Medulla Ext.

Appearance  Conical in shape

oblongata  Continues at the level of foramen magnum
 Central canal continues upward into lower half of medulla
 Expands as the cavity of 4th ventricle in upper half
 Broad extremity directed superiorly
 Connects the pons at pontomedullary junction(CN VI,VII,VIII)
Anterior Posterior
 Decussation of pyramidal fibers at lower  PMS: post surface of lower 1/2 of
part of AMF medulla.
 Pyramids composed of corticospinal  Gracile tubercle (each side of MS)
fibers and cuneate tubercle (lateral to GT)
 Olives are produced by underlying are produced by their underlying
inferior olivary nucleus, posterolateral to nucleus.
the pyramids.  Post surface of upper half forms the
 Rootlets of CN XII emerge between floor of 4th ventricle.
pyramid and olive.
 Ant ext arcuate fibers emerge from
median fissure above pyramidal
decussation run upward laterally and pass
to cerebellum.
 ICP: post to the olive, connects medulla
to cerebellum.
 Roots of CN IX, X, XI emerge between
olive and ICP.
Int. Structure Pyramidal Lemnisci Olives Inferior to pons
decussation decussation
White matter White matter White matter No major change
 Decussation of  Pyramid  Pyramid  Lateral
pyramid  Int arcuate  Med lemniscus- vestibular
 Lat spinothalamic fibres from emerge from nucleus replaced
tract nuclei gracilis decussation of the inferior
 Spinocerebellar and cuneatus- lemnisci> vestibular
tract great sensory thalamus nucleus
 Fasciculus gracilis decussation of  Spinal  Cochlear nuclei
 Fasciculus medial lemnisci meniscus are now on both
cuneatus  Spinal  Med ant and post
lemniscus: longitudinal surfaces of ICP
Gray matter spinothalamic fasciculus
 Nucleus gracilis & tract (lat&ant) &  Spinal tract
cuneatus spinotectal tract and nucleus of
 Spinal nucleus CN occupy an area CN V
V: below, lat to decussation  ICP
continuous with of medial  Ant
substantia lemnisci spinocerebellar
gelatinosa in post  Spinocerebellar, tract.
gray column of SC vestibulospinal,  Tectospinal &
rubrospinal tracts spinotectal
are antlat region tract
of MO.  Reticular
formation:
Gray matter diffuse mixture
 Nucleus and of nerve fibers
spinal tract of & small group
CN V lies lat to of nerve cells
int arcuate fibers
 (assoc with
arousal and
level of
consciousness)

Gray Matter
 Comprising of
XII nucleus,
dorsal nucleus
of X
 N tractus
solitarius-
receive taste,
carotid sinus
ref, aortic ref,
cough ref
 VIII nuclear
complex
 Nucleus
ambiguus- large
MN> fibers
through IX X
XI N
>voluntary
muscles of
palate and
larynx
 Inf. olivary N-
aff from SC/
Cerebr cortex
eff of vol
muscular
movement to
cerebellar
peduncle.
 Arcuate nuclei-
thought to be inf
displaced pontine
nuclei
 Afferent-cerebral
cortex
 Efferent-ant ext
arcuate fibres
pass to
cerebellum

Cranial Nerve  CN IX X XI (N ambiguous)

 XII N
 Dorsal nucleus of X, cochlear
 Nucleus tactus solitarius
 Spinal nucleus of CN V
Blood Supply  Medullary branches from vertebral artery
 From post-inf cerebellar artery supply the posterolateral part of medulla
 Clinical Herniation through foramen magnum
Conditions Arnold-chiari malformation
-congenital anomaly results in internal hydrocephalus
-Last 4 CN affected
Lateral medullary syndrome of Wellenberg- thrombosis @ PICA
-dysphagia & dysarthria
- analgesia & thermoanaesthesia
- vertigo, nausea, vomiting, nystagmus(VIII N)
-ipsilat cerebellar signs gait & limb ataxia
- contralat loss of sensation
Medial medullary syndrome- thrombosis @ vertebral artery
- Contralat hemiparesis
-contralat impared sense of position and movement and tactile discrimination
- ipsilat paralysis of tongue wth deviate to paralysed side when tongue is protruded.

Pons Ext. Appearance Anterior surface Posterior surface

 Bridge-like connecting two cerebellar  Forms the upper half of floor of 4th
hemisphere ventricle & is hidden by cerebellum
 Transverse fibers converge to form the  Limited laterally by MCP
MCP  MS divides the pons into two halves
 ME: elongated elevation on either
 Basilar groove for basilar A
side of MS and bounded laterally by
 CN V (anterolateral) has smaller medial SL
motor root and larger lateral sensory root
 FC: expanded inferior end of ME
 Vestibular area is lateral to SL
Int. Structure  Ant: Basal part
 Post: Tegmentum
 Trapezoid body divides ant and post part
 Post surface forms the superior half of 4th ventricle

