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
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 )
• 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
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