13. General Somatic Efferent Nuclei (GSE)
Hypoglossal Nucleus XII
Abducens Nucleus VI
Trochlear Nucleus IV
Oculomotor Nucleus III
Brain stem 13
14. Special Visceral Efferent Nuclei (SVE)
Nucleus Ambiguus IX, X, XI
Facial Motor Nucleus VII
Trigeminal Motor Nucleus V
Brain stem 14
15. General Visceral Efferent Nuclei (GVE)
Dorsal Motor Nucleus of Vagus X
Inferior Salivatory Nucleus IX
Superior Salivatory Nucleus VII
Edinger-Westphal Nucleus III
Brain stem 15
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
Brain stem 16
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
Brain stem 17
18. Visceral Afferent Nuclei (VA)
Nucleus Tractus Solitarius VII, IX, X
General Visceral Afferent (GVA)
Special Visceral Afferent (SVA): Taste
Gustatory Nucleus
Brain stem 18
23. Reticular
Formation
A. Raphe Nuclei
B. Central
Nuclear Group
C. Lateral
Nuclear Group
D. Precerebellar
Reticular Nuclei
A
B
C
D
Brain stem 23
24. Central Nuclear Group of Reticular Formation
Gigantocellular Reticular Nucleus
Caudal Reticulopontine Nucleus
Oral Reticulopontine Nucleus
Subcuneiform Nucleus
Cuneiform Nucleus
Brain stem 24
25. Lateral Nuclear Group of Reticular Formation
Central Nucleus of Medulla Oblongata
Superficial Ventrolateral Reticular Area
Parvicellular Reticular Nucleus
Parabrachial Nucleus
Pedunculopontine Nucleus
Brain stem 25
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
Brain stem 29
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)Brain stem 31
32. 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)
Posterior White Column-Medial Lemniscal Pathway
DRG
D
Brain stem 32
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)
Brain stem 33
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
Brain stem 34
35. 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)
Spinothalamic Tract (Neospinothalamic Tract)
Spinoreticular Tract (Paleospinothalamic Tract)
DRG
D
Brain stem 35
36. Trigeminothalamic Tract
Modality: General Sensation from 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)
Brain stem 36
37. Trigeminothalamic Tract
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
Brain stem 37
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
Brain stem 38
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
Brain stem 39
40. Auditory Pathways
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
Brain stem 40
41. Auditory Pathway
A. spiral ganglion
B. dorsal cochlear nucleus
C. ventral cochlear nucleus
D. superior olivary nucleus
1. dorsal acoustic striae
2. intermediate acoustic
striae
3. ventral acoustic striae
4. efferent cochlear bundle
5. trapezoid body
6. lateral lemniscus
Brain stem 41
48. 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
Brain stem 48
Efferent Connections
of Cerebellum
53. Components of Medial Longitudinal Fasciculus (MLF)
Descending Components
Medial Vestibulospinal Tract
from medial and inferior vestibular nucleus
Interstitiospinal Tract
from interstitial nucleus of Cajal
Ascending Components
Efferents from Medial Vestibular Nucleus
contralateral III, IV, interstitial nucleus
bilateral VI nucleus
Efferents from Superior Vestibular Nucleus
ipsilateral III, IV, interstitial nucleus
