Brainstem Lec 2

BRAINSTEM
• The Brainstem lies at the base of the brain and

the top of the spinal cord.
• The brainstem is the structure that connects
the cerebrum of the brain to the spinal cord
and cerebellum.
• It is composed of 3 sections in descending
order: the midbrain, pons, and medulla
oblongata.
• It is responsible for many vital functions of life,
such as breathing, consciousness,
blood pressure, heart rate, and sleep.
• It contains many critical collections of
white and grey matter.
• The grey matter within the brainstem consists
of nerve cell bodies and form many important
brainstem nuclei. Ten of the twelve
cranial nerves arise from their cranial nerve
nuclei in the brainstem.
• The white matter tracts of the brainstem include
axons of nerves traversing their course to different
structures (the axons originate from cell bodies
located elsewhere within the CNS.
• Some of the white matter tract cell bodies are
located within the brainstem as well.
• These tracts travel both to the brain (afferent) and
from the brain (efferent) such as the
somatosensory pathways and the corticospinal
tracts, respectively.
Structure of Brainstem
• The brainstem is generally said to be

composed of three parts.
• Components, from above downward:
• Midbrain (or Mesencephalon)
• Pons (part of the metencephalon)
• Medulla (myelencephalon)
Midbrain
• The upper portion of the midbrain is called the

tectum, which means "roof."
• The surface of the tectum is covered with four
bumps representing two paired structures: the
superior and inferior colliculi.
• The superior colliculi are involved in eye
movements and visual processing, while the
inferior colliculi are involved in auditory
processing.
• Another important nucleus, the substantia
nigra, is located here.
• The substantia nigra is rich in dopamine
neurons and is considered part of the
basal ganglia.
Pons
• An important pathway for tracts that run from

the cerebrum down to the medulla and
spinal cord, as well as for tracts that travel up
into the brain.
• It also forms important connections with the
cerebellum via fibre bundles known as the
cerebellar peduncles.
• Pons is a home to several nuclei for
cranial nerves.
• Nerves that carry information about
sensations of touch, pain, and temperature
from the face and head synapse in a nucleus in
the pons.
• Motor commands dealing with eye
movement, chewing, and facial expressions
also originate in the pons.
• Additionally, cranial nerve nuclei in the pons
are involved in several other functions,
including swallowing, tear production,
hearing, and maintaining balance/equilibrium.
Medulla
• The point where the brainstem connects to
the spinal cord.
• Contains a nucleus called the nucleus of the
solitary tract that is crucial for our survival
(receives information about blood flow, along
with information about levels of oxygen and
carbon dioxide in the blood, from the heart
and major blood vessels).
• Essential to our survival because it ensures
vital systems e.g cardiovascular and
respiratory systems are working properly.
• Responsible for several reflexive actions,
including vomiting, swallowing, coughing, and
sneezing. Several cranial nerves also exit the
brainstem at the level of the medulla.
Anatomical Relations
• The brainstem is located in the posterior cranial

fossa.
• Relations :
• Above, the midbrain is continuous with the
cerebral hemisphere.
• Below, the medulla is continuous with the
spinal cord.
• Posteriorly, the pons and medulla are separated
from the cerebellum by the fourth ventricle.
Blood supply
• The brain stem receives its blood supply

exclusively from the posterior circulation,
including the vertebrae and basilar artery.
• The medulla receives its blood supply from the
vertebral via medial and lateral perforating
arteries.
• The pons and midbrain receive their blood
from the basilar via the medial and lateral
perforating arteries.
Functions
• The brainstem has three broad functions:

• 1. Serves as a conduit for the ascending tracts
and descending tracts connecting the
spinal cord to the different parts of the higher
centres in the forebrain.
• 2. Contains important reflex centres associated
with the control of:
• respiration e.g breathing
• cardiovascular system e.g BP
• consciousness
• autonomic functions such as digestion, salivation,
perspiration, dilation or contraction of the pupils,
urination, etc.
• 3. Contains the nuclei of Cranial Nerves III to XII
Clinical Significance
• Significant clinical problems can affect the

brainstem such as stroke, malignancy,
demyelinating processes, and many more. e.g
• Multiple Sclerosis, with visual problems
including blurred double vision being a
common early symptom of MS.
• Stroke affecting the brainstem can cause severe
symptoms which include:Problems with vital functions,
such as breathing - frequently resulting in death.
• Difficulty using with chewing, swallowing, and speaking.
• Weakness or paralysis in the arms, legs, and/or face.
• Problems with balance or sensation.
• Hearing loss
• Vision problems
• Vertigo
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BRAINSTEM

• The Brainstem lies at the base of the brain and

• The brainstem is generally said to be

• The upper portion of the midbrain is called the

• An important pathway for tracts that run from

• The brainstem is located in the posterior cranial

• The brain stem receives its blood supply

• The brainstem has three broad functions:

• Significant clinical problems can affect the

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