nerve distribution)

Q.What are the “special” organs of the head and neck?

Add 2special
-organs of special senses (smell,vision,taste,hearing and balance) afferent&
-Muscles developed from the branchial arches 1 special efferent
columns
 Functional columns in the brain stem:
What are the functional types of nerve fibers you know?

Motor Sensory
(efferent) (afferent)

Voluntary Involuntary somatic visceral

(somatic) (visceral)
 Functional nuclei in the spinal cord:

General somatic efferent (GSE)

The four cell types in
the spinal cord are General visceral efferent (GVE)
termed ‘general’ General somatic afferent (GSA)
General visceral afferent (GVA)
Motor (efferent) Nuclei
Contain multipolar neurons Axons terminates
in muscles & gland

Somatomotor (SM) — General Somatic Efferent (GSE)

nuclei Dorsomedial nuclear column

CN III, IV, VI, XII

Their axons innervate striated muscles derived from somites (eye & tongue)

Branchiomotor (BM) — Special Visceral Efferent

(SVE) nuclei Ventrolateral nuclear column

CN V, VII, IX-X-XI

Their axons innervate striated muscles derived from branchial arches

(muscles of mastication, facial expression, pharynx and larynx muscles)
 Motor (efferent) Nuclei
Contain multipolar neurons Axons
terminates in muscles & gland

General Visceromotor (GVM) — General Visceral Efferent (GVE)

— Parasympathetic — Secretomotor CN III, VII, IX, X

Innervate viscera: smooth muscles or glands (sphincter muscle of the

pupil, salivary glands, other glands & smooth muscles of abdominal &
thoracic viscera)

The innervation occurs in 2 steps:

1)Preganglionic parasympathetic neurons leave the

brain

Synapse with the multipolar neurons located in the

parasympathetic ganglions

2)Postganglionic parasympathetic axons will reach the target

cells
 Sensory (afferent)
Nuclei
Contain mainly multipolar nuclei but they
receive inputs from sensory nerves

General Viscerosensory (GVS) — General Visceral

Afferent (GVA) CN IX, X

Located — lateral to the visceral

motor Receive afferent fibers from

chemo- & Baroreceptors

(carotid sinus, carotid body, abdominal & thoracic
viscera)

Special Viscerosensory (SVS) - Special Visceral

Afferent (SVA) CN VII, IX, X

For taste (an organ of special

senses) Receive afferent taste fibers

from the taste buds

 Sensory (afferent) Nuclei

Contain mainly multipolar nuclei but they

receive inputs from sensory nerves
General Somatosensory (GSS) — General Somatic Afferent (GSA)

CN V

Receive afferent fibers from mechano-, noci- or

thermoreceptors (skin, muscles & joints of the head)

3 sensory subtypes exist:

1. Epicritic:
- Fine touch
- Discriminative touch
- Pressure
- Vibration

2. Protopathic (vitally important information):

- Pain
- Rough (crude) touch
- Temperature

3. Proprioceptive:
- Position of the muscles & joints – afferent information from muscle spindles, tendon
organs

Note: (+) nerves contain Protopathic fibers but don't have separate (own) nuclei; their
Protopathic fibers
terminate on the Spinal Trigeminal nucleus
Note that , the nuclei which has the same functional type are
arranged above each other longitudinally forming columns.
 Nuclei and distribution of each column:
 Nuclei and distribution of each column:
1. Motor columns:
a.General
b.
c.General
special visceral
somatic
visceralefferent:
efferent:
 Nuclei and distribution of each column:
2. Sensory columns:
a. b. General
General somatic
&special afferent:
visceral afferent:
c. Special somatic afferent:
 Nuclei of origion of the different cranial nerve:

5. Trigeminal nerve V:
-motor nucleus of V (SVE):
-sensory nuclei of V (GSA):
a) Main sensory nucleus of V:
b) Spinal nucleus of V:
c) Mesencephalic nucleus of V: (1st order neuron)
 Nuclei of origion of the different cranial nerve:

7. Facial nerve VII:

4 columns (2 motor & 2
sensory):
a) SVE motor nucleus
of VII:

b) GVE ( superior
salivatory,
lacrimatory and
uncertain nuclei):

c) SVA ( nucleus
solitarius):

d) GSA(spinal nucleus
of trigeminal V):
 Nuclei of origion of the different cranial nerve:
8. Vestibulocochlear nerve VIII:

Vestibular and cochlear nuclei (SSA):

 Nuclei of origion of the different cranial nerve:
9.Glossopharyngeal nerve IX:
4 columns ( 2 motor & 2 sensory):
a) SVE ( upper part of nucleus ambiguas)
b) GVE ( inferior salivatory n.)
c) SVA ( N. solitarius)
d) GSA (spinal n. of trigeminal V):
 Nuclei of origion of the different cranial nerve:
10.Vagus nerve X:
4 columns ( 2 motor & 2 sensory):
a) SVE ( middle part of nucleus
ambiguas)

b) GVE ( dorsal vagal nucleus)

c) SVA &GVA ( N. solitarius):

d) GSA (spinal n. of trigeminal

V):
 Nuclei of origion of the different cranial nerve:
11.Accessory nerve XI:
-spinal part:
-cranial part SVE (lower part of N. ambiguas):
 Nuclei of origion of the different cranial nerve:
12.Hypoglossal nerve XII:

Hypoglossal nucleus (GSE):

?