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Basic

Strucrure of
Brain Stem
1. Roof Plate
2. Tegmentum
3. Basal Portion

Basilar
Basilar (Basal)
(Basal) Portion
Portion
Descending Fibers from Cerebral Cortex
1. Corticospinal Tract
2. Corticobulbar Tract

Pyramidal Tract

3. Corticopontocerebellar Fiber
Corticopontine Fiber
Pons Proper (Ventral Pons)
Pontocerebellar Fiber

Basal
Basal Portion
Portion

Descending
Descending Tracts
Tracts

Corticospinal
CorticospinalTract
Tract
Origin:
Origin:Cerebral
CerebralCortex
Cortex
Brodmann
BrodmannArea
Area44(Primary
(PrimaryMotor
MotorArea,
Area,MMI)I)
Brodmann
BrodmannArea
Area66(Premotor
(PremotorArea,
Area,PM
PM))
Brodmann
BrodmannArea
Area3,1,2
3,1,2(Primary
(PrimarySomesthetic
SomestheticArea,
Area,SSI)I)
Brodmann
BrodmannArea
Area55(Anterior
(AnteriorPortion
Portionof
ofSup.
Sup.Parietal
ParietalLobule)
Lobule)

Corona
CoronaRadiata
Radiata
lnternal
lnternalCapsule,
Capsule,Posterior
PosteriorLimb
Limb
Crus
CrusCerebri,
Cerebri,Middle
MiddlePortion
Portion
Longitudinal
LongitudinalPontine
PontineFiber
Fiber
Pyramid
Pyramid--pyramidal
pyramidaldecussation
decussation
Corticospinal
CorticospinalTract
Tract--Lateral
Lateraland
andAnterior
Anterior

Termination:
Termination:Spinal
SpinalGray
Gray(Rexed
(RexedIV-IX)
IV-IX)

Basal
Basal Portion
Portion

Descending
Descending Tracts
Tracts

Corticobulbar Tract
- Corticofugal fibers projecting to, and terminating in,
portions of lower brainstem
- Termination:
1) motor nuclei (upper motor neuron pathway)
hypoglossal, ambiguus, facial motor,
trigeminal motor, abducens, trochlear
and oculomotor nucleus
2) sensory relay nuclei
nuclei gracilis and cuneatus, trigeminal
sensory nucleus, solitary tract nucleus
3) reticular formation (corticoreticular fiber)

Basal
Basal Portion
Portion

Descending
Descending Tracts
Tracts

Corticobulbar Tract - UMN Pathway


- Corticofugal fibers projecting to cranial motor nuclei
GSE - hypoglossal (XII), abducens (VI),
trochlear (IV) and oculomotor (III) nucleus
SVE - ambiguus (IX, X, XI), facial motor (VII),
trigeminal motor (V) nucleus
- largely bilateral
laryngeal, pharyngeal, palatal and upper facial
muscles of mastication and extraocular muscles
- unilateral
lower facial musculature (facial palsy)
SCM and trapezius (uncrossed) --- spinal accessory
- Pseudobulbar Palsy --- syndrome of bilateral UMN lesion

Basal
Basal Portion
Portion

Descending
Descending Tracts
Tracts

Corticopontocerebellar Fiber
- Corticofugal fibers projecting to
cerebellar hemisphere
- consists of 2 neuron chain
1. Corticopontine fiber projecting to
pontine nuclei
2. Pontocerebellar fiber
crossed mudline and enter cerebellum
as middle cerebellar peduncle

Roof
Roof Plate
Plate

Midbrain
Superior Colliculus: vision
Inferior Colliculus: hearing
Closed Medulla
Nucleus Gracilis et Cuneatus:
discriminative touch sensation
cf. Cerebelum: equilibrium

Roof Plate of Hypothetized Chordate Ancestor


A. olfaction
B. vision
C. hearing
D. equilibrium
E. discriminative
touch sensation
1. epithalamus
2. superior colliculus
3. inferior colliculus
4. cerebellum
5. nucleus gracilis
et cuneatus

Tegmentum
Tegmentum
Cranial nerve Nuclei
Precerebellar Nuclei
Reticular Formation
Tracts
Ascending Cortical Pathway
Cerebellar Circuits
Descending Tract
Composite Bundle

Cranial Nerves
Columns of
Brain Stem
Motor Column
1. GSE
2. SVE
3. GVE
Sensory Column
4. VA (GVA & SVA)
5. GSA
6. SSA

Components of Cranial Nerves

General Somatic Efferent Nuclei (GSE)


