Ainstem I

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Advanced Neuroanatomy

Lecture 2
The Brainstem – Part I
Lecture Overview
• Embryology
• Features and Organization
• Specific features of each Subdivision
• Key Structures
• Cranial Nerves
Lecture Overview
• The brainstem is important enough to deserve two
lectures!
– First lecture involves general description, classification of
the brainstem as well as the cross sectional and anatomical
construction of the brainstem
– Second lecture involves detailed review of cranial nerves
and their relationship to the brainstem
The Brainstem
• The Brainstem is the part of the brain that:
1. Forms the zone of transition between the brain and the spinal cord
2. From which most (but not all!) cranial nerves originate
3. Within which are contained centers which are crucial for:
• Awakeness and arousal
• Respiration
• Balance
• Conjugate gaze
4. Is associated with important CSF collections including the:
• Cerebral aqueduct
• 4th ventricle
• CSF cisterns
5. Below which is located the foramen magnum, which forms the
confines of the skull
Embryological Derivation
Organization
Evaginations and Protuberances
• Evaginations: outpouching of a local part of the neural tube
wall
• Protuberances: Proliferation of cells into masses in particular
sites:
– There is no extension of lumen of the neural tube
• Cerebellum
• Mammillary bodies
• Brainstem protuberances:
– Quadrigeminal plate
– Nuclei of the basis pontis
– Inferior olivary eminence
• Most protuberances relate to the brainstem!
Features of the Brainstem
• Essentially the brainstem has the same somite plan
as the spinal cord
• It delineates a transition zone from the diencephalon
to the spinal cord
The Brainstem as a Transition zone
• Given that it is a transition zone, additional features
are present:
– Special motor neurons (cranial nerves)
– Special nuclei and pathways that mediate the special
senses of taste, hearing, equilibrium
– Pathways that control eye movements
– Reticular formation
– Associated nuclei with the above
– Quadrigeminal plate of the midbrain
– The cerebellum: Closely associated with the brainstem
• Cerebellum is “protruding from the dorsum of the pons”
Functional Subdivisions of the
Brainstem
• The brainstem can be divided into:
– Midbrain (mesencephalon)
• Most rostral
– Pons (metencephalon)
• Middle
– Medulla (myelencephalon)
• Most caudal
• On the axial plane, the brainstem is
subdivided into three laminae:
– Tectum (most dorsal)
– Tegmentum (middle)
– Basis (most rostral)
Brainstem Organization
• Multiple manners of classification:
– According to cross sectional subdivisions:
tectum/tegmentum/basis
– According to contents of midbrain/pons/medulla
– According to nuclei and cranial nerves
– Functional classification
Cross-sectional Organization
• Tectum:
– Defined as lamina of the brainstem with tissue
dorsal to the plane of the cerebral aqueduct
– Tectum = roof
– Contents:
• Quadrigeminal plate in the midbrain (roofs over the
aqueduct)
• Superior medullary velum over the pons
• Inferior medullary velum over the medulla
Cross-sectional Organization
• Tegmentum:
– Plate of neurons and tracts between basis and tectum
– Complex relationship of gray and white matter
• General somatomotor and general sensory cranial nerve nuclei
– These are strictly located in the tegmentum: no cranial nerve nuclei are
located in the basis or tectum
• Special visceral efferent nuclei
• Supplementary motor nuclei
– In the medulla: inferior olivary nuclei
– In the pons: Nuclei of the basis pontis
– In the midbrain: Red nucleus and substantia nigra
• Sensory tracts to the thalamus: Lemnisci
• Reticular formation fills the space in the tegmentum that is not occupied
by the above
Cross-sectional Organization
• Basis:
– Transmits descending cortical efferent motor
tracts
• Corticopontine tracts
• Pyramidal tracts
– Corticobulbar
– Corticospinal
• In the medulla, the basis has an oval or “pyramidal”
shape, hence the name medullary pyramids. The name
of pyramidal tracts derives from this.
Ventral View of the Brainstem
Sagittal View of the Brainstem
Dorsal View of the Brainstem
Midbrain General Organization
• Midbrain tegmentum:
– Two cranial nerve nuclei: III, IV
– Two supplementary motor nuclei:
• Red nucleus
• Substantia nigra
• Midbrain tectum:
– Quadrigeminal plate:
• Paired colliculi: two superior, two inferior
Midbrain General Organization
• Midbrain basis:
– Corticopontine tracts
– Pyramidal tracts
• Decussations:
– Superior cerebellar peduncle fibers
– Corticobulbar pathway for volitional horizontal eye
movements
• Contains the aqueduct within the tegmentum
Tracts within the Midbrain
• We will follow the course of several major
tracts within the brainstem:
– Medial longitudinal fasciculus (MLF)
– Medial lemniscus (ML)
– Spinal lemniscus (SL)
– Corticospinal tract (CST)
Tracts within the Midbrain
• MLF: Ventral tegmentum, anterior to
periaqueductal gray
• SL: Lateral tegmentum, dorsal to ML
• ML: Together with SL form a crescent dorsal to
SN
• CST: Midbrain basis
Tectum and Tegmentum
Midbrain (Mesencephalon)
Midbrain (Mesencephalon)
Pons (Myelencephalon)
The Pons
• Pons (Lt. Bridge)
• External anatomy:
– Characteristic protuberance ventrally (“belly” of
the pons)
– Midportion of the brainstem
– Ventral and opposite to the position of the
cerebellum on sagittal views
General Structure
• Cross section: Triad 1
– Tectum: Superior medullary velum
– Tegmentum: Thin plate of gray matter
– Basis: Largest portion of the pons
• Contains longitudinally coursing cortical efferent fibers
and nuclear masses
• Corticopontocerebellar pathway
General Structure
• Pontine peduncles: Triad 2
– Three paired peduncles: afferent and efferent
cerebellar tracts; pure white matter tracts
– Cerebellar peduncles
• Superior (brachium conjuctivum), rostral, cerebellar
afferents and efferents
• Middle, cerebellar afferents only, largest
• Inferior (restiform body), caudal - afferents and
efferents
General Structure
• Pontine cranial nerves:
• Motor cranial nerve nuclei: Triad 3
– V, VI, VII
– Internal loop of VII over VI
• Sensory cranial nerve nuclei: Triad 4
– Rostral part of cochlear VIII
– Rostral part of vestibular VIII
– Sensory nucleus of V
General Structure
• Sensory nucleus of V has 3 subdivisions:
– Mesencephalic nucleus (propioception)
– Main sensory nucleus (touch)
– Spinal nucleus (medulla and rostral spinal cord
(pain/temp)
General Structure
• Decussations in the pons: Triad 5
– Auditory pathways:
• Trapezoid body and superior olive
– Pontocerebellar pathways:
• Decussation from basis pontis to MCP
– Cerebellovestibular pathways:
• Partially decussate across the roof of 4th ventricle
Tracts in the Pons
• MLF:
– Caudal pons: dorsal tegmentum, medial
– Ventral pons: further dorsal, just ventral to 4th
ventricle
• SL/ML: Move dorsally, become horizontal
fibers in midpons. Lat/medial arrangement
• CST: Within the nuclei of the basis pontis
Tractography allows for the study of the brain with imaging rather than dissection
Medulla (myelencephalon)
• External anatomy:
– Bulbous expansion of the spinal cord
– Ventral protuberance of the olive
– Transition zone to the cord
– Open and closed medulla:
• Open medulla: 4th ventricle, rostral
• Closed medulla: caudal to the 4th ventricle
Medulla (myelencephalon)

