nabeel kouka, md, do, mba
TRANSCRIPT
![Page 1: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/1.jpg)
Nabeel Kouka, MD, DO, MBANabeel Kouka, MD, DO, MBAwww.brain101.infowww.brain101.info
Nabeel Kouka, MD, DO, MBANabeel Kouka, MD, DO, MBAwww.brain101.infowww.brain101.info
![Page 2: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/2.jpg)
Basic Basic Strucrure ofStrucrure ofBrain StemBrain Stem
1. Roof Plate1. Roof Plate
2. Tegmentum2. Tegmentum
3. Basal Portion3. Basal Portion
![Page 3: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/3.jpg)
Basilar (Basal) PortionBasilar (Basal) PortionBasilar (Basal) PortionBasilar (Basal) Portion
Descending Fibers from Cerebral CortexDescending Fibers from Cerebral Cortex
1. Corticospinal Tract1. Corticospinal Tract2. Corticobulbar Tract2. Corticobulbar Tract
3. Corticopontocerebellar Fiber3. Corticopontocerebellar Fiber Corticopontine FiberCorticopontine Fiber Pons Proper (Ventral Pons)Pons Proper (Ventral Pons) Pontocerebellar FiberPontocerebellar Fiber
Pyramidal TractPyramidal Tract
![Page 4: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/4.jpg)
Corticospinal TractCorticospinal Tract
Origin: Origin: Cerebral CortexCerebral Cortex Brodmann Area 4 (Primary Motor Area, M I)Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 6 (Premotor Area, PM )Brodmann Area 6 (Premotor Area, PM )
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Corona RadiataCorona Radiata
lnternal Capsule, Posterior Limblnternal Capsule, Posterior Limb
Crus Cerebri, Middle PortionCrus Cerebri, Middle Portion
Longitudinal Pontine FiberLongitudinal Pontine Fiber
Pyramid - pyramidal decussationPyramid - pyramidal decussation
Corticospinal Tract - Lateral and AnteriorCorticospinal Tract - Lateral and Anterior
Termination: Termination: Spinal Gray (Rexed IV-IX)Spinal Gray (Rexed IV-IX)
Corticospinal TractCorticospinal Tract
Origin: Origin: Cerebral CortexCerebral Cortex Brodmann Area 4 (Primary Motor Area, M I)Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 6 (Premotor Area, PM )Brodmann Area 6 (Premotor Area, PM )
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Corona RadiataCorona Radiata
lnternal Capsule, Posterior Limblnternal Capsule, Posterior Limb
Crus Cerebri, Middle PortionCrus Cerebri, Middle Portion
Longitudinal Pontine FiberLongitudinal Pontine Fiber
Pyramid - pyramidal decussationPyramid - pyramidal decussation
Corticospinal Tract - Lateral and AnteriorCorticospinal Tract - Lateral and Anterior
Termination: Termination: Spinal Gray (Rexed IV-IX)Spinal Gray (Rexed IV-IX)
Basal Portion Descending TractsBasal Portion Descending Tracts Basal Portion Descending TractsBasal Portion Descending Tracts
![Page 5: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/5.jpg)
Corticobulbar TractCorticobulbar Tract
- Corticofugal fibers projecting to, and terminating in,- Corticofugal fibers projecting to, and terminating in,
portions of lower brainstemportions of lower brainstem - Termination:- Termination:
1) motor nuclei (upper motor neuron pathway)1) motor nuclei (upper motor neuron pathway)
hypoglossal, ambiguus, facial motor,hypoglossal, ambiguus, facial motor,
trigeminal motor, abducens, trochleartrigeminal motor, abducens, trochlear
and oculomotor nucleusand oculomotor nucleus
2) sensory relay nuclei2) sensory relay nuclei
nuclei gracilis and cuneatus, trigeminalnuclei gracilis and cuneatus, trigeminal