Brain stem 53
54. Ascending Components
solitariohypothalamic fiber
(visceral afferent fiber)
ascending serotonergic fiber
Descending Component
descending fibers from hypothalamus
to periaqueductal gray and
dorsal tegmental nucleus
Components of Dorsal Longitudinal Fasciculus
(DLF, fasciculus of Schütz)
Brain stem 54
67. Open Medulla (Mid-olivary Level)
XII. Hypoglossal Nerve
1. Hypoglossal Nucleus
X. Vagus Nerve
2. Nucleus Ambiguus
3. Dorsal Motor Nucleus of
X
4. Nucleus Tractus Solitarius
5. Spinal Tract Nucleus of V
Brain stem 67
68. A. Dejerine’s Syndrome
1. pyramidal tract
2. hypoglossal nerve
3. medial lemniscus
B. Wallenberg Syndrome
4. spinothalamic tract
5. spinal tract of trigeminal nerve
6. nucleus ambiguus
7. descending autonomic
pathway
Clinical Syndromes
of Open Medulla
Brain stem 68
69. Wallenberg Syndrome
Spinothalamic tract
- contralateral loss of pain and
temperature sensation at the body
Spinal tract of trigeminal nerve
- ipsilateral loss of pain and
temperature sensation at the face
Nucleus ambiguus
- dysphageia, dysarthria, hoarseness
Descending autonomic pathway
- Horner’s syndrome
(meiosis, ptosis, anhydrosis) Brain stem 69
79. Lower Pons (Level of Abducens Nucleus)
Tegmentum
Cranial Nerve Nuclei
Abducens Nucleus, Main Sensory Nucleus of V
Nuclei of Auditory Pathway
Superior Olivary Nuclear Complex
Reticular Formation
Caudal Pontine Reticular & Subceruleus Nucleus
Tracts
Trapezoid Body, lateral Lemniscus,
Central tegmental Tract
Basal Part: Pons Proper:
Pontine Nuclei,
Transverse Pontine Fiber,
Longitudinal Pontine Fiber (Pyramidal Tract)
Brain stem 79
80. Lower Pons (Level of Abducens Nucleus)
Cranial Nerve Nuclei
1. Abducens Nucleus
2. Main Sensory Nucleus of V
3. Lateral vestibular Nucleus
4. Superior Vestibular Nucleus
Auditory Relay Nuclei
A. Superior Olivary Nucleus
B. Nucleus of Trapezoid body
Brain stem 80
82. VII. Facial Nerve
1. Facial Motor Nucleus
2. Superior Salivatory Nucleus
3. Nucleus Tractus Solitarius
4. Spinal Tract Nucleus of V
VI. Abducens Nerve
5. Abducens Nucleus
Brain stem 82
83. A. Facial Palsy
B. A + decreased salivation
C. A + B + hyperacusis
D. A + B + C + decrased
lacrimal secretion
E. Central Type Facial Palsy
1. Facial Motor Nucleus
2. Superior Salivatory Nucleus
3. Solitary Nucleus
4. Spinal Tract Nucleus of
Trigeminal Nerve
Brain stem 83
88. Upper Pons (Level of Trigeminal Motor Nucleus)
Tegmentum
Cranial Nerve Nuclei
Trigeminal Motor Nucleus,
Mesencephalic Tract Nucleus of Trigeminal Nerve
Nuclei of Auditory Pathway
Nucleus of Lateral Lemniscus
Reticular Formation
Reticular Tegmental Nucleus
Unclassified Nucleus
Pontine Central Gray: Ch6
Tracts
Trigeminal Nerve Fiber
Basal Part: Pons Proper
Brain stem 88
89. Upper Pons (Level of Trigeminal Motor Nucleus)
Cranial Nerve Nuclei
1. Trigeminal Motor Nucleus
2. Main Sensory Nucleus of V
3. Mesencephalic Tract
Nucleus of V
4. Superior Vestibular Nucleus
Auditory Relay Nuclei
A. Nucleus of Lateral Lemniscus
Brain stem 89
90. Upper Pons (Level of Trigeminal Motor Nucleus)
Reticular Formation
1. Caudal Pontine
Reticular Nucleus
2. Nucleus Subceruleus
3. Reticular Tegemntal
Nucleus of Bekhterew
(Nucleus Papilloformis of
