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Nabeel Kouka, MD, DO, MBA brain101

Nabeel Kouka, MD, DO, MBA www.brain101.info. Basic Strucrure of Brain Stem. 1. Roof Plate 2. Tegmentum 3. Basal Portion. Basilar (Basal) Portion. Descending Fibers from Cerebral Cortex 1. Corticospinal Tract 2. Corticobulbar Tract 3. Corticopontocerebellar Fiber

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Nabeel Kouka, MD, DO, MBA brain101

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  1. Nabeel Kouka, MD, DO, MBA www.brain101.info

  2. Basic Strucrure of Brain Stem 1. Roof Plate 2. Tegmentum 3. Basal Portion

  3. Basilar (Basal) Portion Descending Fibers from Cerebral Cortex 1. Corticospinal Tract 2. Corticobulbar Tract 3. Corticopontocerebellar Fiber Corticopontine Fiber Pons Proper (Ventral Pons) Pontocerebellar Fiber Pyramidal Tract

  4. Basal Portion Descending Tracts Corticospinal Tract Origin: Cerebral Cortex Brodmann Area 4 (Primary Motor Area, M I) Brodmann Area 6 (Premotor Area, PM ) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Corona Radiata lnternal Capsule, Posterior Limb Crus Cerebri, Middle Portion Longitudinal Pontine Fiber Pyramid - pyramidal decussation Corticospinal Tract - Lateral and Anterior Termination: Spinal Gray (Rexed IV-IX)

  5. Basal Portion Descending Tracts Corticobulbar Tract - Corticofugal fibers projecting to, and terminating in, portions of lower brainstem - Termination: 1) motor nuclei (upper motor neuron pathway) hypoglossal, ambiguus, facial motor, trigeminal motor, abducens, trochlear and oculomotor nucleus 2) sensory relay nuclei nuclei gracilis and cuneatus, trigeminal sensory nucleus, solitary tract nucleus 3) reticular formation (corticoreticular fiber)

  6. Basal Portion Descending Tracts Corticobulbar Tract - UMN Pathway - Corticofugal fibers projecting to cranial motor nuclei GSE - hypoglossal (XII), abducens (VI), trochlear (IV) and oculomotor (III) nucleus SVE - ambiguus (IX, X, XI), facial motor (VII), trigeminal motor (V) nucleus - largely bilateral laryngeal, pharyngeal, palatal and upper facial muscles of mastication and extraocular muscles - unilateral lower facial musculature (facial palsy) SCM and trapezius (uncrossed) --- spinal accessory - Pseudobulbar Palsy--- syndrome of bilateral UMN lesion

  7. Basal Portion Descending Tracts Corticopontocerebellar Fiber - Corticofugal fibers projecting to cerebellar hemisphere - consists of 2 neuron chain 1. Corticopontine fiber projecting to pontine nuclei 2. Pontocerebellar fiber crossed mudline and enter cerebellum as middle cerebellar peduncle

  8. Roof Plate Midbrain Superior Colliculus: vision Inferior Colliculus: hearing Closed Medulla Nucleus Gracilis et Cuneatus: discriminative touch sensation cf.Cerebelum: equilibrium

  9. Roof Plate of Hypothetized Chordate Ancestor A. olfaction B. vision C. hearing D. equilibrium E. discriminative touch sensation 1. epithalamus 2. superior colliculus 3. inferior colliculus 4. cerebellum 5. nucleus gracilis et cuneatus

  10. Tegmentum Cranial nerve Nuclei Precerebellar Nuclei Reticular Formation Tracts Ascending Cortical Pathway Cerebellar Circuits Descending Tract Composite Bundle

  11. Cranial Nerves Columns of Brain Stem Motor Column 1. GSE 2. SVE 3. GVE Sensory Column 4. VA (GVA & SVA) 5. GSA 6. SSA

  12. Components of Cranial Nerves

  13. General Somatic Efferent Nuclei (GSE) Hypoglossal Nucleus XII Abducens Nucleus VI Trochlear Nucleus IV Oculomotor NucleusIII

