Brainstem and Its Associated Cranial Nerves
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
NS201C Anatomy 1: Sensory and Motor Systems
NS201C Anatomy 1: Sensory and Motor Systems 25th January 2017 Peter Ohara Department of Anatomy [email protected] The Subdivisions and Components of the Central Nervous System Axes and Anatomical Planes of Sections of the Human and Rat Brain Development of the neural tube 1 Dorsal and ventral cell groups Dermatomes and myotomes Neural crest derivatives: 1 Neural crest derivatives: 2 Development of the neural tube 2 Timing of development of the neural tube and its derivatives Timing of development of the neural tube and its derivatives Gestational Crown-rump Structure(s) age (Weeks) length (mm) 3 3 cerebral vesicles 4 4 Optic cup, otic placode (future internal ear) 5 6 cerebral vesicles, cranial nerve nuclei 6 12 Cranial and cervical flexures, rhombic lips (future cerebellum) 7 17 Thalamus, hypothalamus, internal capsule, basal ganglia Hippocampus, fornix, olfactory bulb, longitudinal fissure that 8 30 separates the hemispheres 10 53 First callosal fibers cross the midline, early cerebellum 12 80 Major expansion of the cerebral cortex 16 134 Olfactory connections established 20 185 Gyral and sulcul patterns of the cerebral cortex established Clinical case A 68 year old woman with hypertension and diabetes develops abrupt onset numbness and tingling on the right half of the face and head and the entire right hemitrunk, right arm and right leg. She does not experience any weakness or incoordination. Physical Examination: Vitals: T 37.0° C; BP 168/87; P 86; RR 16 Cardiovascular, pulmonary, and abdominal exam are within normal limits. Neurological Examination: Mental Status: Alert and oriented x 3, 3/3 recall in 3 minutes, language fluent. -
Pharnygeal Arch Set - Motor USMLE, Limited Edition > Neuroscience > Neuroscience
CNs 5, 7, 9, 10 - Pharnygeal Arch Set - Motor USMLE, Limited Edition > Neuroscience > Neuroscience PHARYNGEAL ARCH SET, CNS 5, 7, 9, 10 • They are derived from the pharyngeal (aka branchial) arches • They have special motor and autonomic motor functions CRANIAL NERVES EXIT FROM THE BRAINSTEM CN 5, the trigeminal nerve exits the mid/lower pons.* CN 7, the facial nerve exits the pontomedullary junction.* CN 9, the glossopharyngeal nerve exits the lateral medulla.* CN 10, the vagus nerve exits the lateral medulla.* CRANIAL NERVE NUCLEI AT BRAINSTEM LEVELS Midbrain • The motor trigeminal nucleus of CN 5. Nerve Path: • The motor division of the trigeminal nerve passes laterally to enter cerebellopontine angle cistern. Pons • The facial nucleus of CN 7. • The superior salivatory nucleus of CN 7. Nerve Path: • CN 7 sweeps over the abducens nucleus as it exits the brainstem laterally in an internal genu, which generates a small bump in the floor of the fourth ventricle: the facial colliculus • Fibers emanate from the superior salivatory nucleus, as well. Medulla • The dorsal motor nucleus of the vagus, CN 10 • The inferior salivatory nucleus, CN 9 1 / 3 • The nucleus ambiguus, CNs 9 and 10. Nerve Paths: • CNs 9 and 10 exit the medulla laterally through the post-olivary sulcus to enter the cerebellomedullary cistern. THE TRIGEMINAL NERVE, CN 5  • The motor division of the trigeminal nerve innervates the muscles of mastication • It passes ventrolaterally through the cerebellopontine angle cistern and exits through foramen ovale as part of the mandibular division (CN 5[3]). Clinical Correlation - Trigeminal Neuropathy THE FACIAL NERVE, CN 7  • The facial nucleus innervates the muscles of facial expression • It spans from the lower pons to the pontomedullary junction. -
The Interpeduncular Fossa Approach for Resection of Ventromedial Midbrain Lesions
