Podcast
Questions and Answers
Match the following arteries with the brainstem structures they primarily supply:
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.
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:
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:
Match the spinal cord tract with its primary sensory modality:
Match the cranial nerve with its brainstem nucleus where it originates:
Match the cranial nerve with its brainstem nucleus where it originates:
Match each of the following structures with its location:
Match each of the following structures with its location:
Match the brainstem structure with its described function.
Match the brainstem structure with its described function.
Match the syndrome with the arterial occlusion that likely causes it:
Match the syndrome with the arterial occlusion that likely causes it:
Match each of the following symptoms to its description.
Match each of the following symptoms to its description.
Match the brainstem pathway with the proper description.
Match the brainstem pathway with the proper description.
Match the description with the correct term.
Match the description with the correct term.
Relate these cranial nerve nuclei to their associated foramen of exit from the cranium.
Relate these cranial nerve nuclei to their associated foramen of exit from the cranium.
Match the sensory structure with their function.
Match the sensory structure with their function.
Match the structure found in the pons with its primary orientation.
Match the structure found in the pons with its primary orientation.
Match the artery with the section(s) of the brain it primarily supplies.
Match the artery with the section(s) of the brain it primarily supplies.
Match these nuclei to their specific location within the brainstem.
Match these nuclei to their specific location within the brainstem.
Match description with the region of the brainstem where the structure can be found.
Match description with the region of the brainstem where the structure can be found.
Match the brainstem structure with its function:
Match the brainstem structure with its function:
Connect the cranial nerve or nuclei to the function they perform.
Connect the cranial nerve or nuclei to the function they perform.
Match these deficits with a disrupted portion of the brainstem:
Match these deficits with a disrupted portion of the brainstem:
Match the tract with its decussation point.
Match the tract with its decussation point.
Indicate the function of these brainstem tracts.
Indicate the function of these brainstem tracts.
Match the structure with the primary function it serves.
Match the structure with the primary function it serves.
Match the signs to their associated symptoms.
Match the signs to their associated symptoms.
Match the following syndrome with an area associated.
Match the following syndrome with an area associated.
Flashcards
Brainstem Structures
Brainstem Structures
The medulla, pons, and cerebellum
Anterior median fissure
Anterior median fissure
Located on the anterior surface of the medulla; site of pyramidal decussation.
Olivary eminence
Olivary eminence
Small swelling lateral to the preolivary sulcus; location of inferior olivary nucleus.
Restiform body
Restiform body
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Brainstem landmarks
Brainstem landmarks
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Posterior Tubercles
Posterior Tubercles
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Structures in the superior view
Structures in the superior view
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Cerebellar Lobes
Cerebellar Lobes
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Cerebellar Peduncles
Cerebellar Peduncles
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Cerebellar divisions
Cerebellar divisions
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Cerebellar fissures
Cerebellar fissures
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CorticoSpinal Tract (CST)
CorticoSpinal Tract (CST)
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Rubrospinal Tract
Rubrospinal Tract
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DCML
DCML
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Antero Lateral System (ALS)
Antero Lateral System (ALS)
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Ventral Posterolateral Nucleus (VPL)
Ventral Posterolateral Nucleus (VPL)
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Rostral spinal cord
Rostral spinal cord
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Spinal Cord Nuclei
Spinal Cord Nuclei
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Posterior Funiculus
Posterior Funiculus
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Lateral Funiculus
Lateral Funiculus
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Sectional Anatomy
Sectional Anatomy
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Internal to Medulla
Internal to Medulla
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Cranial nerves of the caudal medulla
Cranial nerves of the caudal medulla
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Anatomy of pontine region
Anatomy of pontine region
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Mid-pons structures
Mid-pons structures
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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.