Medulla, Pons, Cerebellum Anatomy
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Questions and Answers

Match the following arteries with the brainstem structures they primarily supply:

Vertebral artery = Medulla oblongata Basilar artery = Pons Superior cerebellar artery (SCA) = Midbrain Posterior cerebral artery (PCA) = Midbrain and thalamus

Match the term with the correct definition.

Vermis = Connects the two cerebellar hemispheres Folia = Leaf-like structures on the surface of the cerebellum Fissure = Grooves in the brain that help define its structures Peduncle = A bundle of nerve fibers joining different parts of the brain

Match the cerebellar peduncle with the specific region it connects to:

Superior cerebellar peduncle = Midbrain Middle cerebellar peduncle = Pons Inferior cerebellar peduncle = Medulla oblongata Restiform body = Medulla oblongata

Match the spinal cord tract with its primary sensory modality:

<p>Dorsal column-medial lemniscus pathway = Fine touch and proprioception Anterolateral system (spinothalamic tract) = Pain and temperature Spinocerebellar tracts = Proprioception from muscles Spinal trigeminal tract = Pain/temperature sense, touch from the head</p> Signup and view all the answers

Match the cranial nerve with its brainstem nucleus where it originates:

<p>Oculomotor nerve (CN III) = Midbrain Abducens nerve (CN VI) = Pons Vagus nerve (CN X) = Medulla oblongata Trochlear nerve (CN IV) = Midbrain</p> Signup and view all the answers

Match each of the following structures with its location:

<p>Superior colliculus = Dorsal midbrain Olivary eminence = Anterior medulla Cerebral peduncles = Anterior midbrain Hypoglossal nucleus = Medulla oblongata</p> Signup and view all the answers

Match the brainstem structure with its described function.

<p>Inferior olivary nucleus = Motor coordination and learning Medial lemniscus = Ascending pathway for discriminative touch Reticular formation = Arousal and consciousness Pyramids = Descending motor control</p> Signup and view all the answers

Match the syndrome with the arterial occlusion that likely causes it:

<p>Wallenberg syndrome = Posterior Inferior Cerebellar Artery (PICA) Medial medullary syndrome = Anterior spinal artery Lateral superior pontine syndrome = Superior Cerebellar Artery occlusion Medial inferior pontine syndrome = Paramedian branches of the basilar artery</p> Signup and view all the answers

Match each of the following symptoms to its description.

<p>Ataxia = Lack of voluntary muscle control or coordination of voluntary movements Dysphagia = Difficulty in swallowing Miosis = Pupil constriction Ptosis = Drooping of the upper eyelid</p> Signup and view all the answers

Match the brainstem pathway with the proper description.

<p>Corticospinal tract = Voluntary motor control of the limbs and trunk Spinothalamic tract = Pain, temperature, and crude touch from the body Medial Lemniscus = Fine touch, vibration, and proprioception sensations from the body Spinocerebellar tracts = Nonconscious proprioception from the body</p> Signup and view all the answers

Match the description with the correct term.

<p>Internal arcuate fibers = Axons crossing midline to form medial lemniscus Restiform body = Inferior cerebellar peduncle entering cerebellum Pyramidal decussation = Crossing of the corticospinal tract in the medulla Anterior white commisure (AWC) = Axons crossing midline in the spinal cord</p> Signup and view all the answers

Relate these cranial nerve nuclei to their associated foramen of exit from the cranium.

<p>Oculomotor nerve = Superior orbital fissure Trochlear nerve = Superior orbital fissure Vagus nerve = Jugular foramen Abducens nerve = Superior orbital fissure</p> Signup and view all the answers

Match the sensory structure with their function.

<p>Gracile fasiculus = Sensory information from lower extremities Cuneate fasiculus = Sensory information from upper extremities Anterolateral system = Pain and temperature from the body Spinal trigeminal nucleus = Pain and temperature from the face</p> Signup and view all the answers

Match the structure found in the pons with its primary orientation.

<p>Middle cerebellar peduncle = Horizontal Corticospinal tract = Vertical Medial lemniscus = Vertical Superior cerebellar peduncle = Ascending</p> Signup and view all the answers

Match the artery with the section(s) of the brain it primarily supplies.

<p>Anterior spinal artery = Medulla Posterior inferior cerebellar artery (PICA) = Medulla Anterior inferior cerebellar artery (AICA) = Pons and cerebellum Superior Cerebellar Artery (SCA) = Pons and cerebellum</p> Signup and view all the answers

Match these nuclei to their specific location within the brainstem.