Hypoglossal Nucleus

XII

Abducens Nucleus

VI

Trochlear Nucleus

IV

Oculomotor Nucleus

III

Special Visceral Efferent Nuclei (SVE)


Nucleus Ambiguus

IX, X, XI

Facial Motor Nucleus

VII

Trigeminal Motor Nucleus

General Visceral Efferent Nuclei (GVE)


Dorsal Motor Nucleus of Vagus

Inferior Salivatory Nucleus

IX

Superior Salivatory Nucleus

VII

Edinger-Westphal Nucleus

III

Motor Nuclei of
Cranial Nerves
1. GSE
III, IV, VI, XII
2. SVE
V, VII,
IX, X, XI
3. GVE
III, VII, IX, X

General Somatic Afferent Nuclei (GSA)


Trigeminal Sensory Nucleus

V, VII, IX, X

Mesencephalic Tract Nucleus


Principal (Main) Sensory Nucleus
Spinal Tract Nucleus
pars oralis
pars interpolaris
pars caudalis

Visceral Afferent Nuclei (VA)


Nucleus Tractus Solitarius

VII, IX, X

General Visceral Afferent (GVA)


Special Visceral Afferent (SVA): Taste
Gustatory Nucleus

Special Somatic Afferent Nuclei (SSA)


Cochlear Nucleus

VIIIc

Dorsal Cochlear Nucleus


Ventral Cochlear Nucleus

Vestibular Nucleus

VIIIv

Medial Vestibular Nucleus


Lateral Vestibular Nucleus
Superior Vestibular Nucleus
Inferior Vestibular Nucleus

Sensory Nuclei of
Cranial Nerves
1. VA
GVA --- IX, X
SVA --- VII, IX, X
2. GSA
V, VII, IX, X
3. SSA
VIIIc, VIIIv

Precerebellar Nuclei
Accessory Cuneate Nucleus
Inferior Olivary Nuclear Complex
Vestibular Nuclus
Red Nucleus
Perihypoglossal Nucleus
Precerebellar Reticular Nuclei

Precerebellar
Nuclei
1. Red Nucleus
2. Vestibular Nucleus
3. Inferior Olivary
Nucleus
4. Perhypoglossal
Nuclei
5. Accessory
Cuneate Nucleus

Reticular
Formation
A. Raphe Nuclei
B. Central
Nuclear Group
C. Lateral
Nuclear Group
D. Precerebellar
Reticular Nuclei

A
B
C
D

Central Nuclear Group of Reticular Formation


Gigantocellular Reticular Nucleus
Caudal Reticulopontine Nucleus
Oral Reticulopontine Nucleus
Subcuneiform Nucleus
Cuneiform Nucleus

Lateral Nuclear Group of Reticular Formation


Central Nucleus of Medulla Oblongata
Superficial Ventrolateral Reticular Area
Parvicellular Reticular Nucleus
Parabrachial Nucleus
Pedunculopontine Nucleus

Raphe Nuclei - Serotonergic Neuron


Nucleus Raphe Obscrus, B2
Nucleus Raphe Pallidus, B1
Nucleus Raphe Magnus, B3
Pontine Raphe Nucleus, B5
Median Raphe or Superior Central Nucleus, B6, B8
Dorsal Raphe Nucleus, B7
Nucleus Linealis

Norepinephrinergic & Dopaminergic Neuron


Norepinephrinergic Neuron
Nucleus Locus Ceruleus, A6
Dopaminergic Neuron
Retrorubral Area, A8
Ventral Tegmental Area, A10
Substantia Nigra, Pars Compacta, A9

Ascending
Ascending Cortical
Cortical Pathway
Pathway
Posterior White Column-Medial Lemniscal Pathway
medial lemniscus
Spinothalamic and Spinoreticular Tract
spinal lemniscus
Ventral and Dorsal Trigeminothalamic Tract
trigeminal lemniscus
Auditory Pathway: lateral lemniscus
Taste (Gustatory) Pathway: central tegmental tract
Vestibular Pathway: medial lemniscus

Ascending
Ascending Cortical
Cortical System
System

General
General Sensation
Sensation

Brain Stem Pathways for General Sensation


Touch & Proprioception from body
Posterior White Colum-Medial Lemniscal Pathway
Pain & Temperature from body
Spinothalamic Tract
cf. Spinoreticular or Spinoreticulothalamic Tract

General Sensation from Face


Trigeminothalamic Tracts

Posterior White Column - medial Lemniscal Pathway


& Spinothalamic Tract

Posterior
Posterior White
White Colum-Medial
Colum-Medial Lemniscal
Lemniscal Pathway
Pathway

