Najeeb Notes by SAQ (Final)

Najeeb notes by Saad Ahmed Qudusi
Index:
0. Najeeb NMJ
1. Introduction to CNS
2. Sensory system and ascending tracts
3. Motor system and descending tracts
4. Medulla
5. Pons
6. Midbrain
7. Cerebellum
8. Diencephalon
9. Thalamus
10. Basal nuclei
11. Oculomotor nerve palsies
12. Blood supply to the brain
1|SAQ’s Najeeb notes

Najeeb (Extra) Neuromuscular junction
Video 1
Introduction:
• Motor neurons come off the anterior horn of the spinal cord.
• The nerve terminal (ending of the neuron) is connected to the muscle at the
neuromuscular junction. The area of muscle at the neuromuscular junction is called the
motor end plate.
• Neurotransmitters are released from the presynaptic membrane (i.e. the nerve
terminal) to transmit the impulse to the post synaptic membrane (i.e. the muscle
membrane)
The neurotransmitter machinery at the NMJ:
• Within the neuron are membrane bound vesicles loaded with acetylcholine
o The vesicles are synthesized in the cell body. These vesicles are made of special
proteins. In fact, all the proteins in the nerve ending are synthesized in the cell
body since there is no nucleus at the nerve endings.
o The acetylcholine is synthesized at the nerve terminal. However, the enzymatic
machinery concerned with ACh release and synthesis is synthesized in the cell
body.
• ACh synthesis
o The nerve ending has choline transporters (special channels which transport
choline inside the nerve ending from outside).
o The acetate for ACh comes from the mitochondria already present in the nerve
ending.
o The enzyme needed for the synthesis of ACh from acetate and choline is called
cholinacetyltransferase.
• ACh loading
o ACh is sequestered in the vesicles mentioned before via special channels in the
vesicle membrane.
The impulse:
• The wave of depolarization approaches the nerve terminal leading to massive influx of
Na+.

• This wave of depolarisation activates depolarization sensitive calcium channels leading
to calcium influx.
• Calcium influx dependent exocytosis of ACh occurs.
o The vesicles have special calcium sensitive proteins on its surface
(synaptobrevin) and so does the membrane of the nerve terminal (syntaxin).
o These protein channels are activated when calcium is bound to them and this
allows both membranes (vesicular and nerve ending) to fuse and ACh is released.
• The ACh now diffuses from presynaptic area to the postsynaptic area.
• ACh gated cation channels (these are nicotinic channels) are present on the
postsynaptic membrane.
o These channels have to binding sites for ACh. As soon as ACh binds to these
binding sites, the channels open
o Sodium (cation) can now move in and Potassium (cation) can now move out.
o However, since the resting membrane potential of -90 mV is nearer to the
Potassium equilibrium potential, movement of potassium is not significant.
Movement of sodium does occur however since -90 mV is far removed from
sodium’s equilibrium potential
• This potential produced by sodium influx is NOT called an action potential since it isn’t
so. It’s called “end-plate potential”
o Small fluctuations in the resting potential of post synaptic membrane are
produced by a small release of ACh and these are called miniature end plate
potentials.
o The influx of sodium takes the resting membrane potential to threshold potential
(if the ACh binding is strong enough) and voltage gated channels open, sodium
influx starts and a new wave of depolarisation (action potential) ensues in the
muscle
• The ACh is degraded soon after the ACh has opened the sodium channels by
acetylcholinesterase.
o The acetate diffuses in blood and leaves
o The choline is reabsorbed into the nerve cell via the choline transporters
mentioned above.
Video 2
• The ACh vesicles which had bound to the nerve membrane to release ACh are also
recycled.
o Proteins called clathrins pull the vesicle’s membrane inward and the whole
vesicle pinches in, now without ACh.

• CC (Patho): Myasthenia Gravis is an autoimmune disorder where the immune system
makes antibodies against the ACh receptors on the muscle which competitively inhibit
ACh binding. The miniature end plate potentials will be less in amount and it is very
difficult to generate enough sodium influx to be able to depolarize muscle cell to
threshold.
o CC (Pharma): AChE inhibitors (physostigmine, neostigmine etc.) can be given in
this condition so that ACh can accumulate in synaptic cleft which will be
beneficial since the inhibition by antibodies is COMPETITIVE and can be
countered by increasing ACh concentration.
• CC (Patho): Eaton-lambert syndrome is a condition where antibodies are produced by
the body against the presynaptic depolarisation sensitive calcium channels.
o In myasthenia gravis, the person’s condition worsens with activity since
accumulated ACh will be depleted but in ELS the person’s condition improves
with activity since repeated action potentials arrive at nerve terminal leading to
increased calcium release.
• CC (Patho): Botulinum toxin is a proteolytic enzyme which is able to enter the
cholinergic nerve ending (esp. at NMJs).
o It cleaves synaptobrevin and syntaxin which were responsible for ACh release
from vesicles into the synaptic cleft
o Neuromuscular transmission ceases. The condition in babies is called floppy baby
syndrome.
• CC (Pharma): A toxin (tubercurare) binds to post synaptic ACh sensitive Na channels to
prevent them from opening, effectively shutting down Neuromuscular transmission.
o Sometimes this drug is used with anesthesia to allow the patient’s muscle to
relax.
• CC (Pharma): Succinyl choline is a drug which repeatedly stimulate the ACh sensitive
postsynaptic Na channels.
o This causes the fast sodium channels in the muscle to transition to inactive state.
To regain their open state they must now transition to closed state first which
can only happen in repolarized state. But since our drug above has the
membrane constantly depolarised, this doesn’t happen and the fast sodium
channels are effectively trapped in inactive state so even though membrane
depolarises to threshold, the impulse is not transmitted as Na channels are
inactive.

Najeeb Neuro Video set 1-Introduction to Neuroanatomy
Video 1:
• Nervous system is concerned with receiving sensory input from the body, processing it
(compare with previously stored information, storing it and concocting an appropriate
response) and finally sending motor signals to effect the response
Functional classification of the nervous system:
• The nervous system is divided into CNS (brain and spinal cord) and PNS (Nerves)
• PNS is further divided as follows:
o Sensory PNS {some of these sensations go up to the consciousness level (you are
aware of them) and others are those which do not go up to the consciousness
level (e.g. BP, peristalsis etc.). The part of the nervous system responsible for
consciousness is the cerebral cortex (all sensations that reach here go up to the
conscious level)}.
Special sensations (sensations only received from certain specialized
parts of the body) which include vision, olfaction, hearing, taste and
sense of equilibrium (mainly from vestibular system)
General sensations
• Somatic sensations (come from skin, locomotion system). They
consist of touch, localized pain, temperature and proprioception
(proprioception are all the sensations (esp. of position) that are
received from the locomotor system). There are a lot of diseases
which affect proprioception.
• Visceral sensations (dull pain, distention)
o Motor PNS {some of these are under your control (somatic motor responses)
and others (e.g. persistalsis) are not (autonomic motor responses)}
Autonomic nervous system is further divided into:
• Sympathetic nervous system (dominates under stress)
• Parasympathetic nervous system (dominates under comfort)
• Brain is divided into:
o Forebrain (Prosencephalon)
Cerebral cortex (grey matter present on surface of the brain)
Superficially: Cerebral hemispheres (talencephalon)
Deep: Diencephalon
o Midbrain (mesencephalon)
o Hindbrain (Rhomboncephalon)

Pons
Medulla
Cerebellum
Video 2
Structural classification of the nervous system:
• Central Nervous system

o Grey matter (collection of cell bodies of neurons within the CNS)
Cortex is the grey matter on the surface of CNS (e.g. cerebral cortex)
Nuclei are collection of cell bodies deep within the CNS (pieces of grey
matter surrounded by white matter). From nuclei axons come out (for
example nucleus of 3rd nerve is that which gives out axons which
constitute the 3rd nerve)
o White matter (collection of axons of neurons within the CNS)
Can be classified as:
• Those that conduct impulses in the vertical axis of the body are
called ‘tracts’ (ascending tracts take sensory information
cephalically i.e. towards brain and descending tracts take motor
information caudally).
• Those that connect right part of CNS with left part and vice versa
are called ‘commissural fibers’. (corpus collossum is the largest
commissure and it connects right cerebral hemisphere to left)
• Those that connect anterior part of CNS with the posterior part
are called ‘association fibers’
• The other type is neuroglial cells which can be considered the connective tissue around
neurons.
Reticular formations:
• In spinal cord, grey matter is in the centre (SCG=Sydney Cricket Ground=Spine Centre
Grey) and white is in the outer region and vice versa for brain.
• Hence as fibers ascend from spine to brain cross, since the white matter of brain needs
to meet white matter of spinal cord.
o This crossing disrupts grey matter which breaks into small pieces and through
these pieces white matter passes and this NETWORK of grey and white matter is
called a reticular formation.
o The larger fragments of grey matter are called nuclei too

Collection of axons outside the central nervous system is called a nerve:
• So a collection of axons INSIDE CNS is called white matter whereas a collection of axons
OUTSIDE CNS are nerves.
• Another major difference between white matter and nerves is that nerves are insulated
via Schwann cells whereas white matter is insulated via oligodendroglia.

Najeeb Neurosciences Video set 6: Sensory system and ascending tracts
Video 1
Introduction:
What are tracts?
• A group of neurons within the CNS with a common origin and destination moving
vertically inside the CNS is called a tract
o Tracts are all white matter since they’re bundle of axons.
o They connect lower part of CNS to upper part and vice versa.
What are associating fibres?
• Association fibers are again white matter

o They connect anterior part of CNS with the posterior part
What are commissures?
• Commissures, too, are white matter

o They connect left CNS to right CNS.
o Corpus collossum is the biggest commissure.
Basics of the Tracts:
• Neuronal receptors are biological transducers (free nerve endings or cells associated
with nerve endings) which can convert stimulus into electrical energy.
o For example rods and cones in the eyes convert visible light stimulus into
electrical energy of the action potentials
• Ascending tracts are groups of nerve fibers which transmit sensory information FROM
receptors TO CNS.
• Descending tracts are groups of nerve fibers which transmit motor information FROM
CNS TO receptors.
• The anterior (ventral) horn of the spinal cord contains motor neurons whereas the
posterior (dorsal) horn contains sensory neurons.
• The dorsal and ventral roots unite laterally to form the trunk of a spinal nerve which
divides into anterior and posterior rami
o The anterior (ventral) ramus innervates anterior and anterolateral parts of the
body and contains both sensory and motor nerve fibers

o The posterior (dorsal) ramus innervates posterior and posterolateral parts of the
body and contains both sensory and motor nerve fibers
• White matter of spinal cord is divided into:
o Dorsal funiculi or dorsal columns (there are two) which contain only ascending
tracts (and, hence, are purely sensory)
These are heavily myelinated and, hence, conduct very fast
o Lateral funiculi or lateral columns (there are two) which contain both ascending
and descending tracts
These are less heavily myelinated and, hence, conduct very slowly
o Anterior funiculi or anterior columns (there are two) which contain both
ascending and descending tracts
These are less heavily myelinated and, hence, conduct very slowly
• So essentially the anterior and lateral columns are grouped together very often and
called the anterolateral system due to similar structural organization.
o The anterolateral system has primitive sensations (e.g. crude touch)
o The dorsal system has well developed sensations (e.g. fine touch)
The basics of the anterolateral system:
• This system is responsible for primitive sensations like pain and itching.
• Information from this system is not very accurately analysed by the CNS.
• These tracts are not very organized and it is difficult to differentiate which part of the
anterolateral system is receiving information from which part of the body.
o For example, your body can’t localize crude touch if you’re not looking at the
area being touched; you only get a rough idea of the location.
The basics of the dorsal system:
• This system is responsible for well developed sensations like proprioception (all
sensations coming from locomotor system)
• Information from this system is very accurately analysed by the CNS.
• These tracts are well organized and it is easy to differentiate which part of the dorsal
system is receiving information from which part of the body.
o For example, if you are pricked with a needle (i.e. fine touch) you will be easily
able to localize the exact position of the needle even if you aren’t looking at the
are being pricked.

