Brainstem
Dr Swathi
Brainstem
Midbrain
Pons
Medulla
Medulla
Lower part of brainstem
Located between pons
& spinal cord
Contains vital centers
2 parts
Upper open part
Lower closed part
External features
Pyramids
2 prominent bulgings on the either
side of anterior median fissure
Olive
Oval elevation
Inferior olivary nucleus
Inferior cerebellar peduncle
Connects medulla to cerebellum
Cranial nerve rootlets
Rootlets of 12th cranial nerve
(hypoglossal nerve) emerges
between pyramid & olive
Rootlets of 9th, 10th & 11th cranial
nerves emerge between olive &
inferior cerebellar peduncle
Posterior aspect
Closed part
Fasciculus gracilis
Fasciculus cuneatus
Inferior cerebellar peduncle
Open part
Forms the lower part of the floor
of IVth ventricle
Internal structure of medulla
At the level of decussation of pyramids
At the level of sensory decussation
At the level of olives
Cross section at the level of pyramidal decussation
Nucleus gracilis
Nucleus cuneatus
Nucleus of spinal tract of
trigeminal nerve
Spinal tract of trigeminal
nerve
Decussation of
pyramidal tract
Transverse section at the level of sensory decussation
Nucleus gracilis
Nucleus cuneatus
Internal arcuate fibres
Lower part of inferior
olivary nucleus
Pyramids
Medial longitudinal
fasciculus
XIIth nerve nucleus,
dorsal nucleus of Xth
nerve & nucleus
tractus solitarius
Transverse section at the level of olives
XIIth nerve nucleus
Dorsal nucleus of Xth
nerve
Vestibular nuclei
Nucleus of tractus
solitarius
Spinal nucleus & tract
of Vth nerve
Nucleus ambiguus
Medial leminiscus
Inferior cerebellar
peduncle
Pyramids
Arterial supply
Vertebral arteries
Anterior & posterior spinal arteries
Anterior & posterior inferior cerebellar arteries
Basilar artery
Applied aspects
Lateral medullary syndrome
Medial medullary syndrome
Pons
Middle part of brainstem
Laterally continuous as middle cerebellar peduncle
External features
Ventral surface
Basilar groove
Rootlets of trigeminal nerve
emerge at the junction of middle
cerebellar peduncle & pons
Pons
Superior border
Cerebral peduncles
Inferior border
6th,7th & 8th nerve
Dorsal surface
Forms the floor of IVth ventricle
Internal structure of pons
Ventral part
Basilar part
Dorsal part
Tegmental part
Basilar part
Longitudinal bundles
Transverse fibers
Pontine nuclei
Transverse section through lower part of pons
Nucleus of 6th
nerve
Motor nucleus of
7th nerve
Vestibular nuclei
Cochlear nuclei
Spinal nucleus of
5th nerve
Trapezoid body
Medial & spinal
leminiscus
Medial
longitudinal
fasciculus
Transverse section through upper part of pons
Motor nucleus of 5th
nerve
Sensory nucleus of 5th
nerve
Medial, trigeminal,
spinal & lateral
leminiscus
Medial longitudinal
fasciculus
Middle cerebellar
peduncle
Superior cerebellar
peduncle
Arterial supply
Basilar artery
Anterior inferior cerebellar artery
Applied aspects
Pontocerebellar angle syndrome
Millard – Gubler syndrome
Midbrain
Upper end of brainstem
Ventral surface
2 crura cerebri
Occulomotor nerve emerges from the groove on
the medial surface of crus cerebri
Trochlear nerve emerges on the dorsal aspect &
curls around the lateral aspect of crus cerebri
Dorsal surface
4 rounded elevations
2 superior colliculi
2 inferior colliculi
Separated by cruciform sulcus
Trochlear nerve emerges one on each side of upper part of
frenulum velum
Thick ridge of white matter extending from colliculi - brachia
Superior brachium- Lateral geniculate body
Inferior brachium – Medial geniculate body
Internal structure of midbrain
Cerebral aqueduct
Coronal plane
Tectum
2 Cerebral peduncles
Cerebral peduncle
Each cerebral peduncle is
divided into
Tegmentum
Substantia nigra
Crus cerebri
Crus cerebri
Descending tracts
Middle 2/3rd
corticospinal & corticonuclear fibres
Medial 1/6th
frontopontine fibres
Lateral 1/6th
temporopontine, parietopontine & occipitopontine fibres
Substantia nigra
Curved pigmented band of
grey matter situated between
tegmentum & crus cerebri
Divided into pars compacta &
pars reticularis
Nerve cells contain melanin &
iron
Transverse section of midbrain at the level of inferior
colliculus
Grey matter
Nucleus of trochlear nerve
Mesencephalic nucleus of
trigeminal nerve
An ovoid mass of grey
matter beneath inferior
colliculus
Substantia nigra
Reticular formation
Section of midbrain at the level of inferior colliculus
White matter
Decussation of
superior cerebellar
peduncles
Leminisci
Medial
Trigeminal
Spinal
Lateral
Medial longitudinal
fasciculus
Tectospinal tract
Rubrospinal tract
Transverse section of midbrain at the level of superior
colliculus
Grey matter
Oculomotor nerve
nucleus
Mesencephalic
nucleus of trigeminal
nerve
Superior colliculus
Pretectal nucleus
Red nucleus
Highly vascular
Pigment
containing iron
Transverse section of midbrain at the level of superior
colliculus
White matter
Dorsal tegmental
decussation
Ventral tegmental
decussation
Blood supply
Basilar artery
Posterior cerebral artery
Superior cerebellar artery
Posterior communicating artery
Anterior choroidal artery
Applied aspects
Weber’s syndrome
Benedikt’s syndrome
Parinaud’s syndrome
Thanks