sensory nucleus, solitary tract nucleussensory nucleus, solitary tract nucleus
3) reticular formation 3) reticular formation (corticoreticular fiber)(corticoreticular fiber)
Basal Portion Descending TractsBasal Portion Descending Tracts Basal Portion Descending TractsBasal Portion Descending Tracts
![Page 6: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/6.jpg)
Basal Portion Descending TractsBasal Portion Descending Tracts Basal Portion Descending TractsBasal Portion Descending Tracts
Corticobulbar Tract - UMN PathwayCorticobulbar Tract - UMN Pathway
- Corticofugal fibers projecting to - Corticofugal fibers projecting to cranial motor nucleicranial motor nuclei
GSE - GSE - hypoglossal (XII), abducens (VI), hypoglossal (XII), abducens (VI),
trochlear (IV) and oculomotor (III) nucleustrochlear (IV) and oculomotor (III) nucleus
SVE -SVE - ambiguus (IX, X, XI), facial motor (VII),ambiguus (IX, X, XI), facial motor (VII),
trigeminal motor (V) nucleustrigeminal motor (V) nucleus
- largely - largely bilateralbilateral
laryngeal, pharyngeal, palatal and upper faciallaryngeal, pharyngeal, palatal and upper facial
muscles of mastication and extraocular musclesmuscles of mastication and extraocular muscles
- - unilateralunilateral
lower facial musculature (facial palsy)lower facial musculature (facial palsy)
SCM and trapezius (uncrossed) --- spinal accessorySCM and trapezius (uncrossed) --- spinal accessory
- - Pseudobulbar PalsyPseudobulbar Palsy --- syndrome of bilateral UMN lesion--- syndrome of bilateral UMN lesion
![Page 7: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/7.jpg)
Basal Portion Descending TractsBasal Portion Descending Tracts Basal Portion Descending TractsBasal Portion Descending Tracts
Corticopontocerebellar FiberCorticopontocerebellar Fiber
- Corticofugal fibers projecting to- Corticofugal fibers projecting to
cerebellar hemispherecerebellar hemisphere
- consists of 2 neuron chain- consists of 2 neuron chain
1. Corticopontine fiber projecting to 1. Corticopontine fiber projecting to pontine nucleipontine nuclei
2. Pontocerebellar fiber2. Pontocerebellar fiber crossed mudline and enter cerebellum crossed mudline and enter cerebellum as middle cerebellar peduncleas middle cerebellar peduncle
![Page 8: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/8.jpg)
Roof PlateRoof PlateRoof PlateRoof Plate
Midbrain Midbrain
Superior ColliculusSuperior Colliculus: : visionvision
Inferior ColliculusInferior Colliculus: : hearinghearing
Closed MedullaClosed Medulla
Nucleus Gracilis et CuneatusNucleus Gracilis et Cuneatus::
discriminative touch sensationdiscriminative touch sensation
cf.cf. CerebelumCerebelum: : equilibriumequilibrium
![Page 9: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/9.jpg)
Roof PlateRoof Plate of Hypothetized of Hypothetized Chordate AncestorChordate Ancestor
A. olfactionB. visionC. hearingD. equilibriumE. discriminative touch sensation
1. epithalamus2. superior colliculus3. inferior colliculus4. cerebellum5. nucleus gracilis et cuneatus
![Page 10: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/10.jpg)
TegmentumTegmentumTegmentumTegmentum
Cranial nerve NucleiCranial nerve Nuclei
Precerebellar NucleiPrecerebellar Nuclei
Reticular FormationReticular Formation
TractsTracts Ascending Cortical PathwayAscending Cortical Pathway
Cerebellar CircuitsCerebellar Circuits
Descending TractDescending Tract
Composite BundleComposite Bundle