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mages/n2a5p1.gif http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=frso
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Medulla
• Tegmentum thickens:
– Primarily due to nuclei of the reticular formation
– Long tracts assemble as a shell around the gray
matter
– Area postrema, only paired circumventricular
organ – located at the caudal end of the 4th
ventricle
Comparison between Medulla and Spinal
Cord
Spinal Cord Medulla
• Central canal • Fourth ventricle
• Reticular nucleus • Reticular formation
• Substantial gelatinosa • Spinal nucleus and tract of V
• Nucleus dorsalis of Clarke • Lateral cuneate nucleus
• Intersegmental ground • Medial longitudinal
bundles fasciculus
• Spinal lemniscus • Continues to medial
lemniscus
Transition from Medulla to Cord
• External features:
– The medulla is larger, the spinal cord is smaller
– Presence of the 4th ventricle in the medulla
– Presence of the external olivary eminence
– Anterior median fissure is obliterated
– Presence of spinal nerves
• Internal features:
– Decussation of the pyramids in the medulla
– Termination of the fasciculi gracilis and cuneatus
– Replacement of Lissauer’s fibers by spinal
trigeminal tract
– Development of CN nuclei
• Most caudal end of the
4th ventricle = obex
• 4th ventricle has the
shape of a writing pen
(=calamus scriptorius)!
• Cranial nerves associated with the medulla:
– Vestibulocochlear (VIII)
– Glossopharyngeal (IX)
– Vagus (X)
– Accessory (XI)
– Hypoglossal (XII)
Medullary Decussations
• 5 important decussations:
• Reticulospinal respiratory pathways
– Just ventral to the obex
• Pyramidal tract
• Internal arcuate fibers: formed by 3 decussations:
– Trigeminal lemniscus: From spinal nucleus of V
– Medial lemniscus: From nuclei gracilis and cuneatus
– Olivocerebellar tracts: From inferior olive
Medullary Tracts
• MLF: Very medial and dorsal, just ventral to the 4th ventricle