Modality: Discriminative Touch Sensation (include Vibration) and


Conscious Proprioception (Position Sensation, Kinesthesia)
from body
Receptor: Most receptors except free nerve endings

Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)


Posterior White Column

2nd Neuron: Dorsal Column Nuclei (Nucleus Gracilis et Cuneatus)


Internal Arcuate Fiber - Lemniscal Decussation - Medial Lemniscus

3rd Neuron: Thalamus (VPLc)


Internal Capsule ----- Corona Radiata

Termination: Primary Somesthetic Area (S I)

Posterior White ColumnMedial Lemniscal Pathway


DRG: Dorsal Root Ganglion
1. Posterior White Column
A. Nucleus gracilis
B. Nucleus cuneatus
2. Medial Lemniscus
3. Corona Radiata
DRG

C. Thalamus (VPLc)
D. Cerebral Cortex (S I)

Spinothalamic
Spinothalamic Tract
Tract

Modality: Pain & Temperature Sensation, Light Touch


from body
Receptor: Free Nerve Ending

Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)


2nd Neuron: Dorsal Horn (Lamina I, IV, V)
Anterior White Commissure
Spinothalamic Tract (Spinal Lemniscus)

3rd Neuron: Thalamus (VPLc & CL)


Internal Capsule ----- Corona Radiata

Termination: Primary Somesthetic Area (S I)

Spinoreticulothalamic
Spinoreticulothalamic Tract
Tract (Paleospinothalamic
(PaleospinothalamicTract)
Tract)
Modality: Pain & Temperature Sensation, Light Touch
from body
Receptor: Free Nerve Ending

Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)


2nd Neuron: Dorsal Horn (Lamina I, IV, V)
Anterior White Commissure
Spinothalamic Tract (Spinal Lemniscus)

3rd Neuron: Reticular Formation


4rd Neuron: Thalamus (CL, Sm, POm)
Internal Capsule ----- Corona Radiata

Termination: Diffuse Cerebral Cotex

Spinothalamic Tract

(Neospinothalamic Tract)

Spinoreticular Tract
(Paleospinothalamic Tract)
DRG: Dorsal Root Ganglion
A. Posterior (dorsal) horn
1. Spinothalamic tract
B. Reticular formation
DRG

2. Spinoreticular tract
C. Thalamus (VPLc, CL)
3. Corona Radiata
D. Cerebral Cortex (S I)

Trigeminothalamic
Trigeminothalamic Tract
Tract

Modality: General Sensation from face


Receptor: Most receptors in the face

Ist Neuron: Trigeminal (Semilunar) Ganglia


2nd Neuron: Trigeminal Sensory Nucleus
pain & temperature ---- pars caudalis of
spinal tract nucleus of V

Ventral and Dorsal Trigeminothalamic Tract


3rd Neuron: Thalamus (VPM)
Internal Capsule ----- Corona Radiata

Termination: Primary Somesthetic Area (S I)

A. trigeminal ganglion
B. trigeminal sensory
nucleus
C. thalamus (VPM)
D. cerebral cortex
(S I)
1. spinal tract of
trigeminal nerve
2. ventral
trigeminothalamic tract
3. dorsal
trigeminothalamic tract
4. corona radiata
V. trigeminal nerve
Trigeminothalamic Tract

Ascending
Ascending Cortical
Cortical System
System

Special
Special Sensation
Sensation

Brain Stem Pathways for Special Sensation


Gustatory Sensation (Taste, SVA)
----- Taste Pathway
Auditory Sensation (Hearing, SSA)
----- Auditory Pathway
Vestibular Sensation (Equilibrium, SSA)
----- Vestibular Pathway

Auditory
Auditory Pathway
Pathway
Modality: Auditory Sensation (Hearing)
Receptor: Organ of Coti of Cochlear Duct
Cranial Nerve: VIIIc

1st Neuron: Spiral Ganglion


2nd Neuron: Cochlear Nucleus, Ventral & Dorsal
dorsal, intermediate and ventral acoustic striae
trapezoid body
lateral lemniscus
3rd Neuron: Inferior Colliculus
brachium of inferior colliculus
4th Neuron: Medial Geniculate Nucleus (MG)
auditory radiation
Termination: Primary Auditory Area (A I)
Brodmann area 31, 32

A. spiral ganglion
B. dorsal and ventral
cochlear nucleus
C. inferior colliculus
D. medial geniculate
nucleus
E. Primary auditory area
F. superior olivary nucleus
G. nucleus of
lateral lemniscus
1. acoustic striae &
trapezoid body
2. lateral lemniscus
3. brachium of inferior
colliculus
4. auditory radiation
5. commissure of
inferior colliculus
VIIIc. cochlear division
Auditory Pathways