The dorsal system of tracts:
• Recall that the dorsal system has ONLY ascending (sensory) tracts.
• Receptors for the dorsal system:
o Meissner’s receptors
o Pacinian receptors
o Muscle spindles
o Golgi tendon organs
• All of the neuronal fibers from these receptors enter via the dorsal root ganglion of the
spinal cord.
o These neurons are called first order neurons since these are the first in the chain
of the sensory system
• Visualise this:
o The fibers from the lower regions (e.g. foot) end up medially in the spinal cord
and then ascend.
o The fibers from the subsequent upper regions (i.e. leg, thigh and so on) start
aligning laterally to those from the lower ones and then ascend.
o So the fibers from the lowest region would be the most medial and the fibers
from the highest region of the body would be the most lateral in position
o And these move ipsilaterally (right bundles from right side of the body and left
from left)
• The above means that the more lateral the lesion in the dorsal column, the more there
are chances of loss of sensation in upper regions of the body and vice versa.
o The medial bundle is called fasciculus gracilis and the lateral bundle is the
fasciculus cuneatus.
o So if you make a section from the lower part of the spinal cord you will find only
fasciculus gracilis as the bundles from the upper part of the body have not been
added yet and if you make a section from the upper part you will find both.
Video 2
• In the brain stem, collections of cell bodies are called nuclei
• The two fasciculus gracilis (first order neurons) terminate in the two nucleus gracilis in
the medulla oblongata of the brain
• The two fasciculus cuneatus (first order neurons) terminate in the two nucleus cuneatus
in the medulla oblongata of the brain
• The neurons in the nucleus gracilis and cuneatus are called second order neurons
• The second order neurons cross the midline to go to the opposite side.
10 | S A Q ’ s N a j e e b n o t e s
o These are called internal arcuate fibers (the crossed fibers that is).
o Hence, right bundle of second order neurons are linked to left side of body and
vice versa.
o These are called the medial lemniscus systems. (one on each side; right and left
medial lemniscus systems)
• Terminology:
o If a lot of axons make a circular bundle, it is called a fasciculus (as before)
o If a lot of axons make a flattened bundle, it is called a lemniscus (as before)
• These medial lemnisci then ascend towards upper medulla, pons and midbrain and
eventually reach the thalamus.
• The thalamus has anterior, posterolateral and posteromedial parts.
o The posterolateral part is further divided into dorsal and ventral. The ventral part
has three nuclei:
Ventroanterior nucleus
Ventrointermediate nucleus
Ventroposterior nucleus (further divided into ventroposterolateral and
ventroposteromedial)
• Ventroposterolateral nucleus receives sensations from most of
the body. It is here that the medial lemnisci reach and second
order neurons terminate. The third order neurons start from here
• Ventroposteromedial receives sensation from head and neck.
• The thalamus lies in the middle and lateral to it on both ends lie one internal capsule
each lateral to which on each side lie one nucleus each.
• The fibers (third order neurons) from ventroposterolateral nucleus of ventral
posterolateral thalamus enter posterior limb of internal capsule and fan out superiorly
to reach the cerebral cortex (this fanning is called corona radiata).
• The area where these third order neurons terminate in the postcentral gyrus (sensory
cortex)
Video 3
The Anterolateral system of tracts:
1. The pain and temperature pathway:
• Receptors for pain are free nerve endings whereas the receptor for temperature are
thermal receptors.
• Thermal sensory pathway follows similar anatomical course as the pain sensations
pathway
• Fibers are divided according to degree of myelination as follows:
o Type A delta fibers are heavily myelinated
o Type B fibers are less heavily myelinated
o Type C fibers are not myelinated at all
1A. The pain sensation pathway:
• Pain sensations are sent via two pathways

o Sharp pain (pin prick) is carried via type A delta fibers
Fast transmission
Sense mechanical and thermal stimuli of pain
Each first order neuron pairs up with one second order allowing for
localization of pain
o Dull pain is carried via type C fibers
Slow transmission
Sense mechanical, thermal and chemical stimuli of pain
One first order neuron may pair up with more than one second order
neuron making it difficult to localize (and hence, dull) pain.
• Chemical mediators of pain are 5HT, histamine, bradykinin, Acids, potassium ion and
PGE2.
• The first order neurons have their cell bodies in the dorsal root ganglion
o The first order fibers terminate in the dorsal grey horn of spinal cord in an area
called substantia gelatinosa.
o Before terminating, however, they give off ascending and descending branches
inside the spinal cord. These branches as a whole are called the dorsolateral
tract of lissaure.
o It is these branches that connect with the second order neurons
• The second order neurons start within the spinal cord in the substantia gelatinosa and
their cell bodies, too, lie in this region unlike the dorsal system.
o The fibers of the second order neurons cross to the contralateral side
o These second order fibers will go up to the thalamus and hence, these are
collectively called the lateral spinothalamic tract.
o This lateral spinothalamic tract is, recall, concerned with pain and temperature
o As we ascend, the fibers are added MEDIALLY, unlike dorsal system which
basically means that fibers from the hand will lie medial to the fibers of the foot.
2. Crude touch pathway:
• The first order neurons follow the same path as the first order of pain and temperature.
• The second order neurons, however, do not go to the contralateral side. Rather they go
to the anterior column of white matter of spinal cord and then ascend and are thus
called anterior spinothalamic tract.
3. The spinotectal pathway:
• Goes from spine to the tectum of mid brain

• Concerned with spinovisual reflexes.
4. The above three pathways fuse together in the medulla:
• Then onwards they run as a single bundle which is called spinal lemniscus which will
now ascend all the way to thalamus from the medulla where they collected together.
o Recall here, that the medial lemniscus was coming from the dorsal columns
o The spinal lemniscus connects with the ventroposterolateral nucleus of the
thalamus
The sharp pain fibers end in the VPL nucleus and so do some of the dull
pain ones
The rest of the dull pain fibers end up in the intralaminal nuclei of the
thalamus and, on their way up the brain stem, give fibers to the reticular
formations.
• Reticular formation is responsible to keep the cortex “awake”.
o Some pain fibers also end up in the singulate gyrus which is associated with the
emotional responses to pain.
o Some pain fibers (esp. dull pain fibers) also end up in the insular cortex associated
with autonomic responses to the pain
o MOST of the pain fibers end up in post central gyrus and are associated with analysis
of the pain (localisation, severity etc.)
Side note:
Often times fibers of other senses give off collateral connections to pain fibers and if these are
stimulated, they can significantly inhibit the pain fibers. (e.g. if you massage the skin, it would
result in a decrease in pain)
Video 4
An Analgesia system in the body:
• Throughout the CNS at various positions are certain nuclei which give off certain
descending neurons.
o These have the capability of inhibiting the pain sensations via release of
morphine-like substances called endorphins and enkephalins.
Spinocerebellar pathways:
• These are ipsilateral pathways (info. From right goes to right cerebellum and info. From
left goes to left cerebellum)
• Dorsal spinocerebellar tract:
o The first order neurons terminate in the grey matter
Cell bodies lie in the dorsal root ganglion
o The second order neurons, move to ipsilateral white matter and ascend
Cell bodies lie in the grey matter
They ascend and, via the inferior cerebellar pudencle, end up in the
cerebellum
The cell bodies make a vertical nucleus called the dorsolateral nucleus of
clark which extends from C8-L3 (This nucleus receives information from
the lower part of the body)
However there are second order neurons till S3 and, hence, these (L4-S3)
ascend to connect with the clark’s nucleus
Above C8, there is another nucleus (accessory cuneate nucleus) which
receives information from upper part of the body.
• This pathway is called the cuneocerebellar pathway
• Anterior spinocerebellar tract:
o The second order neurons cross to the contralateral side in this case and then
ascend to superior cerebellar pudencle to end up in cerebellum
o After that they turn again to recross and finally end in the original part of the
cerebellum they should have ended up in.
Three minor ascending tracts:

1. Spinotectal pathway:
• First order end in grey matter

• Second order cross to contralateral side
o Ascend all the way to tectum
2. Spino-olival pathway:
• First order end in grey matter

• Second order cross to contralateral side
o Ascend all the way to olive
• Third order then go to cerebellum via inferior pudencle
3. Spinoreticular fibers:
• Fibers don’t cross and ascend all the way to reticular formation
Najeeb Neurosciences Video Set 7- Motor system and descending tracts
Video 1
Motor cortex:
• The highest centre responsible for voluntary activity