  14. Special Visceral Efferent Nuclei (SVE) Nucleus Ambiguus IX, X, XI Facial Motor Nucleus VII Trigeminal Motor Nucleus V

  15. General Visceral Efferent Nuclei (GVE) Dorsal Motor Nucleus of Vagus X Inferior Salivatory Nucleus IX Superior Salivatory Nucleus VII Edinger-Westphal NucleusIII

  16. Motor Nuclei of Cranial Nerves 1. GSE III, IV, VI, XII 2. SVE V, VII, IX, X, XI 3. GVE III, VII, IX, X

  17. General Somatic Afferent Nuclei (GSA) Trigeminal Sensory Nucleus V, VII, IX, X Mesencephalic Tract Nucleus Principal (Main) Sensory Nucleus Spinal Tract Nucleus pars oralis pars interpolaris pars caudalis

  18. Visceral Afferent Nuclei (VA) Nucleus Tractus Solitarius VII, IX, X General Visceral Afferent (GVA) Special Visceral Afferent (SVA): Taste Gustatory Nucleus

  19. Special Somatic Afferent Nuclei (SSA) Cochlear Nucleus VIIIc Dorsal Cochlear Nucleus Ventral Cochlear Nucleus Vestibular Nucleus VIIIv Medial Vestibular Nucleus Lateral Vestibular Nucleus Superior Vestibular Nucleus Inferior Vestibular Nucleus

  20. Sensory Nuclei of Cranial Nerves 1. VA GVA --- IX, X SVA --- VII, IX, X 2. GSA V,VII, IX, X 3. SSA VIIIc, VIIIv

  21. Precerebellar Nuclei Accessory Cuneate Nucleus Inferior Olivary Nuclear Complex Vestibular Nuclus Red Nucleus Perihypoglossal Nucleus Precerebellar Reticular Nuclei

  22. Precerebellar Nuclei 1. Red Nucleus 2. Vestibular Nucleus 3. Inferior Olivary Nucleus 4. Perhypoglossal Nuclei 5. Accessory Cuneate Nucleus

  23. Reticular Formation A. Raphe Nuclei B. Central Nuclear Group C. Lateral Nuclear Group D. Precerebellar Reticular Nuclei A B C D

  24. Central Nuclear Group of Reticular Formation Gigantocellular Reticular Nucleus Caudal Reticulopontine Nucleus Oral Reticulopontine Nucleus Subcuneiform Nucleus Cuneiform Nucleus

  25. Lateral Nuclear Group of Reticular Formation Central Nucleus of Medulla Oblongata Superficial Ventrolateral Reticular Area Parvicellular Reticular Nucleus Parabrachial Nucleus Pedunculopontine Nucleus

  26. Raphe Nuclei - Serotonergic Neuron Nucleus Raphe Obscrus, B2 Nucleus Raphe Pallidus, B1 Nucleus Raphe Magnus, B3 Pontine Raphe Nucleus, B5 Median Raphe or Superior Central Nucleus, B6, B8 Dorsal Raphe Nucleus, B7 Nucleus Linealis

  27. Norepinephrinergic & Dopaminergic Neuron Norepinephrinergic Neuron Nucleus Locus Ceruleus, A6 Dopaminergic Neuron Retrorubral Area, A8 Ventral Tegmental Area, A10 Substantia Nigra, Pars Compacta, A9

  28. Ascending Cortical Pathway Posterior White Column-Medial Lemniscal Pathway medial lemniscus Spinothalamic and Spinoreticular Tract spinal lemniscus Ventral and Dorsal Trigeminothalamic Tract trigeminal lemniscus Auditory Pathway: lateral lemniscus Taste (Gustatory) Pathway: central tegmental tract Vestibular Pathway: medial lemniscus

  29. Ascending Cortical System General Sensation Brain Stem Pathways for General Sensation Touch & Proprioception from body Posterior White Colum-Medial Lemniscal Pathway Pain & Temperature from body Spinothalamic Tract cf. Spinoreticular or Spinoreticulothalamic Tract General Sensation from Face Trigeminothalamic Tracts