![Page 11: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/11.jpg)
Cranial NervesCranial Nerves ColumnsColumns of ofBrain StemBrain Stem
Motor ColumnMotor Column
1. GSE1. GSE 2. SVE2. SVE 3. GVE3. GVE
Sensory ColumnSensory Column
4. VA (GVA & SVA)4. VA (GVA & SVA) 5. GSA5. GSA 6. SSA6. SSA
![Page 12: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/12.jpg)
Components of Components of Cranial NervesCranial Nerves
![Page 13: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/13.jpg)
General Somatic Efferent Nuclei (GSE)General Somatic Efferent Nuclei (GSE)
Hypoglossal NucleusHypoglossal Nucleus XIIXII
Abducens NucleusAbducens Nucleus VIVI
Trochlear NucleusTrochlear Nucleus IVIV
Oculomotor NucleusOculomotor Nucleus IIIIII
![Page 14: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/14.jpg)
Special Visceral Efferent Nuclei (SVE)Special Visceral Efferent Nuclei (SVE)
Nucleus AmbiguusNucleus Ambiguus IX, X, XIIX, X, XI
Facial Motor NucleusFacial Motor Nucleus VIIVII
Trigeminal Motor NucleusTrigeminal Motor Nucleus VV
![Page 15: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/15.jpg)
General Visceral Efferent Nuclei (GVE)General Visceral Efferent Nuclei (GVE)
Dorsal Motor Nucleus of VagusDorsal Motor Nucleus of Vagus XX
Inferior Salivatory NucleusInferior Salivatory Nucleus IXIX
Superior Salivatory NucleusSuperior Salivatory Nucleus VIIVII
Edinger-Westphal NucleusEdinger-Westphal Nucleus IIIIII
![Page 16: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/16.jpg)
Motor NucleiMotor Nuclei of ofCranial NervesCranial Nerves
1. GSE1. GSE III, IV, VI, XIIIII, IV, VI, XII
2. SVE2. SVE V, VII, V, VII, IX, X, XIIX, X, XI
3. GVE3. GVE III, VII, IX, XIII, VII, IX, X
![Page 17: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/17.jpg)
General Somatic Afferent Nuclei (GSA)General Somatic Afferent Nuclei (GSA)
Trigeminal Sensory Nucleus Trigeminal Sensory Nucleus V, V, VII, IX, XVII, IX, X
Mesencephalic Tract NucleusMesencephalic Tract Nucleus
Principal (Main) Sensory NucleusPrincipal (Main) Sensory Nucleus
Spinal Tract NucleusSpinal Tract Nucleus
pars oralispars oralis
pars interpolarispars interpolaris
pars caudalispars caudalis
![Page 18: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/18.jpg)
Visceral Afferent Nuclei (VA)Visceral Afferent Nuclei (VA)
Nucleus Tractus SolitariusNucleus Tractus Solitarius VII, IX, XVII, IX, X
General Visceral Afferent (GVA)General Visceral Afferent (GVA)
Special Visceral Afferent (SVA): Special Visceral Afferent (SVA): TasteTaste
Gustatory NucleusGustatory Nucleus
![Page 19: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/19.jpg)
Special Somatic Afferent Nuclei (SSA)Special Somatic Afferent Nuclei (SSA)
Cochlear Nucleus Cochlear Nucleus VIIIc VIIIc Dorsal Cochlear NucleusDorsal Cochlear Nucleus
Ventral Cochlear NucleusVentral Cochlear Nucleus
Vestibular NucleusVestibular Nucleus VIIIv VIIIv Medial Vestibular NucleusMedial Vestibular Nucleus
Lateral Vestibular NucleusLateral Vestibular Nucleus
Superior Vestibular NucleusSuperior Vestibular Nucleus
Inferior Vestibular NucleusInferior Vestibular Nucleus
![Page 20: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/20.jpg)
Sensory NucleiSensory Nuclei of ofCranial NervesCranial Nerves
1. VA 1. VA
GVA --- IX, XGVA --- IX, X
SVA --- VII, IX, XSVA --- VII, IX, X 2. GSA2. GSA V,V, VII, IX, XVII, IX, X
3. SSA3. SSA VIIIc, VIIIvVIIIc, VIIIv
![Page 21: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/21.jpg)