• Lies anterior to the central sulcus of the brain
o Recall that the sensory centres were posterior to the central sulcus
• Precentral gyrus lies immediately anterior to the central sulcus
o This area is called the primary motor cortex
• Anterior to the precentral gyrus is another region called the premotor area.
o Concerned with “planning” the motor activities
o Receives proprioceptive information from the body, analyzes the action that is to
be performed and then sends out the required stimulatory information to
primary motor cortex.
o It doesn’t have a direct connection to the muscles rather it stimulates neurons in
the primary motor cortex which then stimulate the muscles
o Broca’s area is concerned with speech (phonation)
o Frontal eye field is concerened with eye movements (this is superior to broca’s)
o Above that is the neck area
o Above that is an area concerned with planning skilled hand movements
• Superior to the precentral gyrus is another region called the supplementary motor area.
o Concerned with primitive movements like movements of the hip and the trunk
and these are usually bilateral
o Similar to the precentral gyrus, it, too, doesn’t have direct connections to the
muscle and stimulates neurons in the primary motor cortex first which then
stimulates the required muscles
Video 2
The Corticospinal tract:
• Cell bodies of the first order neurons are present in the cortex
o 30% from the primary motor area
Some of the neurons here are very big. These cell bodies are called cell of
Batz often equivalent to the size of 8 RBCs. The fibers from these cells are
heavily myelinated. These directly stimulate the lower motor neurons,
unlike other neurons which connect with internuntial neurons first.
o 30% from the premotor + supplementary motor area
o 40% of the fibers come from the sensory cortex
o All of these cell bodies lie in the 5th lamina of the cerebral cortex
• All of the fibers converge at a point in the internal capsule.
o They fan into this point from all the points in the cortex and are, quite rightly,
called corona radiate (the fanning structure that is)
• Thereafter they continue downwards in a very compact (bundled together) manner
o Often times the arterial supply to this area (lenticulostriate artery) gets blocked
in old age. This results in hemiplagia causing a lot of function to be lost since a lot
of fibers were bundled together and now all of these are affected.
• White matter columns in the mid brain connect the brain stem with the cerebral cortex
(these areas (there are 5) are called crus cerebri)
o These are, ofcourse, our original descending fibers which were descending from
the internal capsule
• These columns proceed to the pons where they are dispersed
o Over here there are also other fibers coming from cortex and connecting with
the pons in the pontine nuclei called the corticopontine fibers
• The columns are dispersed over the pontine nuclei and descend to form the pyramids of
the medulla
o Hence, corticospinal tracts are also called pyramidal tracts in this region.
o In the pyramids, most of them cross to the contralateral side (called the major
motor crossing). These are then called the lateral corticospinal tracts and move
in the lateral white column of the spinal cord. These are concerned with more
developed movements. These are the fibers that are, of course, coming from the
premotor cortex.
o Some of these, however, continue without crossing. These are then called
anterior corticospinal tracts and move in the anterior white column of the spinal
cord. These are concerned with more primitive movements. These are the fibers
that are, ofcourse, coming from the supplementary motor cortex
• Some important connections made by the descending fibers:
o Initially they make collateral connections within the cerebral cortex for
coordination.
o Inferior to that, they make lenticular connections in the basal ganglia
o Inferior to that, they make connections with the red nuclei in the mid brain
o Inferior to that, they make connections with the reticular formations which are
responsible for stimulating the cerebral cortex.
o Inferior to that, they make connections with the vestibular nuclei (I believe this
was at the pontomedullary junction or somewhere around there)
o Inferior to that, they also make connections with the olives in the medulla
Video 3
Upper motor neurons and lower motor neurons:
• Lower motor neurons are those that come out of the CNS and make neuromuscular
junctions.
• Upper motor neurons are all those which originate from higher centres and connect
with the lower motor neurons to affect their activity.
o Some of these have a cortical origin.
Corticospinal tract
Corticonuclear tract (Those connected with nucleus in medulla are called
corticobulbar fibers)
o Others have a subcortical origin
Tectospinal tract (the superior coliculus of the tectum is concerned with
visual reflexes while the inferior coliculus is concerned with visual
reflexes)
Ruberospinal tract from the red nucleus to the lower motor neurons
Reticulospinal tract from reticular formation to LMN.
Vestibulospinal tract from pontomedullary junction to LMN.
Olivospinal tract from olives to LMN
Side note:
Descending tracts are classified as pyramidal tracts (those that pass through the pyramids e.g.
corticospinal tract and corticonuclear tracts) and extrapyramidal tracts (all of the subcortical
origin)
Functional implications:
• Muscles of the body are classified as flexor muscles and extensor muscles
o Extensor muscles serve to support and move the body against gravity e.g. when
standing up
o Flexor muscles serve the opposite function
• Certain tracts serve to enhance the tone of extensor muscles
o Vestibulospinal tracts (major player)
o Pontine reticular nuclei from the reticular formation (accessory player)
• Certain tracts serve to enhance the tone of flexor muscles
o Ruberospinal tracts (major player)
o Medullary tracts
Sympathetic and parasympathetic pathways:
• Sympathetic pathway is thoraco lumbar pathway (T1-L2)

o Originates from posterior group of neurons of the hypothalamus
o Some fibers from T1 and T2 ascend to supply the head and neck
CC: Horner’s syndrome is a condition where the ascending T1 and T2
fibers are blocked. Sweating function of half of the face is gone, ptosis
occurs and the pupils are constricted.
• Parasympathetic pathway is craniosacral pathway (from cranial nerves 3,7,9 and 10 and
S2,S3,S4)
o Originates from anterior group of neurons of the hypothalamus
Najeeb neurosciences video set 11-Medulla
Video 1
• Medulla is the lower part of the brain stem (midbrain, pons and medulla) and is part of
the rhomboncephalon (hind brain (cerebellum, pons and medulla)).
• It extends from the pontomedullary sulcus to the pyramidal decussation
• It has two medial swellings (pyramids) and two lateral swellings (olives) and from
medulla, extend also, the inferior cerebellar pudencles.
• We’ll divide the medulla intro ascending systems (sensory), descending systems (motor),
posterior (cerebellar) connections and anterolateral connections (cranial nerves).
Reticular formation:
• Reticular formation extends throughout the brainstem. It is further divided into

o Ascending reticular formation which connects with the intralaminar nuclei of the
thalamus and then continues towards the cerebral cortex. It serves to keep the
cerebral cortex active maintaining a state of wakefulness.
o Descending reticular formation
• Reticular formation has the following centres in the medulla:
o Cardiac centre
o Vasomotor centre
o Respiratory centre
o Gastrointestinal centre
Area postrema is a break in the blood brain barrier through which the
neurons in this region can sample substances in the blood.
• It can stimulate chemoreceptor trigger zone if it finds toxic
substances.
• CTZ can stimulate gastrointestinal centre to cause reverse
peristalsis and cause nausea
Video 2
Internal structure of the medulla:
Ascending structures:
• Fasciculus gracillis and fasciculus cuneatus from the dorsal column ascend to connect
with the gracillis nucleus and cuneate nucleus respectively.
o Following these nuclei, a crossing of the second order neurons occurs to the
contralateral site (the axons of these neurons are called internal arcuate fibers).
o Following this crossing, they continue ascending as the medial lemniscus
o So from inferior to superior in the medulla (for the dorsal column of the spinal
cord) you find, the fasciculi, the nuclei, the internal arcuate fibers and finally, the
medial lemniscus.
• Also ascending from the spinal cord, are the anterior ascending, lateral ascending and
spinotectal pathways
o These would unite in the spinal lemniscus in the medulla and ascend further
Side note-lateral lemniscus:
At the pontomedullary junction, lie the dorsal and ventral cochlear nuclei which receive
sensations from the cochlear fibers of the vestibulocochlear nerve. After connecting with the
nuclei, the cochlear fibers cross and ascend in what is known as the lateral lemniscus.
Descending structures of the medulla:
• The medially situated pyramids contain the corticospinal (upper motor neurons) tract
which descend to the spinal cord
o Most (90%) of these have crossed to the contralateral side in what is known as
the pyramidal decussation and constitute the lateral corticospinal tract.
o Some (10%) do not cross at the pyramidal decussation and constitute the
anterior corticospinal tract.
They do eventually cross at the level of the body that they supply
Video 3
Posterior connections of the medulla:
• Medulla is connected to the cerebellum via the inferior cerebellar pudencle.

• Three types of fibers ascend from spinal cord to medulla and then move posteriorly to
connect with the cerebellum
o Cuneocerebellar fibers which carry sensory input from upper limb going from
accessory cuneate nucleus to the cerebellum via the inferior cerebellar pudencle
o Dorsal spinocerebellar fibers which carry sensory input from the ipsilateral lower
limb and go to medulla then cerebellum via the inferior cerebellar pudencle
without connecting to the accessory cuneate nucleus
o Ventral spinocerebellar fibers which carry sensory input from the contralateral
lower limb since they cross as soon as they enter the spinal cord
They DON’T exit through the inferior cerebellar pudencle and keep
ascending upto midbrain.
They connect to cerebellum via the superior cerebellar pudencle of the
midbrain.
Once connected, they again, move out of cerebellum and cross to
contralateral side again, eventually terminating at the same side of the
body as their site of origin.
• Olivocerebellar fibers go to the contralateral side of cerebellum from the olives in the
medulla via inferior cerebellar pudencle.
o The olives receive fibers from the red nuclei and hence this entire pathway is
called ruberolivocerebellar pathway
• Also present in the medulla are arcuate nuclei
o Arcuate nuclei receive fibers from the cerebral cortex
o After connecting with the arcuate nuclei these fibers connect with the
cerebellum via the inferior cerebellar pudencle and this pathway is called
arcuatocerebellar pathway
• Reticulocerebellar pathway
o Fibers going from the medullary path of reticular formation to the cerebellum
Side note-Central tegmental pathway:
This is a bundle of white matter within the central part of the brain stem. The ruberolivary
fibers pass through this pathway. Also many fibers from reticular formation pass through this
pathway on their way to the thalamus. Fibers from the nucleus of tectus solitarius also pass
through this path way on its way to the ventroposteromedial nucleus of the thalamus.
Anterolateral connections:
• From the medulla exit

o Fibers of 12th cranial nerve in the preolivary sulcus which lies between pyramid
and olive
o Fibers of 9th nerve (superiorly) in the post olivary sulcus (between olive and
inferior cerebellar pudencle)
o Fibers of 10th nerve (in the middle) in the post olivary sulcus
o Fibers of the cranial part of 11th nerve (inferiorly) in the post olivary sulcus.
• Nuclei:
o The hypoglossal nerve (12th cranial nerve) receives fibers from the
posteromedially placed hypoglossal nucleus
o The vagus nerve (10th cranial nerve) receives fibers from the following
Dorsal nucleus of vagus nerve. This gives off parasympathetic fibers and
lies lateral to the hypoglossal nucleus
Nucleus of tectus solitarius which gives off taste (lateral part) and visceral
sensory fibers (medial part). This lies lateral to the dorsal nucleus of
vagus nerve
Nucleus ambiguous which lies anterior to the three nuclei already
mentioned. This supplies the vagus nerve with branchiomotor fibers for
the larynx pharynx and soft palate.
Spinal nucleus of the trigeminal system
Video 4
o The 9th nerve receives fibers from the following
Branchiomotor fibers from the nucleus ambiguous
Spinal nucleus of the trigeminal nuclear system
Nucleus of the tectus solitarius
o The 11th nerve receives fibers from the nucleus ambiguous
• Other nuclei which lie in the medulla
o Lower part of vestibular nuclei
o Inferior cochlear nuclei
Medial longitudinal fasciculus:
• Present throughout the brain stem