  30. Posterior White Column - medial Lemniscal Pathway & Spinothalamic Tract

  31. Posterior White Colum-Medial Lemniscal Pathway Modality: Discriminative Touch Sensation (include Vibration) and Conscious Proprioception (Position Sensation, Kinesthesia) from body Receptor: Most receptors except free nerve endings Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) Posterior White Column 2nd Neuron: Dorsal Column Nuclei(Nucleus Gracilis et Cuneatus) Internal Arcuate Fiber - Lemniscal Decussation - Medial Lemniscus 3rd Neuron: Thalamus (VPLc) Internal Capsule ----- Corona Radiata Termination: Primary Somesthetic Area (S I)

  32. D Posterior White Column-Medial Lemniscal Pathway DRG: Dorsal Root Ganglion 1. Posterior White Column A. Nucleus gracilis B. Nucleus cuneatus 2. Medial Lemniscus 3. Corona Radiata C. Thalamus (VPLc) D. Cerebral Cortex (S I) DRG

  33. Spinothalamic Tract Modality: Pain & Temperature Sensation, Light Touch from body Receptor: Free Nerve Ending Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) 2nd Neuron: Dorsal Horn (Lamina I, IV, V) Anterior White Commissure Spinothalamic Tract (Spinal Lemniscus) 3rd Neuron: Thalamus (VPLc & CL) Internal Capsule ----- Corona Radiata Termination: Primary Somesthetic Area (S I)

  34. Spinoreticulothalamic Tract (Paleospinothalamic Tract) Modality: Pain & Temperature Sensation, Light Touch from body Receptor: Free Nerve Ending Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion) 2nd Neuron: Dorsal Horn (Lamina I, IV, V) Anterior White Commissure Spinothalamic Tract (Spinal Lemniscus) 3rd Neuron: Reticular Formation 4rd Neuron: Thalamus (CL, Sm, POm) Internal Capsule ----- Corona Radiata Termination: Diffuse Cerebral Cotex

  35. Spinothalamic Tract (Neospinothalamic Tract) Spinoreticular Tract (Paleospinothalamic Tract) D DRG: Dorsal Root Ganglion A. Posterior (dorsal) horn 1. Spinothalamic tract B. Reticular formation 2. Spinoreticular tract C. Thalamus (VPLc, CL) 3. Corona Radiata D. Cerebral Cortex (S I) DRG

  36. Trigeminothalamic Tract Modality: General Sensationfrom face Receptor: Most receptors in the face Ist Neuron: Trigeminal (Semilunar) Ganglia 2nd Neuron: Trigeminal Sensory Nucleus pain & temperature ---- pars caudalis of spinal tract nucleus of V Ventral and Dorsal Trigeminothalamic Tract 3rd Neuron: Thalamus (VPM) Internal Capsule ----- Corona Radiata Termination: Primary Somesthetic Area (S I)

  37. A. trigeminal ganglion B. trigeminal sensory nucleus C. thalamus (VPM) D. cerebral cortex (S I) 1. spinal tract of trigeminal nerve 2. ventral trigeminothalamic tract 3. dorsal trigeminothalamic tract 4. corona radiata V. trigeminal nerve Trigeminothalamic Tract

  38. Ascending Cortical System Special Sensation Brain Stem Pathways for Special Sensation Gustatory Sensation (Taste, SVA) ----- Taste Pathway Auditory Sensation (Hearing, SSA) ----- Auditory Pathway Vestibular Sensation (Equilibrium, SSA) ----- Vestibular Pathway

  39. Auditory Pathway Modality: Auditory Sensation (Hearing) Receptor: Organ of Coti of Cochlear Duct Cranial Nerve: VIIIc 1st Neuron: Spiral Ganglion 2nd Neuron: Cochlear Nucleus, Ventral & Dorsal dorsal, intermediate and ventral acoustic striae trapezoid body lateral lemniscus 3rd Neuron: Inferior Colliculus brachium of inferior colliculus 4th Neuron: Medial Geniculate Nucleus (MG) auditory radiation Termination: Primary Auditory Area (A I) Brodmann area 31, 32

