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Le tronc cérébral

Functions of the Brainstem


Mesencephalon
•Serves as a conduit for long – Also called midbrain
and short tracts – Processes sight, sound, and associated reflexes
(ascending=sensory, – Maintains consciousness
descending=motor) and Pons
houses their related nuclei – Connects cerebellum to brain stem
•Houses cranial nerve nuclei – Is involved in somatic and visceral motor
(sensory and motor) control
•Houses the reticular Medulla Oblongata
– Connects brain to spinal cord
formation (arousal state,
– Relays information
autonomic function, pain
regulation, motor esp. – Regulates autonomic functions:
postural control) • heart rate, blood pressure, and digestion
Généralités, situation, sub-divisions
• Le terme « tronc cérébral » (brainstem) ou
simplement « tronc » recouvre l’ensemble bulbe ou
moelle allongée + pont ou protubérance +
mésencéphale, à l’exclusion du cervelet.
• C’est au niveau du tronc cérébral que naissent
presque tous les nerfs crâniens: leur étude est
indissociable de celle du tronc.
• Comme toute structure du système nerveux
central, le tronc cérébral est composé de substance
grise et de substance blanche.
• C’est le segment du névraxe qui est placé au-dessus
de la moelle, sous le cerveau et en avant du
cervelet, au centre de la fosse crânienne
postérieure.
• Le tronc cérébral est une portion dilatée du
névraxe. Il présente à décrire 3 parties qui sont, de
bas en haut :
 a) - la moelle allongée (bulbe rachidien)
 b) - le pont (protubérance annulaire)
 c) - le mésencéphale (pédoncules cérébraux)
Embryonic Development

Primary brain Secondary brain Definite brain


vesicle vesicle

Prosencephalon Telencephalon Cerebral hemisphere

Diencephalon Diencephalon
Mesencephalon Mesencephalon Midbrain
Rhombencephalon Metencephalon Pons
Cerebellum
Myelencephalon Medulla oblongata
Brain Stem Development
Neural tube

Alar plate Sulcus Basal plate


limitans
(dorsal) (ventral)

Sensory structure Motor structure

General nuclei Special nuclei

Function similar to spinal nerves Function unique to head (hearing,


balance, taste)
Brain Stem Development
Basal plate Alar plate
Brainstem

External features Internal features


Dorsal surface Caudal medulla
Ventral surface Mid medulla
Rostral medulla
face ventrale

Pons
Midbrain
Reticular
formation
Face ventrale
•fissure médiane ventrale
•De chaque côté de la fissure il existe deux reliefs
verticaux appelés pyramides de la moelle allongée.
•En dehors des pyramides se trouve le relief d’un
noyau gris profond qui est l’olive de la moelle
allongée.
•Au niveau du pont les fibres nerveuses constituent un
bourrelet transversal dont les extrémités latéro -
dorsales forment les pédoncules cérébelleux moyens.
•Le sillon horizontal qui sépare la moelle allongée et le
pont s’appelle sillon bulbo-pontique.
• A ce niveau apparaissent plusieurs nerfs crâniens.
•Au niveau du mésencéphale, il existe deux bourrelets
de fibres nerveuses qui ont une direction ascendante
et divergente, ce sont les pédoncules cérébraux.
•L’espace entre les deux pédoncules s’appelle espace
interpédonculaire.
•A cet endroit se trouvent le relief des deux tubercules
mamillaires et la tige de la glande hypophyse.
Face dorsale
Au niveau de la moelle allongée
•au tiers inférieur, la prolongation des cordons dorsaux de la moelle épinière.
•La partie haute de cette région comporte un relief, le corps restiforme, et les reliefs des noyaux
gracile et cunéiforme.
•Puis les deux cordons dorsaux de la moelle allongée s’écartent l’un de l’autre pour délimiter la
cavité du 4ème ventricule et constituer les pédoncules cérébelleux inférieurs.
 Au niveau du pont
•la très large cavité losangique du 4ème ventricule, qui communique, en haut, avec le 3ème
ventricule par un pertuis étroit appelé aqueduc du mésencéphale (a. de Sylvius).
•La partie haute et la partie basse du 4ème ventricule sont recouvertes par des replis du tissu
nerveux appelés valvule de VIEUSSENS en haut, valvule de TARIN en bas.
•Cette dernière possède un orifice appelé trou de MAGENDIE. Le fond de la cavité du 4ème
ventricule constitue le plancher du 4ème ventricule et comporte plusieurs reliefs qui
correspondent aux noyaux des nerfs crâniens.
• Au niveau des angles latéraux du 4ème ventricule se trouvent les plexus choroïdes, à structure
glomérulaire et responsables de la sécrétion du liquide cérébro-spinal, à ce niveau.
 Au niveau du mésencéphale
•un segment étroit appelé Toit du Mésencéphale (ou lame quadrijumelle ) qui comporte les 4
reliefs des tubercules quadrijumeaux, actuellement appelés colliculus supérieur et colliculus
inférieur, qui sont des centres sensoriels réflexes pour la vision et l’audition.
Medulla Oblongata