Auditory Pathway
A. spiral ganglion
B. dorsal cochlear nucleus
C. ventral cochlear nucleus
D. superior olivary nucleus
1. dorsal acoustic striae
2. intermediate acoustic
striae
3. ventral acoustic striae
4. efferent cochlear bundle
5. trapezoid body
6. lateral lemniscus

Vestibular
Vestibular Pathway
Pathway
Modality: Equilibrium Sensation
Receptor: Macula & Crista Ampullaris
Cranial Nerve: VIIIv

Ist Neuron: Vestibular Ganglion


2nd Neuron: Vestibular Nucleus
vestibulothalamic fiber (medial lemniscus)

3rd Neuron: Thalamus (VPLo, VPI?)


Internal Capsule ----- Corona Radiata

Termination: Primary Vestibular Area


----- Primary Somesthetic Area
(Brodmann area 3a, 2v )

Vestibular
Pathway
1. Vestibulocerebellar Tract
2. Vestibulospinal Tract
3. Vestibulothalamic Tract
4. Medial Longitudinal
fasciculus (MLF)
- ascending portion
- descending portion
- interstitiospinal tract

Taste
Taste (Gustatory)
(Gustatory) Pathway
Pathway
Modality: Taste Sensation
Receptor: Taste Bud
Cranial Nerve: VII, IX, X

Ist Neuron: Geniculate Ganglion (VII)


Inferior Ganglion (IX, X)
2nd Neuron: Nucleus Tractus Solitarius
(Gustatory Nucleus)
solitariothalamic fiber (central tegmental tract)

3rd Neuron: Thalamus (VPMpc)


Internal Capsule ----- Corona Radiata

Termination: Gustatory Area


Brodmann area 43 & parainsular cortex

A. nucleus tractus
solitarius
(gustatory nucleus)
B. thalamus (VPMpc)
C. Brodmann area 43
D. parainsular cortex
E. parabrachial
nucleus
1. solitariothalamic
fiber (central
tegmental tract)
2. corona radiata
VII. facial nerve
IX. glossopharyngeal
nerve
X. vagus nerve
Taste Pathways

Cerebellar
Cerebellar Circuits
Circuits

Superior, Middle and Inferior Cerebellar Peduncle


Vestibulocerebellum - Vestibular Nucleus
Spinocerebellum - Red Nucleus and Spinal Cord
Pontocerebellum - Cerebral Cortex and Pontine Nuclei
Inferior Olivary Nuclear Complex

Afferent Connections
of Cerebellum
Inferior Cerebellar Peduncle
1. posterior spinocerebellar tract
2. cuneocerebellar tract
3. vestibulocerebellar tract
Middle cerebellar Peduncle
- corticopontocerebellar
pathway
Superior Cerebellar Peduncle
- anterior spinocerebellar tract

Efferent Connections
of Cerebellum
Superior Cerebellar Peduncle
1. dentatothalamic fiber
2. interpositorubral fiber
3. ascending portion of
uncinate fasciculus of Russell
Inferior Cerebellar Peduncle
1. direct fastigiovestibular fiber
2. descending portion of
uncinate fasciculus of Russell

Connections of
Inferior Olivary
Nuclear Complex
1. Olivocerebellar Tract
2. Cortico-olivary Tract
3. Rubro-olivary Tract
4. Vestibulo-olivary Tract
5. Spino-olivary Tract

Descending
Descending Tracts
Tracts

Rubrospinal Tract
Tectospinal tract
Vestibulospinal Tract
Reticulospinal Tract
pontine and medullary

Descending Autonomic Pathway

Brain
Brain Stem
Stem

Descending
Descending Tracts
Tracts

Descending Tracts from Brain Stem


Dorsolateral (Motor) Pathway
Rubrospinal Tract
Ventromedial (Motor) Pathway
Tectospinal Tract
Vestibulospinal Tract
MLF (Medial Longitudinal Fasciculus)
- interstitiospinal tract
Sensory Modulation pathways
Raphespinal & Cerulospinal Pathways
Descending Autonomic Pathways

Composite
Composite Bundle
Bundle

Medial Longitudinal Fasciculus (MLF)


Dorsal Longitudinal Fasciculus (DLF)
Central Tegmental Tract

Components of Medial Longitudinal Fasciculus (MLF)