TECHNICAL NOTE J Neurosurg 128:834–839, 2018 The interpeduncular fossa approach for resection of ventromedial midbrain lesions *M. Yashar S. Kalani, MD, PhD, Kaan Yağmurlu, MD, and Robert F. Spetzler, MD Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona The authors describe the interpeduncular fossa safe entry zone as a route for resection of ventromedial midbrain le- sions. To illustrate the utility of this novel safe entry zone, the authors provide clinical data from 2 patients who under- went contralateral orbitozygomatic transinterpeduncular fossa approaches to deep cavernous malformations located medial to the oculomotor nerve (cranial nerve [CN] III). These cases are supplemented by anatomical information from 6 formalin-fixed adult human brainstems and 4 silicone-injected adult human cadaveric heads on which the fiber dissection technique was used. The interpeduncular fossa may be incised to resect anteriorly located lesions that are medial to the oculomotor nerve and can serve as an alternative to the anterior mesencephalic safe entry zone (i.e., perioculomotor safe entry zone) for resection of ventromedial midbrain lesions. The interpeduncular fossa safe entry zone is best approached using a modi- fied orbitozygomatic craniotomy and uses the space between the mammillary bodies and the top of the basilar artery to gain access to ventromedial lesions located in the ventral mesencephalon and medial to the oculomotor nerve. https://thejns.org/doi/abs/10.3171/2016.9.JNS161680 KEY WORDS brainstem surgery; interpeduncular fossa; mesencephalon; safe entry zone; surgical technique; ventromedial midbrain HE human brainstem serves as a relay center for the pyramidal tract, which is located in the middle three- ascending and descending fiber tracts that are es- fifths of the cerebral peduncle, to remove ventral lesions sential for motor and sensory control. -
Facial Nerve Disorders Cn7 (1)
FACIAL NERVE DISORDERS CN7 (1) Facial Nerve Disorders Last updated: January 18, 2020 FACIAL PALSY .......................................................................................................................................... 1 ETIOLOGY .............................................................................................................................................. 1 GUIDE TO LESION SITE LOCALIZATION ................................................................................................... 2 CLINICAL GRADING OF SEVERITY .......................................................................................................... 2 House-Brackmann grading scale ........................................................................................... 2 CLINICO-ANATOMICAL SYNDROMES ..................................................................................................... 2 Supranuclear (Central) Palsy ................................................................................................. 2 Nuclear Lesion ...................................................................................................................... 3 Cerebellopontine Angle Syndrome ....................................................................................... 3 Facial Canal Syndrome ......................................................................................................... 3 Stylomastoid Foramen Syndrome ........................................................................................ -
The Brain Stem Medulla Oblongata
Chapter 14 The Brain Stem Medulla Oblongata Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Central sulcus Parietal lobe • embryonic myelencephalon becomes Cingulate gyrus leaves medulla oblongata Corpus callosum Parieto–occipital sulcus Frontal lobe Occipital lobe • begins at foramen magnum of the skull Thalamus Habenula Anterior Epithalamus commissure Pineal gland • extends for about 3 cm rostrally and ends Hypothalamus Posterior commissure at a groove between the medulla and Optic chiasm Mammillary body pons Cerebral aqueduct Pituitary gland Fourth ventricle Temporal lobe • slightly wider than spinal cord Cerebellum Midbrain • pyramids – pair of external ridges on Pons Medulla anterior surface oblongata – resembles side-by-side baseball bats (a) • olive – a prominent bulge lateral to each pyramid • posteriorly, gracile and cuneate fasciculi of the spinal cord continue as two pair of ridges on the medulla • all nerve fibers connecting the brain to the spinal cord pass through the medulla • four pairs of cranial nerves begin or end in medulla - IX, X, XI, XII Medulla Oblongata Associated Functions • cardiac center – adjusts rate and force of heart • vasomotor center – adjusts blood vessel diameter • respiratory centers – control rate and depth of breathing • reflex centers – for coughing, sneezing, gagging, swallowing, vomiting, salivation, sweating, movements of tongue and head Medulla Oblongata Nucleus of hypoglossal nerve Fourth ventricle Gracile nucleus Nucleus of Cuneate nucleus vagus -