<p>Hypoglossal nucleus = Medulla Abducens nucleus = Pons Trigeminal motor nucleus = Pons Oculomotor nucleus = Midbrain</p> Signup and view all the answers

Match description with the region of the brainstem where the structure can be found.

<p>Inferior olivary nucleus = Medulla Superior colliculus = Midbrain Facial motor nucleus = Pons Trochlear nerve decussation = Midbrain</p> Signup and view all the answers

Match the brainstem structure with its function:

<p>Cerebral peduncles = Carry descending motor tracts Medial lemniscus = Carries sensory information from the body Inferior cerebellar peduncle = Connects the medulla with the cerebellum Pontine nuclei = Relays signals from the cerebrum to the cerebellum</p> Signup and view all the answers

Connect the cranial nerve or nuclei to the function they perform.

<p>Abducens nerve = Lateral eye movement Hypoglossal nerve = Tongue movement Trochlear nerve = Superior oblique muscle Facial motor nucleus = Facial expression</p> Signup and view all the answers

Match these deficits with a disrupted portion of the brainstem:

<p>Wallenberg syndrome = Lateral medulla Dysphagia = Medulla Internuclear ophthalmoplegia (INO) = Pons or midbrain Ataxia = Cerebellar connections</p> Signup and view all the answers

Match the tract with its decussation point.

<p>Corticospinal tract = Medullary pyramids Medial lemniscus = Medulla Spinothalamic tract = Anterior white commissure Hypoglossal nerve (CN XII) = Does not decussate</p> Signup and view all the answers

Indicate the function of these brainstem tracts.

<p>Spinocerebellar tract = Carries unconscious proprioceptive sensory information Spinothalamic tract = Carries non-localized pain, temperature, and crude touch Corticospinal tract = Controls voluntary movement of the limbs and body Medial Longitudinal Fasciculus = Coordinates the cranial nerves that innervate extraocular muscles</p> Signup and view all the answers

Match the structure with the primary function it serves.

<p>Cerebellum = Balance and coordination of motor behavior Medulla = Controls involuntary functions like respiratory and cardiac rhythm. Pons = Relays signals between the cerebrum and the cerebellum Midbrain = Controls reflexive sensory tracking, such as vision</p> Signup and view all the answers

Match the signs to their associated symptoms.

<p>Medial inferior pontine syndrome = Contralateral hemiplegia Lateral medullary syndrome = Ipsilateral loss of pain sensation in the trigeminal distribution Medial medullary syndrome = Contralateral loss of tactile and proprioceptive sensation Lateral inferior pontine syndrome = Nystagmus</p> Signup and view all the answers

Match the following syndrome with an area associated.

<p>Wallenberg (lateral medullary) syndrome = Infarction of the lateral medulla Foville Syndrome = Affects structures in the pons Weber's Syndrome = Lesions in the midbrain Locked In Syndrome = Widespread damage to the pons</p> Signup and view all the answers

Flashcards

Brainstem Structures

The medulla, pons, and cerebellum

Anterior median fissure

Located on the anterior surface of the medulla; site of pyramidal decussation.

Olivary eminence

Small swelling lateral to the preolivary sulcus; location of inferior olivary nucleus.

Restiform body

Bundle of fibers connecting the brainstem to the cerebellum

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Brainstem landmarks

Superior, inferior colliculi and the crus cerebri

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Posterior Tubercles

Gracile and cuneate tubercles in the posterior medulla

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Structures in the superior view

Striae medullares, vagal trigone, hypoglossal trigone, and facial colliculus

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Cerebellar Lobes

The anterior lobe, posterior lobe and flocculonodular lobe

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Cerebellar Peduncles

Superior cerebellar peduncles, middle cerebellar peduncles, and inferior cerebellar peduncles

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Cerebellar divisions

The vermis, intermediate hemisphere, and lateral hemisphere

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Cerebellar fissures

Primary fissure, horizontal fissure, postero-lateral fissure

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CorticoSpinal Tract (CST)

Contains descending motor pathways.

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Rubrospinal Tract

Controls muscle tone and posture.

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DCML

Carries tactile and proprioceptive information. (dorsal column medial lemniscus)

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Antero Lateral System (ALS)

Carries pain and temperature information.

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Ventral Posterolateral Nucleus (VPL)

Site of sensory processing for the body

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Rostral spinal cord

Dorsal horn, Intermediate horn and ventral horn.