Olszewski and Baxter)
Brain stem 90
91. A. Millard-Gubler Syndrome
B. Raymond Syndrome
C. Foville Syndrome
D. Raymond-Cestan Syndrome
E. Marie-Poix Syndrome
1. pyramidal tract
2. MLF
3. medial lemniscus
4. spinothalamic tract
5. trigeminal motor nucleus
6. main sensory nucleus of V
7. spinal tract of trigeminal nerve
8. middle cerebellar peduncle
Clinical Syndromes
of Pons
Brain stem 91
92. Trigeminal Neuralgia
(tic douloureux)
- excruciating episodic pain
in the area supplied by
trigeminal nerve, especially
second and third division
- trigger point
- intense pain makes the
patient grimace (tic)
- antiepileptic drug (phenytoin,
carbamazepine) is effective
- surgical treatment
Brain stem 92
93. Lower Midbrain (Level of Inferior Colliculus)
Roof Plate - Tectum: Inferior Colliculus
Tegmentum
Cranial Nerve Nuclei
Trochlear Nucleus
Reticular Formation
Cuneiform, Pedunculopontine, Parabrachial
and Median Raphe (Superior Central) Nucleus
Unclassified Nuclei
Periaqueductal Gray
Tracts
Decussation of Superior Cerebellar Peduncle
Basal Part - Crus Cerebri, Pons Proper
Brain stem 93
94. Roof Plate
A. Inferior Colliculus
Cranial Nerve Nuclei
1. Mesencephalic Tract
Nucleus of
Trigeminal Nerve
2. Trochlear Nucleus
Brain stem 94
Lower Midbrain
(Level of Inferior Colliculus)
95. Reticular Formation
1. Cuneiform Nucleus
2. Pedunculopontine Nucleus
3. Nucleus Locus ceruleus
4. Parabrachial Nucleus
5. Dorsal Raphe Nucleus
6. Median Raphe Nucleus
Unclassified Nuclei
A. Periaqueductal Gray
B. Dorsal Tegmental Nucleus
of Gudden
C. Interpeduncular Nucleus
D. Parabigeminal Nucleus
C
6
5
Brain stem 95
Lower Midbrain
(Level of Inferior
Colliculus)
96. Upper Midbrain (Level of Superior Colliculus)
Roof Plate - Tectum: Superior Colliculus
Tegmentum
Cranial Nerve Nuclei
Oculomotor and Edinger-Westphal Nucleus
Reticular Formation - Subcuneiform Nucleus
Precerebellar Nuclei
Red Nucleus
Unclassified Nuclei
Substantia Nigra, Paranigral, Paralemniscal
Nucleus
Ventral Tegmental Area (VTA)
Tracts
Brachium of Inferior Colliculus
Basal Part - Crus Cerebri
Brain stem 96
97. Roof Plate
A. Superior Colliculus
Precerebellar Nucleus
B. Red Nucleus
Cranial Nerve Nuclei
1. Mesencephalic Tract
Nucleus of V
2. Oculomotor Nucleus
3. Edinger-Westphal Nucleus
Brain stem 97
Upper Midbrain
(Level of Superior Colliculus)
98. Reticular Formation
A. Cuneiform Nucleus
B. Subcuneiform Nucleus
Unclassified Nuclei
1. Periaqueductal Gray
2. Paralemniscal Nucleus
3. Substantia Nigra
3a. Pars Compacta
3b. Pars Reticulata
4. Paranigral Nucleus
5. Ventral Tegmental Area
Brain stem 98
Upper Midbrain
(Level of Superior Colliculus)
99. A. Weber Syndrome
B. Foix Syndrome
C. Benedikt’s Syndrome
D. Claude Syndrome
E. Parinaud’s Syndrome
1. pyramidal tract
2. superior cerebellar peduncle
3. red nucleus
4. medial lemniscus
5. superior colliculus
6. cerebral aqueduct
7. MLF
8. oculomotor nucleus
Brain stem 99
Clinical Syndromes
of Upper Midbrain
100. Pyramidal tract
- contralateral UMN syndrome
at the body and lower face
(contralateral hemiparesis)
Oculomotor Nerve
- ipsilateral ocular palsy
- external strabismus
- mydriasis
- loss of accommodation
- normal consensual light reflex
Brain stem 100