The Clinical Treatment and Outcome of Cerebellopontine Angle
www.nature.com/scientificreports OPEN The clinical treatment and outcome of cerebellopontine angle medulloblastoma: a retrospective study of 15 cases Tao Wu 1,4, Pei-ran Qu3,4, Shun Zhang2, Shi-wei Li1, Jing Zhang1, Bo Wang2, Pinan Liu 1,2, Chun-de Li1,2 & Fu Zhao 1,2 ✉ Medulloblastoma (MB) is the most common malignant pediatric brain tumor arising in the cerebellum or the 4th ventricle. Cerebellopontine angle (CPA) MBs are extremely rare tumors, with few cases previously described. In this study, we sought to describe the clinical characteristics, molecular features and outcomes of CPA MB. We retrospectively reviewed a total of 968 patients who had a histopathological diagnosis of MB at the Beijing Neurosurgical Institute between 2002 and 2016. The demographic characteristics, clinical manifestations and radiological features were retrospectively analyzed. Molecular subgroup was evaluated by the expression profling array or immunohistochemistry. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier analysis. In this study, 15 patients (12 adults and 3 children) with a mean age at diagnosis of 25.1 years (range 4–45 years) were included. CPA MBs represented 1.5% of the total cases of MB (15/968). Two molecular subgroups were identifed in CPA MBs: 5 WNT-MBs (33%) and 10 SHH-MBs (67%). CPA WNT-MBs had the extracerebellar growth with the involvement of brainstem (P = 0.002), whereas CPA SHH-MBs predominantly located within the cerebellar hemispheres (P = 0.004). The 5-year OS and PFS rates for CPA MB were 80.0% ± 10.3% and 66.7% ± 12.2%, respectively. -
DR. Sanaa Alshaarawy
By DR. Sanaa Alshaarawy 1 By the end of the lecture, students will be able to : Distinguish the internal structure of the components of the brain stem in different levels and the specific criteria of each level. 1. Medulla oblongata (closed, mid and open medulla) 2. Pons (caudal, mid “Trigeminal level” and rostral). 3. Mid brain ( superior and inferior colliculi). Describe the Reticular formation (structure, function and pathway) being an important content of the brain stem. 2 1. Traversed by the Central Canal. Motor Decussation*. Spinal Nucleus of Trigeminal (Trigeminal sensory nucleus)* : ➢ It is a larger sensory T.S of Caudal part of M.O. nucleus. ➢ It is the brain stem continuation of the Substantia Gelatinosa of spinal cord 3 The Nucleus Extends : Through the whole length of the brain stem and upper segments of spinal cord. It lies in all levels of M.O, medial to the spinal tract of the trigeminal. It receives pain and temperature from face, forehead. Its tract present in all levels of M.O. is formed of descending fibers that terminate in the trigeminal nucleus. 4 It is Motor Decussation. Formed by pyramidal fibers, (75-90%) cross to the opposite side They descend in the Decuss- = crossing lateral white column of the spinal cord as the lateral corticospinal tract. The uncrossed fibers form the ventral corticospinal tract. 5 Traversed by Central Canal. Larger size Gracile & Cuneate nuclei, concerned with proprioceptive deep sensations of the body. Axons of Gracile & Cuneate nuclei form the internal arcuate fibers; decussating forming Sensory Decussation. Pyramids are prominent ventrally. 6 Formed by the crossed internal arcuate fibers Medial Leminiscus: Composed of the ascending internal arcuate fibers after their crossing. -
Auditory and Vestibular Systems Objective • to Learn the Functional
