Académique Documents
Professionnel Documents
Culture Documents
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
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
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
XII
Abducens Nucleus
VI
Trochlear Nucleus
IV
Oculomotor Nucleus
III
IX, X, XI
VII
IX
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
V, VII, IX, X
VII, IX, X
VIIIc
Vestibular Nucleus
VIIIv
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
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
Posterior
Posterior White
White Colum-Medial
Colum-Medial Lemniscal
Lemniscal Pathway
Pathway
C. Thalamus (VPLc)
D. Cerebral Cortex (S I)
Spinothalamic
Spinothalamic Tract
Tract
Spinoreticulothalamic
Spinoreticulothalamic Tract
Tract (Paleospinothalamic
(PaleospinothalamicTract)
Tract)
Modality: Pain & Temperature Sensation, Light Touch
from body
Receptor: Free Nerve Ending
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
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
Auditory
Auditory Pathway
Pathway
Modality: Auditory Sensation (Hearing)
Receptor: Organ of Coti of Cochlear Duct
Cranial Nerve: VIIIc
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
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
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
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
Brain
Brain Stem
Stem
Descending
Descending Tracts
Tracts
Composite
Composite Bundle
Bundle
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
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
Spinomedullary Transition
(Level of Pyramidal Decussation)
Cranial & Spinal N. Nuclei
1. Supraspinal Nucleus
2. Spinal Accessory Nucleus
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
Lower Medulla
(Level of Lemniscal
Decussation)
Roof Plate
A. Nucleus Gracilis
B. Nucleus Cuneatus
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
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
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
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
Nucleus ambiguus
- dysphageia, dysarthria, hoarseness
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
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.
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
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
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
A. Facial Palsy
B. A + decreased salivation
C. A + B + hyperacusis
D. A + B + C + decrased
lacrimal secretion
E. Central Type Facial Palsy
Facial
Facial Palsy
Palsy
(Bells
(Bells Palsy)
Palsy)
Lower
LowerMotor
Motor
Neuron
Neuron
Syndrome
Syndrome
Central
Central Type
Type
Facial
Facial Palsy
Palsy
Upper
UpperMotor
Motor
Neuron
Neuron
Syndrome
Syndrome
Abducens
Abducens
Palsy
Palsy
Lower
LowerMotor
Motor
Neuron
Neuron
Syndrome
Syndrome
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
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
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
Upper Midbrain
(Level of Superior
Colliculus)
Roof Plate
A. Superior Colliculus
Precerebellar Nucleus
B. Red 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