• Connects with the nuclei of the cranial nerves allowing intercommunication between
the nuclei.
Review:
• If you take an inferior section of the medulla, you will be at the level of the pyramidal
decussation
o At this level you will also find the nucleus gracillis and cuneatus
o At this level you will also find ventral spinocerebellar and dorsal spinocerebellar
tract
o At this level you will also find the lateral spinothalamic tract (spinal lemniscus)
o At this level you will also find the medial longitudinal fasciculus
o At this level you will also find spinal part of accessory nerve
o At this level you will also find spinal nucleus of the trigeminal system
• If you move superiorly for a while, you will soon be at the level of the major sensory
decussation (i.e. the internal arcuate fibers)
o At this level you will also find the uncrossed corticospinal tracts in the pyramids
o At this level you will also find nucleus ambiguous
o At this level you will also find hypoglossal nuclei
o At this level you will also find inferior olivary nuclei
o At this level you will also find the medial longitudinal fasciculus
o At this level you will also find ventral spinocerebellar and dorsal spinocerebellar
tract
• Now we ascend superiorly upto the superiormost part of medulla
o At this level you will also find uncrossed corticospinal fibers
o At this level you will also find inferior olivary nuclei
o At this level you will also find the hypoglossal nuclei
o At this level you will also find dorsal nucleus of vagus
o At this level you will also find nucleus tectus solitarius
o At this level you will also find nucleus ambiguous
o At this level you will also find inferior part of vestibular nuclei
o At this level you will also find inferior cochlear nuclei
o At this level you will also find medial longitudinal fasciculus
Najeeb neurosciences video set 12-Pons
Video 1
Introduction:
• Pons lies in the brain stem above the medulla and below the midbrain.
• Pons is also part of the hindbrain (cerebellum, medulla and pons)
• Pons is connected to the cerebellum via the middle cerebellar peduncle.
o Cerebellum lies on the posterior aspect of the pons
o The middle cerebellar peduncle covers part of the inferior cerebellar peduncle as
well as part of the superior cerebellar peduncle
• Pons is associated with the 5th, 6th, 7th and 8th cranial nerves
o The 5th nerve comes out of the anterolateral aspect of mid pons
o The 6th, 7th and 8th cranial nerves exit from the pontomedullary sulcus.
• Najeeb trivia time-Pons means bridge:
o A lot of fibers come from all lobes of the cerebral cortex to terminate in the
pontine nuclei. These fibers are called corticopontine fibers
o From the pontine nuclei, another set of fibers exit via the contralateral (they
cross) cerebellar peduncles to enter the two cerebellar hemispheres on either
side of the pons. These fibers are called pontocerebellar fibers.
o The entire pathway is thus called, corticopontocerebellar pathway.
The fourth ventricle:
• A CSF filled cavity lies in the upper parts of the brain called the cerebral aqueduct
• Another CSF filled cavity lies in the central part of the spinal cord and is called the spinal
canal.
o The spinal canal ascends and the cerebral aqueduct descends to unite.
o This cavity is expanded posteriorly in the region of their union (at the level of
pons, medulla and cerebellum)
• This expanded cavity is called the fourth ventricle (remember that the main cavity in the
inferior part of the medulla was the central canal whereas the main cavity in the
superior part of the medulla was the floor of the fourth ventricle).
o The floor of the fourth ventricle lies in the brain stem and the roof of the fourth
ventricle lies in the cerebellum
o So in the posterior aspect of pons, lies the upper part of the floor of the fourth
ventricle
Posterior aspect of the pons:
• Remember that the cerebellum lies on the posterior aspect of pons.

• The floor of the fourth ventricle is diamond shaped when viewed from the posterior.
• There is a longitudinal depression in the floor of the fourth ventricle called the median
sulcus
• On the sides of the median sulcus, there is a longitudinal elevation which becomes
swollen as it descends.
o The swelling is produced by the internal genu of the 7th nerve
o The 7th nerve fibers project posteriorly from the 7th nucleus before turning and
exiting anteriorly.
o To do the above, the fibers go posteriorly and arc around the nucleus of 6th
nerve to take a “u-turn”, if you may.
o This “u-turn” of the fibers makes the internal genu of the 7th nerve and it is this
genu that makes the longitudinal elevations appear swollen.
o The swellings (one on either side of the median sulcus) are called facial coliculi
since the 7th nerve is the facial nerve.
• On the lateral sides of the longitudinal elevations are longitudinal depressions called the
sulcus limitans.
o So between the median sulcus in the middle and the sulcus limitans on the sides
lie the longitudinal elevations.
• This depression elevation and then depression sequence is called the median eminence
o On the superior aspect of the median eminence lies the substantia ferrugenia
which contains cell body of highly pigmented neurons.
o These neurons supply noradrenergic fibers to the CNS
o This group of neurons is called the locus cerulius
• Since the 8th nerve (vestibulocochlear nerve) lies lateral to the 7th nerve, the vestibular
and cochlear nuclei lie lateral to the sulcus limitans.
o The vestibular nuclei lie at the pontomedullary junction
o This lateral area of the fourth ventricle is the vestibular area.
Video 2
• The pons lies between the inferior and superior pontine sulci.
A section of pons near the inferior pontine sulcus (i.e. lower level):
• In the front of the pons, the basilar artery lies in the basilar groove.
• The anterior part of the internal structure is called the base of the pons whereas the
posterior part of the internal structure is called the tegmentum
o The demarcation between anterior and posterior is made via the trapezoid body
(crisscross fibers)
• The internal ear has cochlea (associated with hearing) and vestibular apparatus
(associated with sense of balance)
o These give off the cochlear and vestibular components of vestibulocohlear nerve
respectively.
• In pons, there are dorsal cochlear nuclei and ventral cochlear nuclei
o From ventral cochlear nuclei many fibers go contralaterally. There may be some
contribution from dorsal nuclei to this crisscross. It is these crisscross fibers that
make the trapezoid body. There are nuclei as well in the trapezoid body called
the trapezoid nucleus
o The fibers from the trapezoid body would ascend as the lateral lemniscus and
terminate into inferior colliculus of the midbrain. Some fibers, on their way as
the lateral lemniscus, would terminate in the superior olivary nucleus and then
continue towards the inferior colliculus
o From the inferior colliculus, the fibers would go as the inferior brachium and
terminate in the medial geniculate bodies
o From here the fibers would continue as auditory radiation and terminate in the
temporal lobe of the cerebral cortex.
The base of the pons:
THE DESCENDING TRACTS:
• The base contains pontine nuclei