Descending Components
Medial Vestibulospinal Tract
from medial and inferior vestibular nucleus
Interstitiospinal Tract
from interstitial nucleus of Cajal

Ascending Components
Efferents from Medial Vestibular Nucleus
contralateral III, IV, interstitial nucleus
bilateral VI nucleus
Efferents from Superior Vestibular Nucleus
ipsilateral III, IV, interstitial nucleus

Components of Dorsal Longitudinal Fasciculus


(DLF, fasciculus of Schtz)
Ascending Components
solitariohypothalamic fiber
(visceral afferent fiber)
ascending serotonergic fiber
Descending Component
descending fibers from hypothalamus
to periaqueductal gray and
dorsal tegmental nucleus

Components of Central Tegmental Tract


Ascending Components
reticulothalamic fiber
solitariothalamic fiber
(secondary taste fiber)
Descending Component
rubro-olivary tract

Spinomedullary
Spinomedullary Transition
Transition
(Level
(Level of
of Pyramidal
Pyramidal Decussation)
Decussation)
Roof Plate - fasciculus gracilis and fasciculus cuneatus
Tegmentum
Cranial and Spinal Nerve Nuclei
Supraspinal Nucleus
Spinal Nucleus of Trigeminal Nerve, Pars Caudalis
Reticular Formation
Central Nucleus of Medulla Oblongata
(Ventral Reticular Nucleus)
Unclassified Nuclei
Retroambiguus Nucleus
Tracts
Spinal Tracts of Trigeminal Nerve

Basal Part - Pyramid, Pyramidal Decussation

Spinomedullary Transition
(Level of Pyramidal Decussation)
Cranial & Spinal N. Nuclei
1. Supraspinal Nucleus
2. Spinal Accessory Nucleus

Cranial & Spinal Nerve


XI. Accessory Nucleus
C1. motor root of
1st cervical nerve

Lower
Lower Medulla
Medulla (Level
(Level of
of Lemniscal
Lemniscal Decussation)
Decussation)
Roof Plate - nucleus gracilis and nucleus cuneatus
Tegmentum
Cranial and Spinal Nerve Nuclei
Hypoglossal Nucleus, Ambiguus Nucleus
Solitary Tract Nucleus, Dorsal Motor Nucleus of X
Reticular Formation
Lateral Reticular Nucleus
Precerebellar Nuclei
Inferior Olivary Nuclear Complex
Tracts
Ventral Trigeminothalamic Tract
Internal Arcuate Fiber, Lemniscal Decussation

Basal Part - Pyramid, Pyramidal Decussation

Lower Medulla
(Level of Lemniscal
Decussation)
Roof Plate
A. Nucleus Gracilis
B. Nucleus Cuneatus

Cranial Nerve Nuclei


1. Hypoglossal Nucleus
2. Nucleus Ambiguus
3. Dorsal Motor Nucleus of X
4. Nucleus Tractus Solitarius
5. Spinal Tract Nucleus of
Trigeminal Nerve

Lower Medulla
(Level of Lemniscal
Decussation)
Precerebellar Nucleus
1. Inferior Olivary Nuclear Complex
1a. Principal Inferior
Olivary Nucleus
1b. Medial Accessory
Olivary Nucleus
1c. Dorsal Accessory
Olivary Nucleus
2. Nucleus Intercalatus
3. Nucleus Conterminalis
4. Arcuate Nucleus

Lower Medulla
(Level of Lemniscal
Decussation)
Reticular Formation
1. Lateral Reticular Nucleus
2. Central Nucleus of
Medulla Oblongata
2d. subnucleus dorsalis
2v. subnucleus ventralis

Clinical Syndromes
of Lower Medulla
A. Hypoglossal
Alternating Hemiplegia
B. Avelis Syndrome
C. Jackson Syndrome
D. Tapia Syndrome
1. pyramidal tract
2. hypoglossal nerve
3. spinothalamic tract
4. nucleus ambiguus

Hypoglossal
Hypoglossal
Palsy
Palsy

Lower
LowerMotor
Motor
Neuron
Neuron
Syndrome
Syndrome

Deviation of Tongue to affected side


Atrophy of Tongue Muscles

Open
Open Medulla
Medulla (Mid-olivary
(Mid-olivary Level)
Level)
Tegmentum
Cranial Nerve Nuclei
Medial Vestibular Nucleus
Spinal Tract Nucleus of V, pars interpolaris
Precerebellar Nuclei
Accessory Cuneate Nucleus
Nucleus of Roller, Nucleus Interfascicularis Hypoglossi
Reticular Formation
Lateral Reticular Nucleus, subtrigeminal portion
Unclassified Nuclei
Area Postrema
Tracts: Inferior Cerebellar Peduncle, DLF