Caudal part (level of facial colliculus) Cranial part (level of trigeminal

nuclei)
 Medial lemniscus rotates in transverse  Similar to caudal but now it contains the
position as it moves from medulla to motor & principal sensory nuclei of
pons, accompanied by spinal & lateral CN V
lemnisci  SCP situated posterolaterally, ASC
 CN VII & VI present fibres pass to cerebellum through it
 Facial colliculus- the fibers of VII N  Trapezoid body, medial, lateral &
wind around VI N nucleus to produce spinal lemniscus
an eminence
 Spinal nucleus and tract of CN V
 Medial vestibular nucleus
 Medial longitudinal fasciculus
connects VIII N nuclei with nuclei
controlling extraocular muscles (VI, IV,
III)
 Post & ant cochlear nuclei are found
 Trapezoid body made up by fibers from
cochlear nuclei & end in superior
olivary nucleus, or in nucleus of
trapezoid body
  Axons form lat lemniscus
 Lat lemniscus ascends and end in inf
colliculus
 Basal part: corticopontine fibres
terminate in pontine nuclei, axons cross
midline, pass cerebellum through MCP.
 Auditory pathway (refer notes on CN)
Cranial Nerve  CN V motor, main sensory & spinal nucleus
 CN VI motor nucleus
 CN VII nucleus
 Sup & Inf salivatory nucleus
 Dorsal cochlear nucleus
Blood Supply  Pontine branches of basilar A
 Ant, inf & sup cerebellar A
Clinical  Pontine haemorrhage
Conditions  Pontine infarction
 Involvement of corticocerebellar tracts will produce marked cerebellar ataxia and
intention tremor
Midbrain Ext. Appearance Anterior surface Posterior surface
 Long axis inclines anteriorly as it ascends  Corpora quadrigemina: 4 small
through the tentorial notch colliculi (2 superior-visual reflex; 2
 2 lat half called cerebral peduncles (crus inferior-auditory)
cerebri + tegmentum)  CN IV emerge below inferior colliculi
 Interpeduncular fossa (IPF): deep  Cerebral aqueduct of Sylvius:
depression bounded laterally by crus narrow channel connecting 3rd and 4th
cerebri. ventricle
 Post perforated substances: floor of
IPF.
 CN III emerge from medial surface of
crus cerebri
Int. Structure Inferior of midbrain
Cerebral peduncles:
 Crus cerebri (ant)
 Tegmentum (post but lies ant to cerebral aqueduct)
 Cerebral aqueduct connects 3rd to 4th ventricle
 Substantia nigra: pigmented band of gray matter
 Tectum: post to cerebral aqueduct composed of corpora quadrigemina

Inferior colliculi Superior colliculi

 Part of auditory pathway  Superior colliculus: connected to
 CN IV pass laterally & posteriorly to lateral geniculate body by superior
emerge just below inferior colliculi, brachium
decussate in SMV  Receives fibres from optic nerve, visual
 Mesencephalic nucleus of CN V cortex & spinotectal tract
 Receives proprioception of face  Efferent fibres form tectospinal &
especially jaw (jaw jerk) tectobulbar tracts (visual body reflex)
 Substantia nigra: concerned with  Pretectal nuclei: part of subcortical
muscle tone, connected to cerebral visual system:
cortex, spinal cord, hypothalamus, basal - Afferent: Optic tract
nuclei - Efferent: Edinger-Westphal
 MLF nuclei
 Decussation of SCP occupies central - Responsible for
part (efferent fibres from cerebellum to light/accommodation reflex
red nucleus)
  Reticular formation: lateral to - Edinger-Westphal nucleus lies
decussation posterior to CN III nucleus
 Medial, trigeminal, spinal lemniscus  CN III nucleus and N
 Lateral lemniscus ascend to inferior  Red nucleus
colliculus - Afferent: cerebral cortex,
 Crus cerebri: contains the descending cerebellum, lentiform nucleus,
fibres subthalamus, hypothalamus,
substantia nigra & spinal cord
- Efferent: spinal cord, reticular
formation, thalamus &
substantia nigra
 Similar to corticospinal tract.
Vestigeal.???
 Medial, spinal & trigeminal lemnisci
 Reticular formation
 Crus cerebri: descending fibres from
cerebral cortex

Cranial Nerve  CN III nucleus

 CN IV nucleus
 Mesencephalic nucleus of CN V
Blood Supply  PCA
Clinical Trauma Vascular lesion
Conditions  Sudden lateral movement of the head  Weber’s syndrome- occlusion of a
could result in cerebral peduncle branch of PCA- necrosis of CN III
impinging against sharp rigid free edge and crus cerebri
tentorium cereblli  Ipsilateral opthalmoplegia
 Bent, stretched, twisted or torn  Contralateral paralysis of lower part
 Involvement of CN III- ipsilateral of the face, tongue, arm & leg
paralysis of LPS, SR, IR, MR & IO  Eyeball deviated laterally
muscles  Ptosis
 Malfunction of parasympathetic  Dilated pupil and fixed to light &
(Edinger-Westphal) nucleus of CN III- accommodation
dilated pupil, absence of light &
accommodation reflexes
 Involvement of CN IV- contralateral
paralysis of SO muscle
 Involvement of one or both CN III & IV
or corticonuclear fibres that converge
upon them, cause impairment of ocular
movement
 Tumour or pressure from outside may
compress cerebral aqueduct and
produce hydrocephalus