o These nuclei receive the corticopontine fibers mentioned earlier
o These then give off pontocerebellar fibers which move contralaterally to the
middle cerebellar peduncle mentioned earlier
• The corticonuclear as well as corticospinal fibers also pass through the pons on their
way to nuclei and spine respectively
THE ASCENDING TRACTS:
• The medial lemniscus (crossed fibers from the cuneate nucleus and the gracille nucleus
in the medulla) goes through pons on its way to the ventroposterolateral nucleus of
thalamus.
• The spinal lemniscus (anterolateral spinothalamic tracts along with spinotectal fibers)
also moves through pons on its way to the ventroposterolateral nucleus of thalamus
and lies lateral to the medial lemniscus on cross sections.
• The lateral lemniscus (from trapezoid bodies) lies lateral to the spinal lemniscus on cross
sections.
• The ventral spinocerebellar tract can also be seen on cross sections of the pons on its
way to the superior cerebellar peduncle.
THE LOCAL SYSTEM OF THE PONS:
• There are two depressions on the base of the fourth ventricle called the facial colliculi.
o This is where the nucleus of 6th nerve is present
o This is also where the CN VII fibers arc around nucleus VI. These fibers are for
facial expression.
o The nucleus of the 7th nerve is more anterior and more lateral to the 6th nerve
• Nucleus of tractus solitarius also contributes fibers to CN VII.
o These are taste fibers for the anterior two thirds of the tongue
• Another nucleus (medial to tractus solitarius) provides parasympathetic fibers to CN VII.
o Some of these fibers aggregate in teregopalatine (something like that) ganglion
and go to lacrimal glands
o Others aggregate in the submandibular ganglion and go to salivary glands.
• So in essence CN VII receives fibers from motor nucleus of facial nerve, tractus solitarius,
superior salivatory nucleus/lacrimatory nucleus and also receives fibers which convey
touch, pain and temperature from ear and terminate in the spinal nucleus of trigeminal
system.
• The trigeminal system has four nuclei
o The spinal nucleus which lies in all of medulla and lower pons
o The principal nucleus which lies in mid pons
o The mesencephalic nucleus which lies in midbrain mainly
o Motor nucleus of trigeminal nerve which lies medial to the principal nucleus
• The vestibulocochlear nuclei lie laterally in pons
o There are two dorsal and two ventral cochlear nuclei
o There are two vestibular nuclei
o The vestibular nucleus is split into four parts
All of the superior and most of the medial and lateral parts of the
vestibular nuclei lie in pons
The inferior part of the vestibular nuclei lies in the upper medulla
• The medial longitudinal fasciculus is responsible for intercommunication and
coordination between the cranial nerve nuclei
o E.g. if you move your eyes to the right, right eye moves laterally and left eye
moves medially
o There are separate muscles for lateral and medial movement of eyes innervated
by separate cranial nerves (one by 6 and other by 3).
o To facilitate these coordinated movements, the medial longitudinal fasciculus is
required so that the cranial nuclei can communicate and coordinate.
o This medial longitudinal fasciculus also courses throughout most of the brain
stem and, hence, throughout the pons
o CC: medial longitudinal fasciculus syndrome can render the medial longitudinal
fasciculus ineffective due to damage leading to poor coordination in cranial
nerve motor functions.
Najeeb seems awefully quiet for the next 7 mins so I’ll just stop here.
Najeeb neurosciences video set 13-Midbrain
Video 1
The midbrain:
• There are two longitudinal elevations on the sides and in the middle, the area is called
interpeduncular fossa
o The two longitudinal elevations are called crus cerebri
• There are two swellings on each side on the posterior aspect of the midbrain called
colliculi (one superior and one inferior colliculus on either side)
o The superior colliculi are related to the visual system
o The inferior colliculi are related to the auditory system
• If we cut across the midbrain so as to cut it into right and left halves, each half is called a
cerebral peduncle since these halves connect the rest of the CNS to the cerebrum
Cross section of the midbrain:
• On cross sections, on the anterior aspect of midbrain, substantia nigra can be seen
• On cross sections, on the posterior aspect of the midbrain, cerebral aqueduct can be
seen
o So, in essence the following are the cavities across the CNS; central canal for
spinal cord, lower part of the fourth ventricle for the medulla, upper part of the
fourth ventricle for the pons, the cerebral aqueduct for the midbrain and finally
the diencephalon has a cavity called the third ventricle
o All the above cavities are filled with cerebrospinal fluid (CSF)
• Structures posterior to the cerebral aqueduct are called the tectum
• Structures anterior to the substantia nigra are called the crus cerebri
o This part is also called the base of the midbrain
• Structures between the cerebral aqueduct and the substantia nigra are the tegmentum
• So each cerebral peduncle contains, crus cerebrum, tegmentum and then tectum
The tectum:
• As mentioned earlier, the superior colliculi are concerned with visuospinal reflexes
whereas the inferior colliculi are concerned with auditospinal reflexes
• Fibers from the superior and inferior colliculi descend into the spine to mediate these
reflexes (e.g. you moving to the side as soon as you hear a horn honking right behind
you). These fibers are called tectospinal fibers.
Cross section at the level of inferior colliculus:
• To put things into perspective, Crus cerebri anteriorly, substantia nigra posterior to that,
tegmentum posterior to that, cerebral aqueduct posterior to that and finally the tectum
being the most posterior.
• Substantia nigra is divided into two parts
o The posterior part is called pars compacta and has densely packed neurons
o The anterior part is called pars reticularis and has less densely packed neurons
o Substantia nigra has neurons connected to caudatum putamen (something like
that). These neurons have dopaminergic receptors at the nerve endings and they
are called striatum. This pathway is called nigrostriatal pathway
CC: Parkinson’s disease is a condition in which the nigrostriatal pathway
is damaged. There is hypokinesia (difficulty in initiating movement).
There is rigidity and also tremors with loss of postural reflexes
CC: certain drugs can also block this pathway (anti-dopaminergic
pathway)
• Crus cerebri lie anterior to the substantia nigra
o The corticopontine fibers, on their way to the inferiorly situated pontine nuclei
pass through the crus cerebri. These lie on either side of the corticospinal fibers.
o The corticonuclear fibers, on their way to the various cranial nerve nuclei, pass
through crus cerebri. These descend alongside the corticopontine fibers
o The corticospinal fibers, on their way to synapse with the lower motor neurons,
pass through crus cerebri. These lie between two tracts of corticopontine fibers
o SIDE NOTE: throughout the CNS, motor (descending) fibers would lie anteriorly
whereas the sensory (ascending) fibers would lie posteriorly.
• Periaqueductal grey matter is grey matter that surrounds the cerebral aqueduct
o The nucleus of the fourth nerve lies on either side of the periaqueductal grey
matter in the tegmentum at the level of the inferior colliculus. This is the only
cranial nerve that exits through the back of the CNS
o The medial longitudinal fasciculus lies anterior to the periaqueductal grey matter
o The nucleus raphae and central tegmental nuclei can also be found around the
periaqueductal grey matter.
These nuclei have descending fibers and they release enkephalins and
serotonin to inhibit pain transmission at the point of entry of the
anterolateral ascending system of spinal cord
• At this level, you will see the lateral lemnisci approaching the inferior colliculi on the
posterior aspect of the cerebral aqueduct (see below)
o Auditory fibers (cochlear part of the vestibulocochlear nerve) from the ear go to
the cochlear nuclei residing in the pons and medulla
o From the cochlear nuclei, the fibers would come out and cross (most of them) in
the trapezoid body
o The fibers (both crossed and uncrossed) ascend as the lateral lemniscus
o The fibers in the lateral lemniscus synapse in the nuclei inferior colliculi and,
hence, the inferior colliculi receive fibers carrying sensations from both ears
(mostly the contralateral ear but some fibers from the ipsilateral ear as well)
o From the inferior colliculi, fibers (collectively called the inferior brachium) carry
auditory information to the medial geniculate body of the thalamus
From each inferior colliculus, commissural fibers also come out to
connect with the contralateral inferior colliculus.
o From the medial geniculate body, fibers would carry the auditory sensation to
the auditory part of the cortex
• The tegmentum at this level contains the ascending sensory fibers
o Fibers from the dentate nuclei (one on each side) of the cerebellum pass
through the tegmentum of the inferior part of the mid brain to synapse in the
red nucleus which is situated in the tegmentum of the superior part of the mid
brain.
o This pathway is called dentoruberothalamic pathway since fibers from the red
nucleus would also go up and synapse in the thalamus
o The dentorubero fibers cross in the tegmentum of the inferior part of midbrain
o The second ascending system is the medial lemniscus (dorsal spinal column) and
this lies lateral to the dentorubero fibers
o The third ascending system is the spinal lemniscus (anterolateral spinal column
AND spinotectal fibers)
o Lastly, in the center of the tegmentum is the central tegmental tract
It carries reticulothalamic fibers (ascending) connecting the reticular
formation with the thalamus
It also carries the rubero-olivary fibers (descending) connecting the red
nucleus with the inferior olivary nucleus
Video 2
• The mesencephalic nucleus of the trigeminal nerve is present at all levels of the
midbrain.
• The locus cerulius (discussed in pons) can also be found at inferior colliculi level
• The interpeduncular nucleus lies just anterior to the substantia nigra and right in the
between the two peduncles and plays a part in hunger
• Reticular formation is present at all levels of midbrain
Cross section at the level of superior colliculi:
• As before, we have:
o Substantia nigra at the junction of tegmentum and crus cerebri
Anterior to this we have corticospinal, corticonuclear and corticopontine
fibers
o Cerebral aqueduct at junction of tegmentum and tectum
The medial lemniscus and spinal lemniscus are present in the anterior
portion of the tegmentum
o Central tegmental tract
o Mesencephalic nucleus of the trigeminal system
o Medial longitudinal fasciculus
• Additionally, we now have:
o The red nuclei which lie medial to the medial lemniscus in the anterior portion of
the tegmentum
o The somatic nucleus of CN III anterolateral to the cerebral aqueduct
CN III fibers move anteriorly, pass through the substantia nigra and exit
through the medial part of the crus cerebri
They supply levator palpabory superioris and all the extraocular muscles
excepts Lateral rectus and superior oblique
CN III also receives parasympathetic fibers from the edinger westphal
nucleus which lies lateral to the somatic nucleus of CN III. It supplies
them to the ciliary ganglion which supplies fibers to the intraocular
muscles
o Superior colliculi which receive fibers from the visual system via the superior
brachium which are coming from the lateral geniculate body.
It sends off tectospinal fibers for visuospinal reflexes
These are connected to each other via commissural fibers
o Pretectal nuclei which lie in the tectum just anterosuperior to the superior
colliculus.
They are connected to Edinger westphal nucleus
They are also connected to each other via the posterior commisures
Najeeb neurosciences video set 14-Cerebellum
Video 1
Introduction:
• Cerebellum is mainly responsible for maintaining tone of muscles, maintaining posture

and balance and for coordination of movements
• Develops embryologically from the metencephalon
• Cerebellum has an anterior lobe, a posterior lobe and a flocculonodular area
o Flocculonodular lobe is the most primitive part of the cerebellum (also called
archecerebellum) and is concerned mainly with balance
o The anterior lobe is called paleocerebellum and is concerned mainly with the
tone of the muscles
o The posterior lobe of the cerebellum (neocerebellum) is the most “modern”
cerebellar area and is concerned with coordination of movement
• The primary fissure lies between anterior and posterior lobes and the dorsolateral
fissure lies between posterior and flocculonodular lobe.
Posterior view of the cerebellum:
• There is a longitudinal depression in the middle of the posterior aspect of cerebellum

called the vermis
o On either side of the vermis are the two cerebellar hemispheres
o The area immediately lateral to the vermis is called paravermal area or
intermediate zone. (this area is part of the cerebellar hemispheres)
• Control of the trunk and other axial musculature is concerned with the vermal area
whereas control of the locomotor system is concerned with the paravermal area
• Cerebellum controls the balance, posture and coordination of movement ipsilaterally
which means that lesions would be on the same side as the clinical signs.
Role of the cerebellum in the motor functions of the body:
• The idea of a movement originates in the prefrontal lobe of the cortex
o This idea would go to the premotor area and supplementary motor area
o These areas consult with the basal ganglia
o The basal ganglia make evaluations to refine the movement and send the signals
to premotor, supplementary motor and primary motor cortex and the
somatosensory area as well
o From these areas, the upper motor neurons originate to descend to the lower
motor neurons
• But for an appropriate motor program to be formulated, the CNS needs to know the
initial positions of the concerned muscles in space
o This function is associated with the cerebellum i.e. it keeps a record of the parts
and orientation of the body in space
o Therefore, the higher motor centers of the CNS consult with the cerebellum
before initiating the movement
• Also, once the movement is initiated, cerebellum also samples the information at the
uppermotorneuron-lowermotorneuron junction to determine whether the movement is
being executed satisfactorily
o It can, therefore, also predict the result of movements occurring unhindered in
the current directions
o It also, to a very large degree, influences the movements to ensure that the
required movement is executed (examples in lecture)
Internal structure of the cerebellum:
• The general arrangement is as follows:

o Grey matter on the boundaries (cerebellar cortex)
o White matter in the middle
o Deeply residing nuclei within the white matter
INPUT TO CEREBELLUM:
• All the external fibers (all of these are excitatory) entering the cerebellum are input
fibers and can be classified as
o Olivocerebellar fibers (called the climbing fibers) which go from inferior olivary
nuclei to the outermost layer of cerebellar cortex. These fibers release aspartate
upon stimulation
o All the other fibers (called mossy fibers as a group)
Video 2
o All the input fibers, on their way to the cortex, must first synapse with the deeply
residing nuclei and stimulate them
PROCESSING MACHINERY IN THE CEREBELLUM:
• The cerebellar cortex has an outer molecular layer, a middle purkinje layer and a deep
Grenula layer
o Cell bodies of certain flask shaped neurons are present in purkinje area
o Their dendrites lie in the molecular area
o Their axons traverse the grenula on their way to synapse with deep nuclei (these
are inhibitory axons and release GABA to inhibit the deep nuclei)
• The climbing fibers ascend to molecular area and synapse with dendrites of the flask
shaped neurons and release aspartate which is stimulatory to the flask shaped neurons
o This means that the flask shaped neurons release GABA at deep nuclei and,
essentially, the climbing fibers have indirectly inhibited the deep nuclei.
• The mossy fibers ascend up to the grenula and make multiple synapse with grenula cells
o The axons of the grenula cells ascend to the molecular area where they bifurcate
and run parallel in the white matter of the cortex parallel to the curvature of the
cortex, synapsing with dendrites from millions of purkinje cells on their way.
o These fibers are glutaminergic (stimulatory)
o Note that one mossy fiber synapses with multiple grenula cells
o This means that the mossy fibers, too, indirectly inhibit the deep nuclei
• There is an inbuilt inhibitory system, too, residing in the cerebellum.
o One group of these is called golgi cells which are situated in the grenula layer
These can be stimulated by the bifurcated parallel fibers and by the
mossy fibers and, upon stimulation, release GABA at grenula cells to
inhibit it
o The other two groups are called stellate cells and basket cells which reside in
purkinje layer
These are stimulated by the bifurcated parallel fibers and, upon
stimulation, release GABA on surrounding purkinje cells to inhibit them
OUTPUT FROM CEREBELLUM:
• The output fibers are the axons of the deep nuclei
The three lobes of the cerebellum:
• The neocerebellum is connected to the cerebrum and is also called cerebrocerebellum

