Brainstem and Nuclei

Oral Biology

Alex Forrest
Associate Professor of Forensic Odontology Forensic Science Research & Innovation Centre, Griffith University Consultant Forensic Odontologist, Queensland Health Forensic and Scientific Services, 39 Kessels Rd, Coopers Plains, Queensland, Australia 4108

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Learning Objectives

You should have a general picture of the important relationships between the major brainstem nuclei associated with the cranial nerves. You should understand and be able to describe and discuss how the relationships between these nuclei will be useful in diagnosis of neurological lesions you may encounter during practice.

Brainstem

Brainstem

The brainstem unites the brain (cerebrum and cerebellum) with the spinal cord. It comprises three parts:
midbrain pons medulla oblongata

http://www.mhhe.com/socscience/intro/ibank/ibank/0012lll.jpg

Brainstem

The brainstem transmits all sensory and motor pathways and information between the brain and the spinal cord. In the brainstem, one finds the central connections of the cranial nerves and their associated nuclei.
http://wwwunix.oit.umass.edu/~psyc335c/lectures/hindbrain.gif

Reticular Formation

Scattered deeply throughout the brainstem are loosely organized groups of material collectively known as the reticular formation, which have important tasks in relation of the level of awareness or consciousness, respiratory and cardiac function, and other things as well.
http://www.biology.eku.edu/RITCHISO/reticularformation.gif

Midbrain

The midbrain forms the most superior part of the brainstem. It houses a canal which connects a diamondshaped space in the medulla oblongata called the fourth ventricle, which connects with the third ventricle, lying between the cerebral hemispheres of the brain.
http://www.driesen.com/ventricles.jpg

Midbrain

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 102.

This canal joining them is called the cerebral aqueduct, and is continuous with the central canal of the spinal cord.

Midbrain

The part of the midbrain posterior to the aqueduct is called the roof of the aqueduct, or the tectum, and on its surface are four small elevations called the colliculi, arranged in pairs.
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 109.

Midbrain

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 109.

The colliculi are important in reflex activity. The upper pair is associated with vision, the lower pair with hearing and balance.

Midbrain

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 108.

Therefore, the dorsal part of the midbrain is mainly given over to the visual and auditory systems, and in the ventral part are nuclei for the oculomotor (III) and trochlear (IV) nerves.

Midbrain

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 109.

The part anterior to the aqueduct is formed by the cerebral peduncles which enter the cerebral hemispheres.

Pons

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 108.

The pons is the part of the brainstem between the midbrain and the medulla.

Pons

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 108.

It lies anterior to the connections of the cerebellum, and much of its structure comprises fibres passing across the midline to connect one cerebellar hemisphere with that on the other side.

Pons

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 108.

Posteriorly, the cerebellum attaches to the pons by means of the cerebellar peduncles.

Pons

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 108.

In diagrams of the brainstem, the cerebellum is removed to give visibility, and these cut peduncles appear as ovoid masses.

Pons

The dorsal portion of the pons contains sensory and motor tracts, and the nuclei of the abducens, facial and trigeminal nerves. Ventrally, it contains bundles of fibres connecting the two cerebellar hemispheres.
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 111.

Pons

Cranial nerves V VIII exit the brainstem from the pons, and many of the cranial nuclei associated with the trigeminal nerve are found here.

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 111.

Pons
In the pons, it becomes clear that motor nuclei tend to be situated more medially than sensory nuclei. We also find that nuclei with related functions tend to be grouped fairly close to each other.
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, CibaGeigy Medical, Plate 110.

Medulla Oblongata

The medulla oblongata is the most inferior part of the brainstem, and is a direct continuation of the spinal cord as it passes through foramen magnum into the cranium.

http://www.mhhe.com/socscience/intro/ibank/ibank/0012lll.jpg

Medulla Oblongata

It begins at the foramen magnum by convention. This is an arbitrarily chosen border and does not reflect an anatomical change. It ends at the inferior border of the pons.

Medulla Oblongata

On the lateral surface there is a swelling on each side known as the olive, and anteriorly, a second swelling close to the midline called the pyramid. The pyramids are separated by the anteromedian fissure.
Grays Anatomy, Longmans, London, 38th Ed 1989 p. 965

Medulla Oblongata
The grey matter and white matter of the spinal cord get rearranged in this area. The ventral grey horns (motor) of the spinal cord continue into the regions of the pyramids, where there is extensive crossingover of fibres from one side to the other (pyramidal decussation).