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Spinal Cord Nuclei

Spinal accessory nucleus and spinal trigeminal tract

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Posterior Funiculus

Gracile fasiculus, Cuneate fasiculus

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Lateral Funiculus

Rubro-spinal tract, Lateral cortico-spinal tract

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Sectional Anatomy

Cerebellar vermis and cerebellar tonsil

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Internal to Medulla

Internal arcuate fibers and Medial Lemniscus

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Cranial nerves of the caudal medulla

Cranial nerve nuclei that lie internal to caudal medulla

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Anatomy of pontine region

Superior cerebellar peduncle, medial lemniscus and pontine reticular formation

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Mid-pons structures

Lingula of cerebellum, superior cerebellar peduncle

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Study Notes

Medulla, Pons, Cerebellum

  • Brainstem includes the medulla, pons, and cerebellum
  • Focus areas incude external anatomy, fiber tracts, sections, major blood supply, and vascular syndromes

Brainstem Anatomy and Exit Points

  • The brainstem anatomy is viewed from an inferior perspective
  • Key structures: crus cerebri (cerebral peduncles), pons (brachium pontis), pre- and post-olivary sulci, olivary eminence, pyramids, and restiform body
  • Cranial nerve exit points from the brainstem:
  • Pons: IV (dorsal exit) and V
  • Pons/medulla: VI, VII, VIII
  • Cerebello-pontine angle (interface of pons, medulla, and cerebellum): VII, VIII
  • Medulla: post-olivary sulci IX, X, and pre-olivary sulci XII
  • Reference points: posterior median sulcus (1), posterior intermediate sulcus (2), posterolateral sulcus (3), anterior median sulcus (4), and anterolateral sulcus (5)

Brainstem Anatomy - Superior View

  • Key features from a superior view include the superior and inferior colliculi, crus cerebri (cerebral peduncles), restiform body, and gracile and cuneate tubercles
  • Other significant structures are the striae medullares, vagal trigone, hypoglossal trigone, and facial colliculus

Cerebellum - External Anatomy

  • External anatomy consists of the anterior lobe, posterior lobe, vermis, intermediate hemisphere, lateral hemisphere, and tonsils
  • Primary, horizontal, and posterolateral fissures are noted
  • The flocculo-nodular lobe, nodulus, and flocculus are present

Descending Pathways - Major

  • Corticospinal Tract (CST) is highlighted
  • Includes cortical upper motor neurons (UMNs), internal capsule, crus cerebri (cerebral peduncles), pontine CST, and medullary CST (pyramids)
  • Fiber decussation leads to the lateral corticospinal tract (LCS) in the lateral funiculus
  • Absence of decussation results in the anterior corticospinal tract (ACS) located in the anterior funiculus
  • Pathway terminates at the ventral horn lower motor neurons (LMN)
  • Features the rubrospinal tract, red nucleus, ventral tegmental decussation in the midbrain and its course through the lateral funiculus and influence on proximal limb flexor LMNs

Ascending Pathways - Major

  • Dorsal Column Medial Lemniscus (DCML) pathway carries tactile and proprioceptive information
  • Contains two dorsal columns (fasciculi): gracile (lower extremities) and cuneate (upper extremities)
  • Includes two medullary nuclei: gracile and cuneate
  • The pathway decussates via internal arcuate fibers
  • Travels in the medial lemniscus (white matter)
  • Proceeds to the Ventral Posterolateral Nucleus (VPL) of the thalamus and then to the somatic sensory cortex
  • Anterior Lateral System (ALS) * pain and temp : input for ALS)

Antero Lateral System

  • Lateral System (ALS) pathway relates to pain and temperature
  • Includes two lateral columns of fibers from dorsal horn interneurons
  • Undergoes decussation via the anterior white commissure (AWC)
  • Forms dorsal and ventral spinothalamic tracts (Antero Lateral System)
  • ALS approaches medial lemniscus, reaches VPL of thalamus
  • Terminates in somatic sensory cortex
  • Trigeminal System (head / face) utilizes BOTH “DCML” and “ALS”
  • Fibers transmit to the Ventral Posteromedial Nucleus of Thalamus (VPM), and then to Somatic Sensory Cortex