(also called the pontocerebellum)
• The palleocerebellum is connected to the spinal cord and is also called spinal
cerebelleum
• The archecerebellum is connected to the vestibular system and is also called the
vestibulocerebellum
THE VESTIBULOCEREBELLUM:
• In the inner ear lies the vestibular apparatus which sends information in the vestibular
nerve to either the cerebellum directly or the vestibular nuclei and then the cerebellum
• The mossy fibers eventually go to the cortex through the general pathway that mossy
fibers follow (mentioned in previous section)
• Axons from the deep nuclei (fastigial nucleus), fibers (cerebellovestibular fibers) come
out to synapse with and stimulate the vestibular nuclear complex. This pathway then
fires up and fires down
o The descending output goes to vestibulospinal tract (antigravity tract; VIP makes
you stand)
o The ascending output goes to nuclei of CN 3,4 and 6
THE SPINOCEREBELLUM:
• Globose and emboliform nuclei in the cerebellum are associated with the
spinocerebellum
• Vermis and paravermal area receive input from the spinal cord
o The dorsal spinocerebellar tract takes proprioceptive information from the lower
limb and trunk to the cerebellum via the inferior cerebellar peduncle
Fibers from hip region come to vermal area and those from distal part of
the limb go to the para vermal area
o The cuneocerebellar pathway (THIS IS NOT COMING FROM NUCLEUS CUNEATUS)
takes proprioceptive information from upper limb to the cerebellum via the
inferior cerebellar peduncle
Fibers from trunk to the vermal area and those from the limbs to the
paravermal area
Video 3
o The ventral spinocerebellar pathway enters the spine, crosses to contralateral
side, ascends to superior cerebellar peduncle, descends a little and then goes to
the contralateral side while still within the cerebellum
• All of the above fibers enter as mossy fibers and, through the mossy fiber pathway
discussed earlier, end up on globose and emboliform nuclei (deep nuclei)
o From these nuclei information (output) goes up and down
Ascends to the red nucleus and then the thalamus and then the cortex
Ascends directly towards the thalamus and then to cortex
FROM THE RED NUCLEUS, some fibers descend in the ruberospinal tract
FROM THE CEREBRAL CORTEX, some fibers will descend to the muscles
CEREBROCEREBELLUM:
• Lateral part of the cerebellar hemisphers (area lateral to paravermal area) is called
cerebrocerebellum or neocerebellum.
• Pontine nuclei receive corticopontine fibers from the cerebral cortex
o Pontocerebellar fibers cross to contralateral side and enter the cerebellum via
the middle cerebellar peduncle
o They course as mossy fibers and synapse at dentate nucleus (deep nucleus)
o From dentate nuclei, fibers go to red nucleus then thalamus then motor cortex
OR fibers go to thalamus then motor cortex.
These fibers are concerned with movement and helps to make the
precise movements that the cortex wanted
Najeeb neurosciences video set 15-Diencephalon
Video 1 and 2 combined
A bit of embryology:
• The CNS develops from the neural tube which develops 3 cranial swellings during
development; forebrain (prosencephalon), midbrain (mesencephalon) and hindbrain
(rhomboncephalon)
o The prosencephalon further divides into two vesicles
The superior vesicle develops much faster than the inferior one resulting
in the inferior vesicle becoming buried within the superior vesicle
The superior and, now, outer swelling is called telencephalon and the
inferior and, now, inner swelling is called diencephalon
The telencephalon eventually develops into cerebral hemispheres and
the diencephalon develops into thalami (there are two), hypothalamus,
subthalami, epithalamus and optic nerve and chiasma.
o The mesencephalon remains as is in terms of vesicles.
o The rhomboncephalon also further divides into two vesicles
The diencephalon:
• Lies superior to the midbrain

• The cerebral aqueduct expands cranially to form the third ventricle
o The third ventricle lies between the two thalami
The epithalamus:
o Posterior to the third ventricle lies the pineal gland/body

o Habinular nuclei lie on both superoposteriolateral corners of the third ventricle
The two habinular nuclei are connected to each other (right with left and
vice versa) via the habinular commisure, a bundle of fibers that pass
through the stalk of pineal gland.
• The habinular nuclei along with the pineal gland constitute the epithalamus
• The two thalami, also have an interthalamic adhesion (a mass of grey matter which sort
of “sticks” the two thalami together). Discussed in thalamus video
Side note|-Anterior commisure:
Connects the right and left temporal lobes of the brain
Hypothalamus:
• The third ventricle anteriorly extends beyond the midbrain
o The mass of grey matter anterior to the midbrain AND inferior, anterior and
inferolateral to the anterior aspect of the third ventricle is the hypothalamus
• Under the hypothalamus is a central swelling
o The swelling is called the median eminence (the superior part of the median
eminence is called the tubercinerium)
o The median eminence is continuous inferiorly with the stalk of the pituitary
gland
o The stalk is then, of course, continuous with the anterior and posterior pituitary
glands inferiorly
The anterior pituitary is a derivative of Ruthke’s pouch and is NOT A PART
OF DIENCEPHALON
• Under the hypothalamus are two more swellings.
o These lie posterior to the central swelling (one on the left and the other on the
right side) and are called mamillary bodies
Subthalami:
• Lie inferior to the thalami and superior to the midbrain (consider them as butter
(subthalamus) between two slices of bread (thalamus and midbrain))
Miscellaneous points:
• The thalami have two swellings each on their posterior aspect; the medial and lateral
geniculate bodies
• In front of the hypothalamus, the optic chiasma divides into the right and left optic
tracts
• Posteriorly the hypothalamus is connected to the thalami at the hypothalamic sulci
o Just anterior to the hypothalamic sulci, are two “holes” in the third ventricle
which are called interventricular foramen and these connect with the lateral
ventricles
• So, a way of thinking about the diencephalon is that it comprises of all the structures
present around the third ventricle
o In this regard, the third ventricle CAN be considered the cavity of the
diencephalon
Najeeb neurosciences video set 16-Thalamus
Video 1
Note: Preferably, you should have watched diencephalon videos before starting this. It will
make stuff much easier. The notes are made with the assumption that you have already
watched diencephalon.
Introduction:
• The two thalami constitute the largest part of the diencephalon.

• Thalamus is a very large mass of grey matter and has a “Y” shaped white matter lamina
in the middle called the internal medullary lamina
o The lamina divides the thalamus into medial, anterior and lateral thalamus
The lateral thalamus is further divided into ventral and dorsal parts
• The dorsal part consists the dorsal tier nuclei
• The ventral part consists the ventral tier nuclei
o Thalamic nuclei are connected to each other via fibers which reside in the
internal medullary lamina
• There is a “sheet” of white matter on top of the thalamus called the stratum zonale
• There is another “sheet” of white matter on the lateral aspect of the thalamus called the
external medullary lamina
• Between the two thalami, there is interthalamic adhesion (grey matter)
• On the posteroinferior aspect of the thalamus lie the lateral geniculate body connected
to the visual system and the medial geniculate body connected to the auditory system.
• Another nucleus lies on the outer aspect of the external medullary lamina anterolateral
to the thalamus
o This is called the reticular nucleus
o Even though this lies outside the thalamus, it is considered part of the thalamic
nuclear group
Anatomical relationship of the structures at the base of the brain:
The structures mentioned in this section are IN ADDITION to the ones already mentioned in
diencephalon notes (refer to that lecture for an overview of diencephalon)
• Lateral to the external medullary lamina of the thalami are thick bundles of white
matter which contain both ascending and descending fibers. This bundle is called
internal capsule.
o This has a bend which complements the bend of the lentiform nucleus and it is
called the internal genu of the internal capsule
• Lateral to these bundles are masses of grey matter called the lentiform nuclei
o The lentiform nucleus is divided into two parts
The lateral part is called the putamen
The medial part is called the globus pallidus (something like that)
• Lateral to the lentiform nuclei are thin sheets of white matter again. This bundle is
called external capsule
• The caudate nucleus lies anterior (head), superior (body) and posterior (tail) to the
thalamus.
o The part anterior to the thalamus extends laterally to the lentiform nucleus and
so does the posterior part
o The posterior part of the caudate nucleus has a small amygdaloid body attached
to it but the amygdaloid body is NOT part of the caudate nucleus.
It is responsible for anger and certain primitive feelings like sexual ones.
• The third ventricle has two openings (interventricular foramen) which connect it to the
lateral ventricle
o The lateral ventricle extends anteriorly into the frontal lobe
o Its body lies above the thalamus and in the parietal lobe
o It extends posteriorly into the occipital lobe
o It extends laterally into the temporal lobe
• In the temporal lobe, in close association with the temporal extension of the lateral
ventricle lie the hippocampal and parahippocampal areas
o From the parahippocampal area, a bundle of white matter (fornix) extends to the
mammilary body of the hypothalamus
Video 2
• Stria terminalis (najeeb isn’t sure) is a bundle of white matter extending from
amygdaloid body to the hypothalamus
Thalamus:
• Posterolaterally, the thalamus has a free margin called the pulvinar

• The anterior and dorsomedial (same as medial) nucleus are concerned with the limbic
system (This system is concerned with behavior and emiotions)
ANTERIOR THALAMIC NUCLEUS
• Its major function is to adjust mood in reference to recent memories (e.g. happiness on
hearing good news)
• This nucleus is in intimate relationship with the limbic system
• Most of the fibers of fornix terminate in the mamillary body. From the mamillary body,
fibers go to the anterior nucleus of the thalamus (the mamillothalamic tract)
o From the anterior thalamic nucleus, fibers would carry this information to the
singulate gyrus.
o The entire circuit from the parahippocampus to singulate gyrus is called papez
circuit and is concerned with recent memory.
o CC: in severe thiamine deficiency, mamillary bodies will degenerate resulting in
patient developing amnesia.
o When information that doesn’t carry a high emotional component is received,
there aren’t many action potentials in the papez circuit but in the opposite
scenario, there are loads of action potentials in this circuit which explains why
emotionally significant memories are almost always long-term.
MEDIAL THALAMIC NUCLEUS
• The most important nucleus in this region is the dorsomedial nucleus