Basal Part - Pyramid

Open Medulla
(Mid-olivary Level)
Cranial Nerve Nuclei
1. Hypoglossal Nucleus
2. Nucleus Ambiguus
3. Dorsal Motor Nucleus of X
4. Nucleus Tractus Solitarius
5. Spinal Tract Nucleus,
pars interpolaris
6. Medial Vestibular Nucleus

Open Medulla
(Mid-olivary Level)
Precerebellar Nucleus
1. Accessory Cuneate Nucleus
2. Inferior Olivary Nuclear Complex
2a. Principal Inferior Olivary Nuc.
2b. Medial Accessory Olivary Nuc.
2c. Dorsal Accessory Olivary Nuc.

3. Nucleus Intercalatus
4. Nucleus of Roller
5. Nucleus Interfascicularis
Hypoglossi
6. Nucleus Conterminalis

Open Medulla (Mid-olivary Level)


XII. Hypoglossal Nerve
1. Hypoglossal Nucleus

X. Vagus Nerve
2. Nucleus Ambiguus
3. Dorsal Motor Nucleus of X
4. Nucleus Tractus Solitarius
5. Spinal Tract Nucleus of V

Clinical Syndromes
of Open Medulla
A. Dejerines Syndrome
1. pyramidal tract
2. hypoglossal nerve
3. medial lemniscus
B. Wallenberg Syndrome
4. spinothalamic tract
5. spinal tract of trigeminal nerve
6. nucleus ambiguus
7. descending autonomic
pathway

Wallenberg Syndrome
Spinothalamic tract
- contralateral loss of pain and
temperature sensation at the body

Spinal tract of trigeminal nerve


- ipsilateral loss of pain and
temperature sensation at the face

Nucleus ambiguus
- dysphageia, dysarthria, hoarseness

Descending autonomic pathway


- Horners syndrome
(meiosis, ptosis, anhydrosis)

Open
Open Medulla
Medulla (Upper
(Upper Level
Level of
of Medulla)
Medulla)
Tegmentum
Cranial Nerve Nuclei
Inferior Vestibular Nucleus
Dorsal Cochlear Nucleus
Precerebellar Nuclei
Nucleus Prepositus Hypoglossi
Reticular Formation
Gigantocellular Reticular Nucleus
Paragigantocellular Reticular Nucleus
Parvocellular Reticular Nucleus
Raphe Nuclei
Unclassified Nuclei
retrofacial, supravestibular nucleus, nucleus interpositus
Tracts: stria medullaris of 4th ventricle

Basal Part - Pyramid

Open Medulla
(Upper Level of Medulla)
Cranial Nerve Nuclei
1. Nucleus Ambiguus
2. Nucleus Tractus Solitarius
3. Spinal Tract Nucleus,
pars oralis
4. Medial Vestibular Nucleus
5. Inferior Vestibular Nucleus
6. Dorsal Cochlear Nucleus

Open Medulla
(Upper Level of Medulla)
Precerebellar Nucleus
1. Inferior Olivary Nuclear Complex
2a. Principal Inferior Olivary Nuc.
2b. Medial Accessory Olivary Nuc.
2c. Dorsal Accessory Olivary Nuc.

2. Nucleus Prepositus Hypoglossi


3. Pontobulbar Body
4. Arcuate Nucleus
5. Medial Vestibular Nucleus
6. Inferior Vestibular Nucleus

Open Medulla
(Upper Level of Medulla)
Reticular Formation
1. Paramedian reticular Nucleus
2. Gigantocellular Reticular Nucleus
3. paragigantocellular
Reticular Nucleus
4. Parvocellular Reticular Nucleus
5. Nucleus raphe Obscrus (B2)
6. Nucleus Raphe Pallidus (B1)
7. Nucleus Raphe Magnus (B3)

Unclassifiied Nuclei
A. Nucleus Retrofacialis
B. Supravestibular Nucleus
C. Nucleus Interpositus

Open Medulla (Upper Level of Medulla)


IX. glossopharyngeal
Nerve
1. Nucleus Ambiguus
2. Inferior Salivatory Nucleus
3. Nucleus Tractus Solitarius
4. Spinal Tract Nucleus of V

Pontomedullary
Pontomedullary Junction
Junction
Tegmentum
Cranial Nerve Nuclei
Facial Motor Nucleus
Ventral Cochlear Nucleus
Precerebellar Nuclei
Reticular Formation
Unclassified Nuclei
nucleus ovalis
Tracts
Basal Part - Pyramid