• A continuation of the spinal cord


Limite:
• Forms the inferior part of the brain
stem Superior – plan orizontal superior de
• The white matter of the medulla coluculii cuadrigemeni superiori
consists of tracts (both ascending Inferior – plan orizontal prin marginea
sensory tracts and descending motor inferioară a decusaţiei piramidale şi
tracts) that go to and from the brain mijlocul arcului anterior al atlasului
• Within the medulla, most of the large
motor tracts on the left side cross
over to the right, and most on the Orientare: oblic , cranial şi anterior
right side cross over to the left at the Lungime: 8,5-9 cm
decussation of pyramids
• Faţă ventrală
– Formă trapezoidală
• Baza mică – joncţiunea bulbo-medulară
• Baza mare – şanţ bulbo-pontin
• Inferior - foramen magnum
• Superior- procesul bazilar occipital
– şanţul ventral bulbar
– Decusaţia piramidală
– Foramen caecum
– şanţuri colaterale ventrale (originea aparentă a n.XII)
– Piramide ventrale bulbare (originea aparentă n.VI)
• Faţă dorsală
– Parte inferioară, extraventriculară (între şanţurile colaterale dorsale bulbare; conţine continuarea
tracturilor gracilis şi cuneatus)
– Parte superioară, ventriculară
• Feţe laterale (2)
– Anterior – şanţul colateral ventral, poaterior de care se află oliva bulbară (proeminenţă ovoidală ce
conţine complexul nuclear olivar inferior)
– Posterior – şanţul colateral dorsal (originea aparentă radiculară a n. IX, X, XI), dorsal de care se află
tuberculul cenuşiu (segment bulbar al coloanei senzitive trigeminale – nucleul spinal al trigemenului)
– Inferior – se continuă cu cordonul lateral medular
– Superior şi dorsal olivei bulbare – foseta supraolivară (originea aparentă a n.VII) şi retroolivară
(originea aparentă a n.VIII)
Medulla oblongata
Ventral surface
• Pyramid: contain pyramidal tract
(corticospinal tract)
• Decussation of pyramid: formed by
crossing fibers of corticospinal tract
• Olive: produced by underlying inferior
olivary nucleus
• Anterolateral sulcus: rootlets of
hypoglossal nerve emerge from it
• Retroolivary sulcus:
rootlets of
glossopharyngeal, vagus and accessory
nerves emerge from it
Medulla oblongata

Dorsal surface
• Lower portion
– Gracile tubercle: produced by
gracile nucleus
underlying
– Cuneate tubercle: marks the site of
cuneate nucleus
– Inferior cerebellar peduncle
– Obex
• Upper portion: forms the lower half
of rhomboid fossa
Medulla Oblongata
• The gray matter of the medulla contains several nuclei
which control vital body functions:
– Cardiovascular center—regulates the rate and force
of the heartbeat and the diameter of blood vessels
– Medullary rhythmicity area—adjusts the basic
rhythm of breathing
– Nuclei for cranial nerves VIII-XII
– Other nuclei control reflexes for swallowing,
vomiting, coughing, sneezing, and hiccupping
The Medulla Oblongata
• Allows brain and spinal cord to communicate
• Coordinates complex autonomic reflexes
• Controls visceral functions
3 types nuclei
1. Autonomic nuclei:
– control visceral activities
2. Sensory and motor nuclei:
– of cranial nerves
3. Relay stations:
– along sensory and motor pathways
Medulla oblongata
Function