Auditory and Vestibular Systems Objective • To learn the functional organization of the auditory and vestibular systems • To understand how one can use changes in auditory function following injury to localize the site of a lesion • To begin to learn the vestibular pathways, as a prelude to studying motor pathways controlling balance in a later lab. Ch 7 Key Figs: 7-1; 7-2; 7-4; 7-5 Clinical Case #2 Hearing loss and dizziness; CC4-1 Self evaluation • Be able to identify all structures listed in key terms and describe briefly their principal functions • Use neuroanatomy on the web to test your understanding ************************************************************************************** List of media F-5 Vestibular efferent connections The first order neurons of the vestibular system are bipolar cells whose cell bodies are located in the vestibular ganglion in the internal ear (NTA Fig. 7-3). The distal processes of these cells contact the receptor hair cells located within the ampulae of the semicircular canals and the utricle and saccule. The central processes of the bipolar cells constitute the vestibular portion of the vestibulocochlear (VIIIth cranial) nerve. Most of these primary vestibular afferents enter the ipsilateral brain stem inferior to the inferior cerebellar peduncle to terminate in the vestibular nuclear complex, which is located in the medulla and caudal pons. The vestibular nuclear complex (NTA Figs, 7-2, 7-3), which lies in the floor of the fourth ventricle, contains four nuclei: 1) the superior vestibular nucleus; 2) the inferior vestibular nucleus; 3) the lateral vestibular nucleus; and 4) the medial vestibular nucleus. Vestibular nuclei give rise to secondary fibers that project to the cerebellum, certain motor cranial nerve nuclei, the reticular formation, all spinal levels, and the thalamus. -
Lecture 12 Notes
Somatic regions Limbic regions These functionally distinct regions continue rostrally into the ‘tweenbrain. Fig 11-4 Courtesy of MIT Press. Used with permission. Schneider, G. E. Brain structure and its Origins: In the Development and in Evolution of Behavior and the Mind. MIT Press, 2014. ISBN: 9780262026734. 1 Chapter 11, questions about the somatic regions: 4) There are motor neurons located in the midbrain. What movements do those motor neurons control? (These direct outputs of the midbrain are not a subject of much discussion in the chapter.) 5) At the base of the midbrain (ventral side) one finds a fiber bundle that shows great differences in relative size in different species. Give examples. What are the fibers called and where do they originate? 8) A decussating group of axons called the brachium conjunctivum also varies greatly in size in different species. It is largest in species with the largest neocortex but does not come from the neocortex. From which structure does it come? Where does it terminate? (Try to guess before you look it up.) 2 Motor neurons of the midbrain that control somatic muscles: the oculomotor nuclei of cranial nerves III and IV. At this level, the oculomotor nucleus of nerve III is present. Fibers from retina to Superior Colliculus Brachium of Inferior Colliculus (auditory pathway to thalamus, also to SC) Oculomotor nucleus Spinothalamic tract (somatosensory; some fibers terminate in SC) Medial lemniscus Cerebral peduncle: contains Red corticospinal + corticopontine fibers, + cortex to hindbrain fibers nucleus (n. ruber) Tectospinal tract Rubrospinal tract Courtesy of MIT Press. Used with permission. Schneider, G. -
Lipoma of the Midbrain
LIPOMA OF THE MIDBRAIN POST-MORTEM FINDING IN A PATIENT WITH BREAST CANCER VERÔNICA MAIA GOUVEA * — MYRIAM DUMAS HAHN ** — LEILA CHIMELLI ** SUMMARY — Intracranial lipomas are rare, usually do not have clinical expression and are located mare frequently in the corpus callosum. Other locations include the spinal cord, midbrain tectum, superior vermis, tuber cinereum, infundibulum and more rarely cerebello pontine angle, hypothalamus, superior medullary velum and insula. We report the case of a lipoma of the left inferior colliculus which was a post-mortem finding in a woman who died of breast cancer. Although there are reports of intracranial lipomas in patients with malignant tumors there is no explanation for the co-existence of the two tumors. The present tumor also includes a segment of a nerve which is not uncommon, but a less common finding was the presence of nests of Schwann cells within it, shown by immunohistochemistry. Lipoma do mesencéfalo: achado de necrópsia, em paciente com câncer da mama. RESUMO — Lipomas intracranianos são raros, em geral sem expressão clínica, localizados