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, CibaGeigy Medical, Plate 108.

Medulla Oblongata

Fibre tracts from the spinal cord continue into the medulla. Above this, the architecture of the medulla bears little resemblance to that of the spinal cord, and you might expect this, since there are nuclei scattered throughout the region, and these will give rise to new tracts as they approach the brain.

Medulla Oblongata

Clusters of nerve cell bodies, called nuclei, are also found here. Nuclei of cranial nerves 9 12 are found in the medulla, and the nucleus of VIII is partly in the medulla and partly in the pons.

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 111.

Medulla Oblongata

Grays Anatomy, Longmans, London, 38th Ed 1989 p. 949.

Close to the olive, we observe the exit of cranial nerves IX XII.

Medulla Oblongata

Grays Anatomy, Longmans, London, 38th Ed 1989 p. 952.

Trigeminal Nerve (V)

Trigeminal Nerve

The cell bodies of most of the somatic sensory neurons are located in the trigeminal ganglion, a ganglion that in many ways resembles the dorsal root ganglion found in spinal nerves.
Modified from Grays Anatomy, Longmans, London, 38th Ed 1989 p. 1107

Trigeminal Nerve

The central processes of these cells form the bulk of the sensory root of the trigeminal nerve, and it enters the side of the pons.
Grays Anatomy, Longmans, London, 38th Ed 1989 p. 951.

Trigeminal Nerve

Here, we need to recall what happens in a spinal nerve. Recall that a sensory fibre terminates there in the dorsal horn. In particular, fibres for pain and temperature terminate in the substantia gelatinosa. Also recall that fibres need not terminate in the spinal segment in which they originated, but rather may ascend or descend a variable number of segments in the dorsolateral fasciculus before reaching the dorsal horn.

Trigeminal Nerve

It turns out that there are similar structures in the brainstem associated with the trigeminal nerve. We find that there are three sensory nuclei which simulate aspects of the dorsal gray horn, and a tract that simulates the dorsolateral fasciculus. In particular, the nucleus of the spinal tract simulates (and is continuous with) the substantia gelatinosa of the spinal cord. Histologically, we do not see any difference between the two.

Trigeminal Nerve

The three general sensory nuclei, from superior to inferior, are:

mesencephalic nucleus chief sensory nucleus nucleus of the spinal tract

The tract associated with these is called the spinal tract, or the tract of the spinal nucleus.

Trigeminal Nerve

These three nuclei run from the medulla oblongata up to the midregion of the midbrain.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve

The chief sensory nucleus and the nucleus of the spinal tract are nuclei of common sensation. In other words, it is here that the cell bodies of general sensory cells that relay to higher centres are located.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve

The mesencephalic nucleus is a very specific nucleus. It deals with proprioception, and is intimately involved with reflex control of mastication.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve

The need for speed in this control is great, and so this is the only nucleus in the central nervous system where the peripheral sensory cell bodies lie within the CNS.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve

Fibres from proprioceptive organs in TMJ, periodontal ligaments, muscle spindles in the muscles of mastication, and proprioceptive organs in the sutures of the maxilla terminate here.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve
Central processes of many of these neurons pass directly to the trigeminal motor nucleus without synapsing with an interneuron. This establishes rapid reflex control over the biting forces exerted during mastication.
Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 111.

Trigeminal Nerve

Fibres from the TMJ also relay to the chief sensory nucleus to provide conscious information about the joint position.

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 111.

Trigeminal Nerve

The chief sensory nucleus principally subserves the function of discriminative touch.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve
The nucleus of the spinal tract (also known as the Spinal Nucleus) is, as we have already said, partly responsible for the perception of simple touch and pressure. Crucially, it also relays the modalities of pain and temperature, but only towards its more caudal end.
Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve

The spinal tract (often but wrongly called the trigeminal spinal tract) is in many ways equivalent to the dorsolateral fasciculus in the spinal cord. It is continuous with it, and within it there is blending of fibres from both spinal cord and brainstem.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve

Sensory axons, entering the pons through the trigeminal sensory root, combine with other general sensory fibres from other cranial nerves with a sensory function (VII, IX and X), and those from the upper cervical spinal segments that pass cranially into the medulla, to form the spinal tract.
Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve

Some of the sensory fibres from cranial nerves also pass through the foramen magnum and descend in what becomes the dorsolateral fasciculus as far caudally as the third cervical segment.