Connects the spinal cord &


the brain

Center for autonomic


functions
- Breathing
- Digestion
- Heart rate
- Blood pressure
Pons
• Faţa ventrală (aspect striat, alungită transversal)
• Located above the medulla in the brain Limite
stem • Inferior – şanţul bulbo-pontin
• “Bridge” that connects parts of the brain • Superior – şanţul ponto-peduncular
with one another • Lateral – 2 planuri prin originile aparente
• Like the medulla, contains tracts and ale n.V
nuclei Median – şanţul bazilar, artera bazilară
• The pneumotaxic area and the Lateral–piramidele pontine (tracturile
corticospinale şi nucleii pontini), lateral,
apneustic area help the medulla control
originea aparentă a n.V
breathing • Faţa dorsală
• Contains nuclei for cranial nerves V-VIII. • Cuprinsă între pedunculii cerebeloşi superiori
• The pons is a broad band of white • Formează segmentul superior al fosei
matter located anterior to the romboidale
cerebellum and between the midbrain • Faţa laterală
and medulla oblongata. The pons • Se continuă fără limite de demarcaţie cu
contains fiber tracts linking the pedunculul cerebelos mijlociu
cerebellum and medulla to higher • Plan parasagital lateral de originea aparentă a
cortical areas; two-way conduction n.V
pathway between areas of the brain and
other areas of the body;influences
respiration.
Pons
Links cerebellum with mesencephalon,
diencephalon, cerebrum, and spinal cord
Ventral surface
• Basilar part
• Basilar sulcus
• Bulbopontine sulcus : from medial to
lateral, the abducent, facial and
vestibulocochlear nerves appear
• Middle cerebellar peduncle nerve
• Pontocerebellar trigone: the junction of
medulla, pons and cerebellum
Dorsal surface
• Superior cerebellar peduncle
• Superior medullary velum
• Trochlear nerve
Pons

4 groups
1. Sensory and motor nuclei of cranial nerves V,
VI, VII, VIII
2. Nuclei involved with respiration:
– apneustic center and pneumotaxic center
– modify respiratory rhythmicity center
activity

3. Nuclei and tracts:


– process and relay information to and from cerebellum
4. Ascending, descending, and transverse tracts:
– transverse fibers (axons)
• link nuclei of pons w/ opposite cerebellar hemisphere
Figure 14–6c
Pons Function

Connects the medulla &


midbrain

Transmit information
between spinal cord &
higher brain regions
via neural circuits

Relay motor
information
between cerebral
cortex & cerebellum
Midbrain
• Located above the pons in the brainstem
• Also contains tracts and nuclei
• The cerebral aqueduct passes through it to connect the
third ventricle to the fourth ventricle
• On the posterior side of the midbrain are a pair of
superior colliculi and a pair of inferior colliculi
• The superior colliculi are visual reflex centers (ex.
adjusts the pupil size, adjusts the lens shape for near
and far vision)
• The inferior colliculi are auditory reflex centers (ex.
startle reflex caused by a loud noise)
• Faţa ventrală
– Discontinuă
– Reprezentată de feţele laterale ale pedunculilor cerebrali, încrucişate caudo-cranial de : arterele
cerebeloase superioare, arterele cerebeloase posterioare, tracturile optice
– Feţele mediale: şanţ unde are originea n.III
– Delimitează cu tracturile şi chiasma optică fosa interpedunculară (spaţiul optopeduncular)
– Inferior se află substanţa perforată inferioară (pătrund ramurile centrale ale arterei cerebrale
posterioare
• Faţa dorsală
– Coliculii cvadrigemeni ( 2 perechi de proeminenţe rotunjite separate printr-un şanţ cruciform,
superior şi inferior)
– Prezintă:
• braţ vertical
– evazat cranial, loja glandei epifize
– Caudal – frâul văluzui medular superior
– Lateral – originea aparentă a n. trohlear
• Braţ conjunctival – corpii geniculaţi lateral şi medial
• Faţa laterală
– Anterior – şanţul lateral al istmului (marchează limita între crus cerebri şi tegmentum)
– Posterior – şanţul interpeduncular (separă pedunculii cerebrali de pedunculul cerebelos
superior)
– Proemină fibrele lemniscusului lateral (pentru coliculul inferior) – triunghiul Reil
– Încrucişată cranio-caudal de tractul optic, nervul trohlear şi artera cerebrală posterioară
– Fisura cerebrală laterală (o delimitează şi separă de girusul parahipocampic)
Midbrain