• SL: Very lateral, and now quite separate from the medial
lemniscus

• ML: Large and medial, immediately ventral to MLF and


spanning all the way ventral to the position of the medullary
pyramids

• CST: Decussation (int arcuate fibers)


Specific Brainstem Structures
– Reticular formation
– Fourth ventricle and surrounding structures
– Quadrigeminal plate
– Periaqueductal gray
– The olives
– The red nucleus
– Substantia nigra
– Locus ceruleus
– Central pathways for the control of breathing
Reticular Formation
• Unique neuroanatomical structure
• Huge implications on who we are and how we
function
• “Formation” since neurons are loosely
arranged, collection of nuclear groups
• Has “reticular” pattern on microscopic
sections
Reticular Formation
• Anatomically it extends through the entire brainstem
tegementum
• Caudally at the cervico-medullary junction
• Rostrally: difficult to tell, but likely at the midbrain-
diencephalic junction

• Nuclear regions: 4 nuclear regions define the RF:


– Raphe nucleus (midline)
– Medial gigantocellular nuclei
– Lateral gigantocellular nuclei
– Cerebellar RF nuclei
Functions of the RF
• Mediates consciousness, attention span, alertness
• Sleep-wake cycle
– RF is tonically activated during wake and sleep, but in different manners
and through different nuclei
• Homeostasis and neurovegetative reflexes:
– Reflexes that controls visceral function:
• Breathing, pulse, blood pressure
• Upper GI and respiratory tracts
• Coughing, sneezing, vomiting, hiccups, chewing, sucking and feeding – all have
RF control
• Somatomotor and sensory motor reflexes:
– Postural reflexes
– Muscle tone
– Vestibular reflexes affecting eyes and somatic muscles
Subdivisions of the RF
• Rostral half of RF (above midpontine tegmentum)
– Responsible for arousal, consciousness, attention

• Caudal half of RF (below midpontine tegmentum)


