1

Repeat campaign 2008 A/L

Brain stem
Medulla oblongata + pons + mid brain
In the posterior cranial fossa of the skull
1. Pathway for ascending & descending tracts
2. Reflex center (cvs/resp sys)
3. Cranial nerve nuclei
Cranial nerve nuclei
Mid brain CN 3
CN 4
Pons

CN 6
CN 7
Medulla
oblangata

CN 9
CN 10(NA,NTS,DNV)
CN 11
CN 12

Leminisci

Spinal leminiscus -ant spinothalamic + lat spinothalamic VPL nucleus(thalamus)


Medial leminiscus -nucleus cuneatus + nucleus gracilis VPL nucleus


Trigerminal leminiscus -sensory nuclei of CN 5 VPM nucleus(thalamus)


Lateral leminiscus -superior olivery & trapezoid body medial geniculate body

Note
Medial longitudinal fasciculus connect CN 3, 4, 6, 8
Carries fibers that connect vestibular & cochlear nuclei to the nuclei controlling ocular movements
C 3,4,6
CN 8
Mesencephalic

CN 5

Spinal nucleus
Motor
Main sensory



2

Repeat campaign 2008 A/L
Anterior view of the brain stem











6, 7, 8 cranial nerves emerge through the ponto-medullary junction
7, 8 nerves are found in the cerebello-pontine angle
9, 10, 11 cranial nerves emerge between inferior cerebellar peduncle & olive
12 nerve emerge olive & pyramid


Posterior view of the brain stem











Trochlear nerve is the only cranial nerve to emerge from the posterior surface.
Middle cerebellar peduncle does NOT contribute to form the lateral boundaries of the 4
th
ventricle.
3

Repeat campaign 2008 A/L
Medulla oblongata - Motor decussation













Medulla oblongata - Sensory decussation













4

Repeat campaign 2008 A/L
Medulla oblongata - Level of olivary nucleus












Pons - level of facial colliculus







Pons - level of trigeminal nucleus






5

Repeat campaign 2008 A/L
Mid brain - inferior colliculus









Mid brain - superior colliculus











Applied neuroanatomy
Brainstem lesions ipsilateral cranial nerve damage , contralateral hemiparesis,contralateral sensory loss
in the body
Medulla oblongata
Blood supply Posterior inferior cerebellar artery
Medullary artery
(Anterior inferior cerebellar artery- Basilar artery
Vertebral artery
6

Repeat campaign 2008 A/L
Lateral medullary syndrome
Cause : thrombosis in PICA or vertebral artery
1. Analgesia & thermoanasthesia on ipsilateral face
2. Vertigo, nausea, vomiting, nystagmus
3. Dysphagia & dysarthria

4. Loss of pain & temperature( contralateral body)
5. Ipsilateral Horners syndrome
6. Ipsilateral cerebellar signs(ataxia)

Spinal nucleus of trigerminal(CN 5)
Vestibular nuclei(CN 8)
Paralysis of ipsilateral palatal & laryngeal
muscles(Nucleus Ambiguus)(CN 9,10,11)
Spinal leminiscus(spinothalamics)
Descending sympathetic fibers
Inferior cerebellar peduncle


Medial medullary syndrome
Cause : thrombosis of medullary branch of vertebral artery
1. Contralateral hemiparesis
2. Contralateral loss of proprioception & 2point
discrimination
3. Ipsilateral tongue paralysis(deviate to paralyzed
side when protruded)
Pyramidal tract
Medial leminiscus

Hypoglossal nerve


Pons
1. Weakness of jaw muscles
2. Anesthesia to light touch in face(pain
& temperature preserved)
3. Paresis of lateral rectus
4. Weakness of ipsilateral facial muscles
5. Nystagmus,vertigo
6. Impairement of hearing
7. Contralateral hemiparesis
8. Contralateral sensory defects in trunk
9. Ipsilateral cerebellar signs
Motor nucleus of CN5
Main sensory nucleus of CN 5 (spinal nucleus intact)

Abducent nucleus (CN 6)
Facial nerve(CN 7)
Vestibular nuclei(CN 8)
Cochlear nucleus(CN 8)
Pyramidal tracts
Medial & spinal leminisci
Cerebellar peduncle/corticopontocerebellar fibers


1.1 Explain the term decussation.(10)
Describe the motor & sensory decussations in the medulla.(60)
State briefly the changes in sensory & motor functions in lesions above and below each decussation.(30)
(AL 2002 main)

2. Sixty year old hypertensive female patient complains of imbalance& difficulty in speaking. She also complains of nausea & vertigo. On
examination she was found to have right sided palatal paralysis, loss of pain & temperature sensation over the right side of the face. There
were also positive cerebellar signs on the right side.
a) Where is the most possible site of the lesion?
b) What is the most possible cause?
c) Explain the above signs & symptoms
d) What other clinical features would you expect to find in this patient?

3. Draw & label a cross section at the trigeminal level of the pons to show the position of the ascending & descending tracts (50 marks)
Give the commencement & the termination of these tracts (50 marks)

4. Draw a labeled diagram of the transverse section through the pons at the level of the facial nucleus (40)
On what anatomical basis would you differentiate between UMN lesion & LMN lesion of the facial nerve (20)

5. Draw & label a diagram of the midbrain at the level of inferior colliculus (30)
Describe the trochlear nerve from its origin to its termination (70)