Tectum
Eye
movement
Auditory &
visual
processing

Behaviour

Tegmentum

Has substantia nigra


(important motor nuclei)
Crus Cerebri
Midbrain
Ventral surface
• Crus cerebri
• Interpeduncular fossa oculomotor nerves
emerge from medial of crus cerebri
• Posterior perforated substance

Dorsal surface
• Superior colliculus constitute centers for
visual reflexes
• Inferior colliculus associated with auditory
pathway
• Brachium of superior colliculi
• Brachium of inferior colliculi
Brain Stem

midbrain
a. crus cerebri
b. interpeduncular fossa – III
c. posterior perforated substance
d. superior colliculus
e. brachium of superior colliculus
f. inferior colliculus - IV
g. brachium of inferior colliculus
Reticular formation
(Latin = incomprehensible  )

• Part of primitive brain


• Diffuse network
– Polyneuronal,
polysynaptic, polymodal,
asc & desc, crossed and
uncrossed, axon
collaterals
• Location: tegmentum of
medulla, pons, midbrain
Reticular formation

• Core of brain stem


• Has ensembles of local-circuit interneurons (generate motor patterns,
coordinate reflexes and simple behaviour)
• Input – summary of much of sensory information that enters the spinal cord and
brain stem
• Controls level of consciousness, cardiovascular system and respiratory system
• Inputs: diffuse, all forms of sensation, from sp cord & CN, cerebral ctx, hypothal,
limbic sys, basal gangl
• Outputs: diffuse, cerebral ctx, sp cord
• ANS centers
– Respiratory centers
– Cardiovascular centers
Locus ceruleus

• NE neuronal soma
• Location: floor of rostral 4th ventricle
• Asc and desc fibers throughout CNS
• Active when awake
• Most active when startled
• Ascending reticular activating
system
• Damage - coma
Substantia nigra & VTA

• DA neuronal soma
• Location: midbrain
• Output: caudate & putamen,
forebrain
• Fxn: movement control (PD),
motivation (nuc accumbens)
Raphe nuclei

• 5HT neuronal soma


• Location: midline brainstem
• Inputs: diffuse, all forms of sensation, from
sp cord & CN, cerebral ctx, hypothal, limbic
sys, basal gangl
• Outputs: diffuse, cerebral ctx, sp cord
• ANS centers
– Respiratory centers
– Cardiovascular centers
–Chemical Organization of the Reticular
Formation
Locus ceruleus – NE
SN/VTA - DA
Raphe nuclei – 5HT
Review blood supply

• Vertebral
• Basilar
• Posterior cerebral
• Anterior spinal
• Posterior spinal
• PICA
• AICA
• Superior cerebellar
• Posterior communicating
Lesions to the brain stem

• Cause – stroke, tumor, multiple sclerosis


• Lesion type – unilateral
• Effects – ipsilateral cranial nerve dysfunction,
contralateral spastic hemiparesis, hyperreflexia
and an extensor plantar response, contralateral
hemisensory loss and ipsilateral coordiation.
Horner’s syndrome

• Through brainstem near ALS


• Desc symp path from hypothal to intermediolateral ce
column
• Ipsilateral face
• Miosis – constric pupil
• Ptosis – droopy eyelid
• Anhydrosis – no sweating
Injury Mechanisms
The brain is a complex and delicate organ, and one that is
vulnerable to injury from a variety of different traumas.
These include:
 Frontal Lobe Injury
 Occipital Lobe Injury
 Temporal Lobe Injury
 Side Impact Injury
 Coup/Contre-coup Injury
 Diffuse Axonal Injury
 Epidural Hematoma
 Subdural Hematoma
Lateral Medullary Syndrome
• Loss of pain and
temperature - left body
• Sparing of touch
• Loss of pain and
temperature - right face
• Hoarseness and difficulty
swallowing
• Right Horner’s syndrome
(loss of sympathetic
innervation to face)
• Vertigo
• Nystagmus (abnormal eye
movements)
• Cerebellar ataxia