Cranial Nerve - Vestibulocochlear Nerve (VIII)


Facial Nerve (VII)

Pontomedullary
Junction
Cranial Nerve Nuclei
1. Facial Motor Nucleus
2. Nucleus Ambiguus
3. Spinal Tract Nucleus,
pars oralis
4. Medial Vestibular Nucleus
5. Inferior Vestibular Nucleus
6. Ventral Cochlear Nucleus

Pontomedullary
Junction
Precerebellar Nucleus
1. Principal Inferior
Olivary Nucleus
2. Nucleus Prepositus
Hypoglossi
3. Pontobulbar Body
4. Arcuate Nucleus
5. Medial Vestibular Nucleus
6. Inferior Vestibular Nucleus

Pontomedullary
Junction
Reticular Formation
1. Paramedian reticular Nucleus
2. Gigantocellular
Reticular Nucleus
3. paragigantocellular
Reticular Nucleus
4. Parvocellular Reticular Nucleus
7. Nucleus Raphe Magnus (B3)

Unclassifiied Nuclei
A. Nucleus Interpositus
B. Nucleus Ovalis

Lower
Lower Pons
Pons (Level
(Level of
ofAbducens
Abducens Nucleus)
Nucleus)
Tegmentum
Cranial Nerve Nuclei
Abducens Nucleus, Main Sensory Nucleus of V
Nuclei of Auditory Pathway
Superior Olivary Nuclear Complex
Reticular Formation
Caudal Pontine Reticular & Subceruleus Nucleus
Tracts
Trapezoid Body, lateral Lemniscus,
Central tegmental Tract

Basal Part: Pons Proper:


Pontine Nuclei,
Transverse Pontine Fiber,
Longitudinal Pontine Fiber (Pyramidal Tract)

Lower Pons (Level of Abducens Nucleus)


Cranial Nerve Nuclei
1. Abducens Nucleus
2. Main Sensory Nucleus of V
3. Lateral vestibular Nucleus
4. Superior Vestibular Nucleus

Auditory Relay Nuclei


A. Superior Olivary Nucleus
B. Nucleus of Trapezoid body

Lower Pons (Level of Abducens Nucleus)


Reticular Formation
1. Gigantocellular
Reticular Nucleus
2. Caudal Pontine
Reticular Nucleus
3. Parvocellular
Reticular Nucleus
4. Nucleus Subceruleus

VII. Facial Nerve


1. Facial Motor Nucleus
2. Superior Salivatory Nucleus
3. Nucleus Tractus Solitarius
4. Spinal Tract Nucleus of V

VI. Abducens Nerve


5. Abducens Nucleus

A. Facial Palsy
B. A + decreased salivation
C. A + B + hyperacusis
D. A + B + C + decrased
lacrimal secretion
E. Central Type Facial Palsy

1. Facial Motor Nucleus


2. Superior Salivatory Nucleus
3. Solitary Nucleus
4. Spinal Tract Nucleus of
Trigeminal Nerve

Facial
Facial Palsy
Palsy
(Bells
(Bells Palsy)
Palsy)

Lower
LowerMotor
Motor
Neuron
Neuron
Syndrome
Syndrome

Triple W Sign - Wrinkle, Wink, Whistle

Facial Palsy (Bells Palsy)

Right facial paralysis

Central
Central Type
Type
Facial
Facial Palsy
Palsy

Upper
UpperMotor
Motor
Neuron
Neuron
Syndrome
Syndrome

facial motor nucleus neurons


supplying forehead muscle
Bilateral Corticobulbar Tract

Abducens
Abducens
Palsy
Palsy

Lower
LowerMotor
Motor
Neuron
Neuron
Syndrome
Syndrome

Lateral Gaze Paralysis

Upper
Upper Pons
Pons (Level
(Level of
of Trigeminal
Trigeminal Motor
Motor Nucleus)
Nucleus)
Tegmentum
Cranial Nerve Nuclei
Trigeminal Motor Nucleus,
Mesencephalic Tract Nucleus of Trigeminal Nerve
Nuclei of Auditory Pathway
Nucleus of Lateral Lemniscus
Reticular Formation
Reticular Tegmental Nucleus
Unclassified Nucleus
Pontine Central Gray: Ch6
Tracts
Trigeminal Nerve Fiber

Basal Part: Pons Proper

Upper Pons (Level of Trigeminal Motor Nucleus)


Cranial Nerve Nuclei
1. Trigeminal Motor Nucleus
2. Main Sensory Nucleus of V
3. Mesencephalic Tract
Nucleus of V
4. Superior Vestibular Nucleus