Spinal Cord - Rostral Region

  • Key structures in the rostral spinal cord include the dorsal horn, spinal accessory nucleus, spinal trigeminal tract, posteromarginal nucleus, and substantia gelatinosa
  • The intermediate horn contains the Dorsal nucleus of Clarke
  • lateral motor columns, medial motor columns form part of the anterior horn
  • Posterior, lateral, and anterior funiculi are identified
  • Gracile and cuneate fasiculus are in the posterior
  • Rubro-spinal tract, Lateral cortico-spinal tract Anterolateral system Spinocerebellar tracts are in the lateral – Anterior cortico-spinal tract, Medial longitudinal fasiculus Vestibulo-, Tecto-, reticulo-spinal tracts are in the anterior

Sectional Anatomy - Medulla

  • Structures in the medullary region include the cerebellar vermis, cerebellar tonsil, foramen of Magendie, inferior cerebellar peduncle, cerebellar cortex, and medial lemniscus
  • Inferior olivary nucleus, cortico-spinal tract, and medullary pyramids are also present

Caudal Medulla - Key Nuclei

  • The caudal medulla contains the hypoglossal nucleus, dorsal vagal motor nucleus, nucleus ambiguus, solitary nucleus and tract, and spinal trigeminal nucleus and tract
  • The reticular formation, DCML, internal arcuate fibers, MLF, ALS, spinocerebellar tracts, inferior olivary nucleus, and corticospinal tract/pyramids are identified

Rostral Medulla - Key Nuclei

  • Rostral medulla contains the hypoglossal nucleus, vestibular nuclei, cochlear nuclei, dorsal vagal motor nucleus, nucleus ambiguus and spinal trigeminal nucleus and tract
  • The reticular formation, inferior cerebellar peduncle, medial lemniscus, MLF, ALS, spinocerebellar tracts, inferior olivary nucleus and corticospinal tract/pyramids are also present

Blood Supply - Brainstem and Cerebellum

  • Major arteries supplying the brainstem and cerebellum are highlighted
  • Vertebral artery & Basilar artery
  • AICA, PICA, and SCA are named.
  • Vertebral and basilar arteries supply structures that can be split into the tectum, basilar region, and tegmentum
  • Basilar branches include paramedian and long/short cirucumferential branches

Wallenberg Syndrome - Lateral Medulla

  • Wallenberg (lateral medullary) syndrome is caused by an infarction of the brainstem
  • Vertebral and PICA arteries involved
  • Involves the vestibular nuclei, trigeminal nuclei (tract), solitary nucleus, and nucleus ambiguus
  • Four key ipsilateral features:
  • Vertigo (vestibular nuclei)
  • Decreased facial pain and temperature sensation (trigeminal nuclei/tract)
  • Decreased taste (solitary nucleus)
  • Dysphagia and hoarseness (nucleus ambiguus, IX, X)
  • Dejerine (medial medullary) syndrome is characterized by tongue weakness, contralateral hemiparesis, and contralateral loss of touch and proprioception
  • Involves the anterolateral system and cerebellar peduncle

Tonsillar Herniation

  • Related to medulla compression

Pontine Region - Sectional Anatomy

The sectional anatomy of the pontine region presents with the 4th ventricle and Superior medullary velum,

  • Superior Cerebellar peduncle, and the Medial Lemniscus
  • Pontine Reticular formation, Middle Cerebellar peduncle and Cortico-spinal Tract are visible

Caudal Pons - Key Nuclei

  • Abducens nucleus, Sensory & Motor facial nucleus is here along with the Vestibular nuclei
  • Spinal trigeminal nucleus, and tract are here
  • The dentate, interposed, & fastigial are cerebellar nuclei
  • Cerebellar peduncles, Reticular formation, Medial and Lateral Lemniscus
  • Pontine, bulbar and corticospinal are found here too

Mid-Pons - Key Nuclei

  • Mid-pons contains the Trigeminal sensory and motor nuclei
  • Mesencephalic nucleus and tract are here

Brainstem Syndromes - Pons

  • Damage can results ipsilateral or contralateral symptoms
  • medial damage causes il horizontal gaze palsy and internuclear opthalmoplegia (INO) lateral damage can causes il facial paralysis, ataxia. il jaw weakness and/or facial numbness
  • cl pain and temp and decreased taste can be side effects
  • tinnitus, deafness too

Review Spinal Cord, Medulla, Pons

  • Blood is brought by the anterior/posterior spinal arteries and the vertebral/basilar complex
  • PICA, AICA, and paramedian branches provide the blood
  • Of basilar artery, vertebral artery
  • These review slides summarize the location of each in sections

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Description

Overview of the anatomy of the medulla, pons, and cerebellum, including external anatomy and cranial nerve exit points. Key structures, fiber tracts, and blood supply are described. Vascular syndromes are also covered.

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