– Responsible for breathing, vestibular reflexes,
cardiovascular, pulmonary and gastrointestinal reflexes,
genitourinary and defecation reflexes.
4th Ventricle
• Rhomboid shaped cavity
• Lies over pons and medulla
• Superiorly: aqueduct of the midbrain
• Inferiorly: central canal of the spinal cord
• Defined by:
– Roof: Part towards the cerebellum
– Formed by superior and inferior medullary veli
– Roof forms apex in cerebellum: fastigium
• Superior medullary velum: Pontine part of the
roof of 4th ventricle
• Inferior medullary velum: Medullary part
• Tela choroidea: point of attachment of the
choroid plexus to the roof, passes into the
lateral recesses at either side
• Widest part of the 4th ventricle is immediately
caudal to the MCP
• Floor of the 4th ventricle: Rhomboid fossa
– Median sulcus splits the rhomboid fossa
– Lateral to the median sulcus: medial eminence:
• Contains the bulge of the facial colliculus
• Hypoglossal trigone caudally
• Vagal trigone lateral to the hypoglossal trigone
• Area postrema
• Point of junction of the walls of the 4th v = obex
Quadrigeminal Plate
• Located dorsally in the midbrain
• Unique structure – two paired sets of
protuberances
• Caudally: Superior colliculi – important in the
control of gaze, particularly upgaze
• Rostrally: Inferior colliculi – important as relay
in auditory stimuli
Periaqueductal Gray Zone
• AKA periventricular gray zone
• Dense collection of small cells
• Functionally heterogeneous
• Part of the tegmental nuclei, together with raphe
nuclei and interpeduncular nuclei
• Surround the aqueduct
• Contains several nuclear groups including:
– Mesencephalic nucleus of the trigeminal nerve
– Locus ceruleus (pigmented cells)
• PAG implicated in:
– Central analgesic mechanisms
– Vocalization
– Control of reproductive behaviour
– Aggressiveness
– Mechanism of gaze

– They receive afferents including hypothalamus, raphe


nuclei, locus ceruleus and spinal cord
The Olives
• Superior and inferior olives
• Superior olive:
• Inferior olive: Olivary eminence of the medulla
– Most characteristic feature of the medulla
– Consists of three parts:
• Principal inferior olivary nucleus
• Medial
• Dorsal accessory olivary nuclei
– Crossed olivocerebellar fibers constitute the largest component of the
inferior cerebellar peduncle
– End as climbing fibers in the cerebellar cortex
– Powerful excitatory action on Purkinje cells
• Principal olivary nucleus is surrounded by a band of myelinated fibers:
Amiculum olivae
Medulla (myelencephalon)
Red Nucleus
• Midbrain
• Medial and immediately dorsal to the substantia
nigra
• Fibers of the superior cerebellar peduncle wrap
around it
• Uncrossed projections: Rubroolivary
• Crossed projections:
– Von Monacow’s fibers (rubrospinal)
– Important role in control of movement
– Facilitates flexor muscle tone
Midbrain
Substantia Nigra
• Pigmented set of nuclei dorsal to the midbrain
peduncles
• Pigment: Neuro-melanin
– Biproduct of the metabolism of dopamine
– Two parts:
• SNc – SN pars compacta: cell rich region, mainly
efferents
• SNr – SN pars reticulata: cell poor region, mainly
afferents
• Efferents from SN are mainly dopaminergic
• Axons from SNr are mainly GABAergic
Locus Ceruleus
• Pigmented nuclei in the
dorsal pontine
tegmental area
• Major neurotransmitter
release: Noradrenergic
• Major nuclei important in release of
neurotransmitters:
– Noradrenergic – Locus ceruleus
– Dopaminergic – SNpc
– Serotonergic – Raphe
– Cholinergic – Nucleus basalis of Meynert
(substantia innominata) – not in the brainstem
Central Pathways of Breathing
• Breathing involves three different functions:
– Speech: volitional breathing
– Emotional expression: Associated with laughing,
crying
– Homeostasis: Oxygen exchange: mediated by
medullary respiratory neurons and reticulospinal
pathways

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