  40. A. spiral ganglion B. dorsal and ventral cochlear nucleus C. inferior colliculus D. medial geniculate nucleus E. Primary auditory area F. superior olivary nucleus G. nucleus of lateral lemniscus 1. acoustic striae & trapezoid body 2. lateral lemniscus 3. brachium of inferior colliculus 4. auditory radiation 5. commissure of inferior colliculus VIIIc. cochlear division Auditory Pathways

  41. Auditory Pathway A. spiral ganglion B. dorsal cochlear nucleus C. ventral cochlear nucleus D. superior olivary nucleus 1. dorsal acoustic striae 2. intermediateacoustic striae 3. ventral acoustic striae 4. efferent cochlear bundle 5. trapezoid body 6. lateral lemniscus

  42. Vestibular Pathway Modality: Equilibrium Sensation Receptor: Macula & Crista Ampullaris Cranial Nerve: VIIIv Ist Neuron: Vestibular Ganglion 2nd Neuron: Vestibular Nucleus vestibulothalamic fiber (medial lemniscus) 3rd Neuron: Thalamus (VPLo, VPI?) Internal Capsule ----- Corona Radiata Termination: Primary Vestibular Area ----- Primary Somesthetic Area (Brodmann area 3a, 2v )

  43. Vestibular Pathway 1. Vestibulocerebellar Tract 2. Vestibulospinal Tract 3. Vestibulothalamic Tract 4. Medial Longitudinal fasciculus (MLF) - ascending portion - descending portion - interstitiospinal tract

  44. Taste (Gustatory) Pathway Modality: Taste Sensation Receptor: Taste Bud Cranial Nerve: VII, IX, X Ist Neuron: Geniculate Ganglion (VII) Inferior Ganglion (IX, X) 2nd Neuron: Nucleus Tractus Solitarius (Gustatory Nucleus) solitariothalamic fiber (central tegmental tract) 3rd Neuron: Thalamus (VPMpc) Internal Capsule ----- Corona Radiata Termination: Gustatory Area Brodmann area 43 & parainsular cortex

  45. A. nucleus tractus solitarius (gustatory nucleus) B. thalamus (VPMpc) C. Brodmann area 43 D. parainsular cortex E. parabrachial nucleus 1. solitariothalamic fiber (central tegmental tract) 2. corona radiata VII. facial nerve IX. glossopharyngeal nerve X. vagus nerve Taste Pathways

  46. Cerebellar Circuits Superior, Middle and Inferior Cerebellar Peduncle Vestibulocerebellum - Vestibular Nucleus Spinocerebellum - Red Nucleus and Spinal Cord Pontocerebellum - Cerebral Cortex and Pontine Nuclei Inferior Olivary Nuclear Complex

  47. Afferent Connections of Cerebellum Inferior Cerebellar Peduncle 1. posterior spinocerebellar tract 2. cuneocerebellar tract 3. vestibulocerebellar tract Middle cerebellar Peduncle - corticopontocerebellar pathway Superior Cerebellar Peduncle - anterior spinocerebellar tract

  48. Efferent Connections of Cerebellum Superior Cerebellar Peduncle 1. dentatothalamic fiber 2. interpositorubral fiber 3. ascending portion of uncinate fasciculus of Russell Inferior Cerebellar Peduncle 1. direct fastigiovestibular fiber 2. descending portion of uncinate fasciculus of Russell

  49. Connections of Inferior Olivary Nuclear Complex 1. Olivocerebellar Tract 2. Cortico-olivary Tract 3. Rubro-olivary Tract 4. Vestibulo-olivary Tract 5. Spino-olivary Tract

  50. Descending Tracts Rubrospinal Tract Tectospinal tract Vestibulospinal Tract Reticulospinal Tract pontine and medullary Descending Autonomic Pathway

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