mais freqüentemente no corpo caloso. Outras localizações incluem medula espinhal, teto mesencefálico, vermis superior, tuber cinereum, infundibulum e mais raramente o ângulo ponto-cerebelar, hipotálamo, véu medular superior e insula. Relatamos o achado de necrópsia de um lipoma do colículo inferior esquerdo em uma mulher com câncer de mama. Embora haja relatos de lipomas intracranianos em pacientes com tumores malignos não há explicação para a co-existência dos dois tumores. O presente tumor também inclui o segmento de um nervo, o que não é incomum, mas um achado menos comum foi a presença de ninhos de células de Schwann no tumor, mostradas por imuno-histoquímica. -
Anatomy of the Brainstem
Anatomy of the Brainstem Neuroanatomy block-Anatomy-Lecture 5 Editing file Objectives At the end of the lecture, students should be able to: 01 List the components of brain stem. 02 Describe the site of brain stem 03 Describe the relations between components of brain stem & their relations to cerebellum. 04 Describe the external features of both ventral & dorsal surfaces of brain stem Color guide 05 List cranial nerves emerging from brain stem 06 Describe the site of emergence of each cranial nerve ● Only in boys slides in Green ● Only in girls slides in Purple ● important in Red ● Notes in Grey Development of Brain Brain stem ● The brain develops from the cranial part of neural tube. ● The brainstem is the region of the brain that connects the ● The cranial part is divided into 3 parts: cerebrum with the spinal cord. ● Site: It lies on the basilar part of occipital bone (clivus). - Subdivided into: ● Parts from above downwards : 1. Telencephalon: (cavities: 2 lateral ventricles) 1. Midbrain Two cerebral hemispheres. Forebrain 2. Pons 2. Diencephalon: (cavity: 3rd ventricle) 3. Medulla oblongata thalamus, hypothalamus, epithalamus & subthalamus ● Connection with cerebellum: Each part of the brain stem is connected to the Midbrain - (cavity: cerebral aqueduct) cerebellum by cerebellar peduncles (superior, middle & inferior). - (cavity: 4th ventricle) - Subdivided into: Hindbrain 1. Pons 2. Cerebellum 3. Medulla oblongata 3 Sagittal section of Brain 4 Functions of the Brain Stem Pathway of tracts between cerebral cortex & spinal cord (ascending and descending tracts). 1 Site of origin of nuclei of cranial nerves (from 3rd to 12th). 2 Site of emergence of cranial nerves (from 3rd to 12th). -
ON-LINE FIG 1. Selected Images of the Caudal Midbrain (Upper Row
ON-LINE FIG 1. Selected images of the caudal midbrain (upper row) and middle pons (lower row) from 4 of 13 total postmortem brains illustrate excellent anatomic contrast reproducibility across individual datasets. Subtle variations are present. Note differences in the shape of cerebral peduncles (24), decussation of superior cerebellar peduncles (25), and spinothalamic tract (12) in the midbrain of subject D (top right). These can be attributed to individual anatomic variation, some mild distortion of the brain stem during procurement at postmortem examination, and/or differences in the axial imaging plane not easily discernable during its prescription parallel to the anterior/posterior commissure plane. The numbers in parentheses in the on-line legends refer to structures in the On-line Table. AJNR Am J Neuroradiol ●:●●2019 www.ajnr.org E1 ON-LINE FIG 3. Demonstration of the dentatorubrothalamic tract within the superior cerebellar peduncle (asterisk) and rostral brain stem. A, Axial caudal midbrain image angled 10° anterosuperior to posteroinferior relative to the ACPC plane demonstrates the tract traveling the midbrain to reach the decussation (25). B, Coronal oblique image that is perpendicular to the long axis of the hippocam- pus (structure not shown) at the level of the ventral superior cerebel- lar decussation shows a component of the dentatorubrothalamic tract arising from the cerebellar dentate nucleus (63), ascending via the superior cerebellar peduncle to the decussation (25), and then enveloping the contralateral red nucleus (3). C, Parasagittal image shows the relatively long anteroposterior dimension of this tract, which becomes less compact and distinct as it ascends toward the thalamus. ON-LINE FIG 2.