Auditory Relay Nuclei


A. Nucleus of Lateral Lemniscus

Upper Pons (Level of Trigeminal Motor Nucleus)


Reticular Formation
1. Caudal Pontine
Reticular Nucleus
2. Nucleus Subceruleus
3. Reticular Tegemntal
Nucleus of Bekhterew
(Nucleus Papilloformis of
Olszewski and Baxter)

Clinical Syndromes
of Pons
A. Millard-Gubler Syndrome
B. Raymond Syndrome
C. Foville Syndrome
D. Raymond-Cestan Syndrome
E. Marie-Poix Syndrome
1. pyramidal tract
2. MLF
3. medial lemniscus
4. spinothalamic tract
5. trigeminal motor nucleus
6. main sensory nucleus of V
7. spinal tract of trigeminal nerve
8. middle cerebellar peduncle

Trigeminal Neuralgia
(tic douloureux)
- excruciating episodic pain
in the area supplied by
trigeminal nerve, especially
second and third division
- trigger point
- intense pain makes the
patient grimace (tic)
- antiepileptic drug (phenytoin,
carbamazepine) is effective
- surgical treatment

Lower
Lower Midbrain
Midbrain (Level
(Level of
of Inferior
Inferior Colliculus)
Colliculus)
Roof Plate - Tectum: Inferior Colliculus
Tegmentum
Cranial Nerve Nuclei
Trochlear Nucleus
Reticular Formation
Cuneiform, Pedunculopontine, Parabrachial
and Median Raphe (Superior Central) Nucleus
Unclassified Nuclei
Periaqueductal Gray
Tracts
Decussation of Superior Cerebellar Peduncle

Basal Part - Crus Cerebri, Pons Proper

Lower Midbrain
(Level of Inferior
Colliculus)
Roof Plate
A. Inferior Colliculus
Cranial Nerve Nuclei
1. Mesencephalic Tract
Nucleus of
Trigeminal Nerve
2. Trochlear Nucleus

Lower Midbrain
(Level of Inferior
Colliculus)
Reticular Formation
1. Cuneiform Nucleus
2. Pedunculopontine Nucleus
3. Nucleus Locus ceruleus
4. Parabrachial Nucleus
5. Dorsal Raphe Nucleus
6. Median Raphe Nucleus

Unclassified Nuclei

A. Periaqueductal Gray
B. Dorsal Tegmental Nucleus
of Gudden
C. Interpeduncular Nucleus
D. Parabigeminal Nucleus

Upper
Upper Midbrain
Midbrain (Level
(Level of
of Superior
Superior Colliculus)
Colliculus)
Roof Plate - Tectum: Superior Colliculus
Tegmentum
Cranial Nerve Nuclei
Oculomotor and Edinger-Westphal Nucleus
Reticular Formation - Subcuneiform Nucleus
Precerebellar Nuclei
Red Nucleus
Unclassified Nuclei
Substantia Nigra, Paranigral, Paralemniscal Nucleus
Ventral Tegmental Area (VTA)
Tracts
Brachium of Inferior Colliculus

Basal Part - Crus Cerebri

Upper Midbrain
(Level of Superior
Colliculus)
Roof Plate
A. Superior Colliculus

Precerebellar Nucleus
B. Red Nucleus

Cranial Nerve Nuclei


1. Mesencephalic Tract
Nucleus of V
2. Oculomotor Nucleus
3. Edinger-Westphal Nucleus

Upper Midbrain
(Level of Superior
Colliculus)
Reticular Formation
A. Cuneiform Nucleus
B. Subcuneiform Nucleus

Unclassified Nuclei
1. Periaqueductal Gray
2. Paralemniscal Nucleus
3. Substantia Nigra
3a. Pars Compacta
3b. Pars Reticulata
4. Paranigral Nucleus
5. Ventral Tegmental Area

Clinical Syndromes
of Upper Midbrain
A. Weber Syndrome
B. Foix Syndrome
C. Benedikts Syndrome
D. Claude Syndrome
E. Parinauds Syndrome
1. pyramidal tract
2. superior cerebellar peduncle
3. red nucleus
4. medial lemniscus
5. superior colliculus
6. cerebral aqueduct
7. MLF
8. oculomotor nucleus

Weber Syndrome
Pyramidal tract
- contralateral UMN syndrome
at the body and lower face
(contralateral hemiparesis)

Oculomotor Nerve
- ipsilateral ocular palsy
- external strabismus
- mydriasis
- loss of accommodation
- normal consensual light reflex