• This area functions to adjust behavior and psychological and physical state in
accordance with the mood of the person.
o The part of the cerebral cortex associated with this function is the frontal lobe,
particularly the prefrontal cortex.
• Connections:
o Medial thalamic nucleus is connected to prefrontal cortex.
o Medial thalamic nucleus receives input from all the other areas of thalamus
Remember that all the sensory information passes through thalamus
EXCEPT olfactory.
All the motor activity of the other thalamic areas also goes through the
medial thalamic nucleus
o Lentiform nucleus is also heavily connected to the dorsomedial nucleus
INTRALAMINAR NUCLEI
• Although it is a sheet of white matter, the internal lamina has collections of grey matter
within it called the intralaminar nuclei.
o These nuclei are closely related with the reticular formations
• Connections:
o The ascending reticular formation connects with the intralaminar nuclei
o Some of the spinothalamic pain fibers connect directly with the intralaminar
nuclei
o Certain fibers from the head carry pain-related information through the
trigeminothalamic system and these also connect with the intralaminar nuclei
o Also connected to all other thalamic nuclei
• The intralaminar nuclei then send information via fibers connected to all of the cortex
o This pathway just described is concerned with cerebral arousal and keeping the
cerebral cortex “activated”.
• Severe pain can cause the intralaminar nuclei to be damaged
• The largest intralaminar nucleus is the centromedian nucleus.
o This nucleus is connected to the rest of the thalamus
o This nucleus is also connected to the motor cortex and basal ganglia
o It can regulate the level of arousal
Najeeb neurosciences video set 17-Basal nuclei
Video 1
Introduction:
• Masses of grey matter at the base of the cerebral hemisphere

• Lateral to the lentiform nucleus was the external capsule
o Lateral to external capsule is another mass of grey matter called the clostrum
o Lateral to clostrum is another bundle of white matter called the extreme capsule
o Insula is a mass of grey matter
• The posterior part of the substantia nigra (midbrain structure) is called pars compacta
• The basal ganglia are classified using either traditional or clinical classification
o Traditionally, caudate nucleus, lentiform nucleus, amygdala and clostrum are
considered basal ganglia
o Clinically, caudate nucleus, lentiform nucleus, subthalami and the substantia
nigra are considered basal ganglia. (this video follows this classification)
Terminology:
• Globus pallidus of the lentiform nucleus is divided into medial (internal) and lateral
(external) parts
• The lentiform nucleus and the caudate nucleus are collectively called corpus striatum
• The putamen of the lentiform nucleus and the caudate nucleus collectively are called
neostriatum or just striatum
• The globus pallidus is called paleo striatum
Functional perspective of the basal ganglia:
• Motor plans are stored in basal ganglia and cerebellum. These are programs that are
executed for movements to occur.
o This means that the basal ganglia have activity occurring even before the
movement occurs
• Corticospinal and corticonuclear fibers originate from primary, pre and supplementary
motor areas as well as somatosensory area of the cortex
• When the idea of a movement is thought in the prefrontal cortex, it is transmitted to
pre and supplementary motor cortex
o These then send signals to the basal ganglia which refines the movement and,
via the thalamus send this refined signals to the four areas mentioned in the
previous bullet.
Video 2
The basal ganglia:
THE STIMULATORY PATHWAY:
Note: GABA will inhibit postsynaptic neurons and glutamate will stimulate postsynaptic
neurons. Watch the video alongside reading the following description to avoid getting confused
• Cortical fibers descend to stimulate fibers in the putamen and are called corticostriatal
fibers
o From the putamen, fibers go to the globus pallidus internal (striatopallidal fibers)
o From the GPI, pallidothalamic fibers connect to thalamus
o From the thalamus, thalamocortical fibers connect back to the cortex
• The neurotransmitter released by corticostriatal and thalamocortical fibers is glutamine
o The glutamate receptor at post synaptic membrane causes cation influx when
glutamine attaches
o The striatopallidal fibers and the pallidothalamic fibers release GABA and
substance P as their neurotransmitters
• Under conditions of rest, the motor cortex isn’t stimulating this pathway
o Pallidothalamic fibers are very active in this state, releasing GABA on
ventroanterior, ventrolateral and dorsomedial nuclei of thalamus
o GABA can hyperpolarize the postsynaptic membrane via either Cl influx or K
efflux and this keeps the thalamocortical fibers inhibited
• Under conditions of activity, corticostriatal fibers are stimulated to release glutamate
o This stimulates striatopallidal fibers to release GABA at pallidothalamic fibers
o GABA inhibits pallidothalamic release of GABA at thalamocortical fibers by the
mechanism described earlier
o Since pallidothalamic fibers are now inhibited, thalamocortical are now
disinhibited and can now fire and stimulate the motor cortex via glutamate
THE INHIBITORY PATHWAY:
• Cortical fibers descend to stimulate fibers in the putamen and are called corticostriatal
fibers
o From putamen, fibers go to globus pallidus EXTERNAL
o From globus pallidus EXTERNAL, fibers go to subthalamus
o From subthalamus, fibers go to globus pallidus INTERNAL
o From GPI, fibers go to thalamus
• Under conditions of rest, the motor cortex stimulates this pathway
o The corticostriatal fibers stimulate striatopallidal to release GABA at
pallidosubthalamic fibers
o Pallidosubthalamic fibers are inhibited and thus DON’T release much GABA on
subthalamopallidal fibers
o So now subthalamopallidal fibers are stimulated to release glutamate on
pallidothalamic fibers
o Pallidothalamic fibers are stimulated to release GABA on thalamocortical fibers
o Thalamocortical fibers are thus inhibited and motor centres ARE NOT
STIMULATED
SUBSANTIA NIGRA’s ROLE:
• Dopaminergic fibers from pars compacta synapse at the striatopallidal fibers of both the
stimulatory and the inhibitory pathways
o These dopaminergic fibers facilitate the initiation of the movement
o The striatopallidal fibers of the stimulatory pathway have D1 receptors, to which
dopamine binds and stimulates the neuron
o The striatopallidal fibers of the inhibitory pathway have D2 receptors, to which
dopamine binds and inhibits the neuron
o So, essentially, dopaminergic firing on both the striatopallidal fibers results in
stimulation of motor cortex
• Corticonigral fibers form the cortex synapse at substantia nigra so that the cortex can
communicate with the substantia nigra so it knows whether the movement is to be
stimulated here
• Pars reticularis can be functionally considered inferiorly displaced globus pallidus
internal
CHOLINERGIC NEURONS:
• Within the striatum lie cholinergic neurons which antagonize dopamine’s actions on the
stimulatory and inhibitory pathways
Pathologies:
PARKINSON’s
• This disease degenerates neurons in pars compacta resulting in less release of dopamine
from nigrostriatal pathway resulting in hypokinesia, rigidity and tremors
o Hypokinesia:
Hence, the stimulatory pathway discussed earlier is inhibited as a whole
Hence, the inhibitory pathway discussed earlier is stimulated as a whole
This leads to the motor cortex remaining inhibited to a certain degree
o Rigidity:
Corticoreticular fibers function to inhibit reticular formation
Since cortex is inhibited as already mentioned, the reticular formation is
over-stimulated and muscle tone is increased both on flexors and
extensors
This means that it is difficult to cause any movement since the antagonist
muscles for that movement is stimulated
o Tremors:
Dopaminergic activity is low in this disease which means that the
cholinergic activity is now unchecked
There are reverberation circuits within the lentiform nuclei and with loss
of dopaminergic activity, these circuits keep alternatively stimulating
flexors and extensors unchecked resulting in tremors
• Parkinson like situations can occur in patients undergoing therapy with anti-
dopaminergic drugs and with MPTP.
DISEASES WITH HYPERKINESIA:
1. HUNTINGTON’s disease:
• Striatopallidal fibers of the inhibitory pathway are damaged
• This will eventually lead to inhibitory pathway being “shut down” and the inhibitory
effect will not be there anymore
o This will lead to overstimulation of cerebral cortex resulting in hyperkinesia or
dyskinesia
• Etiology: Trinucleotide (CAG) repeats on chromosome 4. Head of caudate nucleus
degenerates and lateral ventricle appears abnormally large
Side note-types of hyperkinesia
>>Chorea (huntington’s, sydenham’s, Wilson disease): sudden brisk dance-like movements

resulting from damage to GABArgic neurons in inhibitory pathway. Motor cortex releases motor
programs in a haphazard fashion
>>Athetosis: slow writhing dancelike movements resulting from damage to GABArgic neurons
in inhibitory pathway
>>Dystonias: overcontraction of axial muscles resulting from damage to GABArgic neurons in

inhibitory pathway
>>Hemi ballismus: damage to subthalamus (classically in diabetic or hypertensive individuals)

which is unilateral so that only one thalamus is affected. Clinical features (sudden, erratic
movements of hip and shoulder girdles) appear on the contralateral side of lesion
>> Tardive dyskinesia: classically in pts. Taking dopamine receptor blockers. Dopamine receptor
upregulation occurs with long term use.
Najeeb neurosciences video set 19-Oculomotor nerve palsies
Video 1
The oculomotor nerve:
• Has general somatic efferents from the third nerve nucleus and has general visceral
efferents (parasympathetic fibers) from the edinger westphall nucleus
o They exit from the medial side of crus cerebri in the upper level of midbrain
o They pass through the interpeduncular fossa and approach the lateral wall of the
cavernus sinus
• In the orbit lies the superior orbital fissure behind which lies the cavernus sinus
o Within the lateral wall of the cavernus sinus, these fibers (oculomotor nerve)
move anteriorly and, through the superior orbital fissure, enter the orbit
• Of the extraocular muscles, the oculomotor nerve supplies the Medial rectus (MR),
Inferior rectus (IR), Superior rectus (SR) and inferior oblique (IO).
o The superior oblique originates from posterior part of the orbit, moves anteriorly
to sling around the trochlea and attach to the eye
o SO4-Superior oblique is supplied by the 4th nerve
o LR6-Lateral rectus is supplies by the 6th nerve
Anatomy:
• Course:
o 3rd nerve enters the orbital cavity and divides into superior and inferior divisions
The parasympathetic fibers wouold go along the inferior division
o The inferior division supplies MR, IO and IR
o The superior division supplies SR and levator palpabre superioris (eyelid)
The levator palpabre superioris also receives fibers from the sympathetic
innervations (this part of the muscles is called the muller’s muscle).
Muller’s muscle is used to elevate eyelids unconsciously whereas the
other part is used to elevate eyelids voluntarily
rd
• The 3 nerve exits very close to posterior cerebral and posterior communicating arteries
and abnormal vasodilation of these can result in 3rd nerve palsies
• The parasympathetic fibers lie peripherally in the nerve (especially in the superior part
of the nerve) and the somatic efferents lie central to them.
o The clinical significance here is that irritative lesions from the top would cause
excessive parasympathetic activity leading to miosis (pinpoint pupil).
o Once these lesions start destroying the parasympathetic fibers, patient now
experiences pupilodilation.
o Parasympathetic fibers reach ciliary ganglion and some of these supply Internal
oblique, others supply ciliaris and others, still, supply sphincter pupilli.
Palsies:
• If parasympathetic effect is more pronounced, we think of surgical reasons and,