Trigeminal Nerve

There is also a physical arrangement of sensory fibres from the different branches of the trigeminal nerve in the spinal tract. The fibres of V3 lie dorsally, those of V1 lie ventrally, and those of V2 lie in between.

Trigeminal Nerve

The spinal tract, and therefore the spinal nucleus, serve as the common centre for processing general sensory input from four cranial nerves (V, VII, IX and X). It is therefore inappropriate to refer to it simply as a trigeminal nucleus, although many textbooks make this mistake.

Trigeminal Nerve

Because pain and temperature fibres from all of these nerves terminate in the same portion of the spinal nucleus, there is a possibility of referral of pain to areas subserved by other nerves. For example, pain in a lower posterior tooth (classically a lower 8) may be felt as an earache as well, and may even involve temporary deafness in the ipsilateral ear until the inflammation is relieved.

Trigeminal Nerve

The peripheral sensory fibres all synapse within the chief sensory nucleus and the spinal nucleus, and CNS neurons take the information to other destinations. These include the trigeminal motor nucleus, the motor nucleus of VII (you screw your face up if someone touches it lightly and unexpectedly, and you close your eyes if the cornea of the eye is touched). Connections therefore occur between these nuclei at this level.

Trigeminal Nerve

In fact, there is a tremendous amount of crosstalk between nuclei of the brainstem, and this results in many of the effects we see in living people.

Trigeminal Nerve

Other destinations include the hypoglossal nucleus (tongue), nucleus ambiguus (cough, gag and vomit reflexes), the thalamus (emotional response and relays to the cortex), the reticular formation (awareness together with other centres, including awareness of changes in external conditions such as air movements, temperature etc.).

Trigeminal Nerve

The central motor fibres of the trigeminal nerve originate in other brain centres and descend to terminate in the trigeminal motor nucleus. This nucleus lies medial to the chief sensory nucleus.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve
Here they synapse with peripheral fibres, whose cell bodies make up this nucleus. Their axons form the bulk of the motor root of V, which exits the cranium through the foramen ovale and connects with the sensory trunk of V3 shortly afterwards.
Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Trigeminal Nerve

Most of these motor fibres originate from the opposite side of the brain, but not all of them, which means there is a certain amount of insurance if the tracts on one side are injured or destroyed, for example, during a stroke.

Facial Nerve (VII)

Facial Nerve

The nuclei of importance with respect to the facial nerve include .

Facial Nerve

the facial motor nucleus for the somatic motor function of the nerve, the superior salivatory nucleus for supply of the parasympathetic secretomotor fibres to the salivary glands,

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 111.

Facial Nerve

the lacrimal nucleus for parasympathetic secretomotor fibres to the lacrimal gland, and the nucleus of the solitary tract which supplies taste fibres.

Netter, F. 1989, Atlas of Human Anatomy, Summit, New Jersey, Ciba-Geigy Medical, Plate 111.

Facial Nerve

Recall that general sensory functions of VII are subserved by the nucleus of the spinal tract in the brainstem.

Facial Nerve

The motor nucleus of the facial nerve lies in the pons medially to the nucleus of the spinal tract, and slightly inferior to the chief sensory nucleus of the trigeminal nerve.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Facial Nerve

Motor fibres originating in the facial motor nucleus pass towards the abducens nucleus, which they wind around before exiting from the brainstem en route for the internal acoustic meatus.
Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 959.

Facial Nerve

The sharp angle made by the fibres as they wind around the abducens nucleus is called the internal genu, as opposed to the external genu of the nerve in the facial canal of the temporal bone.

Modified from: Grays Anatomy, Longmans, London, 38th Ed 1989 p. 953

Learning Objectives

You should have a general picture of the important relationships between the major brainstem nuclei associated with the cranial nerves. You should understand and be able to describe and discuss how the relationships between these nuclei will be useful in diagnosis of neurological lesions you may encounter during practice.

The End