otherwise, we think of medical causes when general somatic efferent effect is more
pronounced
• Diabetes mellitus can cause oculomotor palsy which can cause general somatic efferent
failure and later on progresses to parasympathetic fibers
• In oculomotor palsy, only the SO, LR and muller’s muscle remain intact
o The upper lid droops down since levator palpabre superioris is compromised (ptosis)
o The eyeball is displaced outward (LR) and downward (SO)
o Since parasympathetic fibers are gone, pupiloconstriction is compromised and the
pupil is dilated
o The patient also develops diplopia (double vision) since the axes of both eyes are not
aligned
o Paralysis of accommodation occurs due to lack of innervations to ciliaris (cycloplegia)
Najeeb Neurosciences Video set 30-Blood supply to the brain
Video 1
• About 15% of the cardiac output is dedicated to the CNS
• Blood goes to CNS via two systems namely,
o carotid (Internal carotid arteries) system which is also called the anterior system
o vertebral arteries (lie posteriorly and ascend medially behind the Internal carotid
arteries) which are also called the posterior system or the vertebrobasilar
system. Vertebral arteries originate from the subclavian arteries.
• CNS is surrounded by piamatter, which is surrounded by arachinoid matter, which is
surrounded by subarachinoid space (full of CSF), which is surrounded by duramatter.
• All the major arteries that enter the cranial cavity lie in the subarachinoid space
o This means that these major arteries have to pierce the duramatter.
o Berry aneurysms are commonly present in the circle of villus and when these
rupture they produce a haemorrhage in the subarachinoid space.
The vertebrobasilar system:
• There are foramina in the transverse processes of cervical vertebra through which
vertebral arteries pass and through the foramen magnum, they enter the cranial cavity.
o The two vertebral arteries (one from each subclavian artery) move forward
upward and medially over the medulla and meet at the pontomedullary junction
following which they ascend as one basilar artery.
o The basilar artery gives off terminal branches just above the exit of CN III which
are the right and left posterior cerebral arteries
Branches of the vertebrobasilar system:
1. Anterior spinal artery (ASA)
• Course:
o Branches (right and left) come off the lower part of vertebral arteries in front of
the medulla
o These unite in front of the lower part of the medulla and make the anterior
spinal artery which descends in the anterior median fissure of the spine
• Anterior two thirds of the spinal cord are supplied by ASA:
o A blockade in ASA will result in anterior 2/3rd of spinal cord in that blocked
region getting infracted
• Multiple segmental arteries reinforce ASA:
o These segmental arteries come from the left and right sides of the body as ASA
descends
o As these segmental arteries move medially, they divide into anterior and
posterior reticular branches
The anterior branches reinforce ASA’s blood flow
The posterior branches reinforce blood flow in Posterior spinal arteries
(there are two)
Side note:
>>There are three important groups of segmental arteries which reinforce blood flow in the
spinal arteries:
Deep cervical arteries in the neck region

Intercostal arteries in the thoracic region
Lumbar arteries in the lumbar region
>>The most important reinforcer of blood flow for ASA is called the great medullary artery of
Adamkiewicz. If this is blocked, a big part of spinal cord may undergo infarction.
>>The weakest blood supply from ASA in the spinal cord is at two points:
At the level of T4
At the level of L1
These two are the most likely sites of infarction in case of a blockade
>>The weakest blood supply from PSA is at the level of T1,T2 and T3
2. Posterior spinal arteries: (PSA)
• Either come directly off vertebral arteries or come off PICA (see below)
• Descend on the posterior side of the spinal cord
3. Posterior inferior cerebellar artery: (PICA)
• Supplies lateral medulla in addition to posterior inferior surface of the cerebellum
4. Anterior inferior cerebellar artery: (AICA)
• Originate either from the superior part of vertebral arteries or lower part of basilar
artery
• Supplies lateral pons in addition to anterior inferior surface of cerebellum
5. Labyrinthine arteries:
• Branch off AICA or less commonly, basilar artery
6. Pontine arteries:
• Branch off basilar artery
7. Superior cerebellar artery:
• Originate under CN III off the basilar artery
8. Posterior cerebral arteries:
• Supply midbrain, temporal lobe’s inferior area and occipital lobe
Video 2
The carotid system:
• The internal carotid arteries move superiorly and enter via carotid canal at the
undersurface of the base of the cranium and enters the middle cranial fossa via foramen
lacerum
o It pierces the duramatter in this region to find itself inside the cavernus sinus
where it moves upward to pierce arachinoid matter to enter the subarachinoid
space.
o To further add detail, these arteries lie on each side of the pituitary gland
Branches from the carotid system:
1. Ophthalmic artery: (anterior branch)
• Enters the orbital cavity through the optic canal

• Gives off further branches:
o Central retinal artery
CC: Thrombi from left atrium or mitral or aortic valve may dislodge and if
they come into carotid circulation, they may block retinal artery and
unilateral blindness will result in the eye supplied by that retinal artery.
o Supratrochlear artery
o Supraorbital artery
o Some more were mentioned really fast…
2. Posterior communicating artery: (posterior branch)
• This artery links carotid and vertebrobasilar system

• They are given off posteriorly from each internal carotid artery and link with the
posterior cerebral arteries on each side (these, of course, are part of the vertebrobasilar
system
3. Anterior coroidal artery: (posterior branch)
• Supplies the coroid plexus of the lateral ventricle
4. Anterior cerebral artery (moves anteriorly)
• Moves anteriorly and arches upward and backwards to arch over corpus collosum
• Gives cortical branches to the medial surface of frontal lobe and parietal lobe and these
branches also supply the upper part of frontal and parietal lobes
5. Middle cerebral artery (moves laterally)
• Moves laterally through the lateral sulcus until it appears on the superolateral surface of
the cerebral hemisphere.
• As it travels the sulcus, it gives off striatal branches which go into deeper structures in
the corpus striatum.
• Gives off further branches after reaching lateral end of lateral sulcus and these branches
Fan out.
• If middle cerebral artery is occluded, foot and leg will be spared since these regions of
the brain are supplied by the anterior cerebral artery but the other parts of the body will
experience weakness (see homunculus to understand this concept)
6. Anterior communicating artery
• Similarly on the opposite side, anterior and middle cerebral arteries will be given off,
among other branches.
• They are linked via the anterior communicating artery, a horizontal branch which comes
off the anterior cerebral arteries on either side and serve to link the anterior cerebral
arteries with each other
• This artery is the most common site of berry aneurysms.
Side note|-Circle of villus:
Connects the right carotid system with the left carotid system and links the anterior carotid
circulation with the posterior carotid circulation and also link the carotid circulation with the
vertebrobasilar system.
So it is present in subarachinoid space under the base of the brain in front of the mid brain and
under the cerebral hemispheres.
What happens is this:
1. Internal carotid arteries give off anterior cerebral arteries (make the anterolateral border of
the circle of villus).
2. The ACAs are linked via anterior communicating artery (makes the anterior border of the
circle)
3. The carotid arteries also give off posterior communicating branches (see ‘2.’ Above) (which
form the posterolateral and lateral borders of the circle).
4. The posterior communicating branches link up with the posterior cerebral arteries and the
posterior cerebral arteries make up the posterior border of the circle
So this unique type of collateral blood supply compensates for blockade in any one part of the
circulation through these anastomoses.

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Najeeb notes by Saad Ahmed Qudusi

1|SAQ’s Najeeb notes

The neurotransmitter machinery at the NMJ:

2|SAQ’s Najeeb notes

3|SAQ’s Najeeb notes

4|SAQ’s Najeeb notes

Functional classification of the nervous system:

5|SAQ’s Najeeb notes

• Central Nervous system

6|SAQ’s Najeeb notes

7|SAQ’s Najeeb notes

What are associating fibres?

• Association fibers are again white matter

What are commissures?

• Commissures, too, are white matter

Basics of the Tracts:

8|SAQ’s Najeeb notes

The basics of the anterolateral system:

The basics of the dorsal system:

9|SAQ’s Najeeb notes

1A. The pain sensation pathway:

• Pain sensations are sent via two pathways

2. Crude touch pathway:

3. The spinotectal pathway:

• Goes from spine to the tectum of mid brain

4. The above three pathways fuse together in the medulla:

Three minor ascending tracts:

• First order end in grey matter

• First order end in grey matter

Najeeb Neurosciences Video Set 7- Motor system and descending tracts

• The highest centre responsible for voluntary activity

Sympathetic and parasympathetic pathways:

• Sympathetic pathway is thoraco lumbar pathway (T1-L2)

Najeeb neurosciences video set 11-Medulla

• Reticular formation extends throughout the brainstem. It is further divided into

Side note-lateral lemniscus:

Descending structures of the medulla:

• Medulla is connected to the cerebellum via the inferior cerebellar pudencle.

• From the medulla exit

• Present throughout the brain stem

Najeeb neurosciences video set 12-Pons

The fourth ventricle:

Posterior aspect of the pons:

• Remember that the cerebellum lies on the posterior aspect of pons.

The base of the pons:

THE DESCENDING TRACTS:

• The base contains pontine nuclei

THE ASCENDING TRACTS:

THE LOCAL SYSTEM OF THE PONS:

Najeeb neurosciences video set 13-Midbrain

Cross section of the midbrain:

Cross section at the level of inferior colliculus:

Cross section at the level of superior colliculi:

Najeeb neurosciences video set 14-Cerebellum

• Cerebellum is mainly responsible for maintaining tone of muscles, maintaining posture

Posterior view of the cerebellum:

• There is a longitudinal depression in the middle of the posterior aspect of cerebellum

Role of the cerebellum in the motor functions of the body:

• The idea of a movement originates in the prefrontal lobe of the cortex

Internal structure of the cerebellum:

• The general arrangement is as follows:

PROCESSING MACHINERY IN THE CEREBELLUM:

OUTPUT FROM CEREBELLUM:

• The output fibers are the axons of the deep nuclei