Precerebellar NucleiPrecerebellar Nuclei
Accessory Cuneate Nucleus Accessory Cuneate Nucleus
Inferior Olivary Nuclear ComplexInferior Olivary Nuclear Complex
Vestibular NuclusVestibular Nuclus
Red NucleusRed Nucleus
Perihypoglossal NucleusPerihypoglossal Nucleus
Precerebellar Reticular NucleiPrecerebellar Reticular Nuclei
![Page 22: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/22.jpg)
PrecerebellarPrecerebellarNucleiNuclei
1. Red Nucleus1. Red Nucleus 2. Vestibular Nucleus2. Vestibular Nucleus
3. Inferior Olivary3. Inferior Olivary NucleusNucleus
4. Perhypoglossal4. Perhypoglossal NucleiNuclei
5. Accessory 5. Accessory Cuneate NucleusCuneate Nucleus
![Page 23: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/23.jpg)
Reticular Reticular FormationFormation
A. Raphe NucleiA. Raphe Nuclei B. Central B. Central Nuclear GroupNuclear Group
C. LateralC. Lateral Nuclear GroupNuclear Group
D. PrecerebellarD. Precerebellar Reticular NucleiReticular Nuclei
A
B
C
D
![Page 24: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/24.jpg)
Central Nuclear Group of Reticular FormationCentral Nuclear Group of Reticular Formation
Gigantocellular Reticular Nucleus Gigantocellular Reticular Nucleus
Caudal Reticulopontine NucleusCaudal Reticulopontine Nucleus
Oral Reticulopontine NucleusOral Reticulopontine Nucleus
Subcuneiform NucleusSubcuneiform Nucleus
Cuneiform NucleusCuneiform Nucleus
![Page 25: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/25.jpg)
Lateral Nuclear Group of Reticular FormationLateral Nuclear Group of Reticular Formation
Central Nucleus of Medulla OblongataCentral Nucleus of Medulla Oblongata
Superficial Ventrolateral Reticular AreaSuperficial Ventrolateral Reticular Area
Parvicellular Reticular NucleusParvicellular Reticular Nucleus
Parabrachial NucleusParabrachial Nucleus
Pedunculopontine NucleusPedunculopontine Nucleus
![Page 26: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/26.jpg)
Raphe Nuclei - Serotonergic NeuronRaphe Nuclei - Serotonergic Neuron
Nucleus Raphe Obscrus, BNucleus Raphe Obscrus, B22
Nucleus Raphe Pallidus, Nucleus Raphe Pallidus, BB11
Nucleus Raphe Magnus, Nucleus Raphe Magnus, BB33
Pontine Raphe Nucleus, Pontine Raphe Nucleus, BB55
Median Raphe or Median Raphe or Superior CentralSuperior Central Nucleus, Nucleus, BB6, 6, BB88
Dorsal Raphe Nucleus, Dorsal Raphe Nucleus, BB77
Nucleus LinealisNucleus Linealis
![Page 27: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/27.jpg)
Norepinephrinergic & Dopaminergic NeuronNorepinephrinergic & Dopaminergic Neuron
Norepinephrinergic NeuronNorepinephrinergic Neuron
Nucleus Locus Ceruleus, ANucleus Locus Ceruleus, A66
Dopaminergic NeuronDopaminergic Neuron
Retrorubral Area, Retrorubral Area, AA88
Ventral Tegmental Area, Ventral Tegmental Area, AA1010
Substantia Nigra, Pars Compacta, Substantia Nigra, Pars Compacta, AA99
![Page 28: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/28.jpg)
Ascending Cortical PathwayAscending Cortical PathwayAscending Cortical PathwayAscending Cortical Pathway
Posterior White Column-Medial Lemniscal PathwayPosterior White Column-Medial Lemniscal Pathwaymedial lemniscusmedial lemniscus
Spinothalamic and Spinoreticular TractSpinothalamic and Spinoreticular Tractspinal lemniscusspinal lemniscus
Ventral and Dorsal Trigeminothalamic TractVentral and Dorsal Trigeminothalamic Tracttrigeminal lemniscustrigeminal lemniscus
Auditory Pathway: Auditory Pathway: lateral lemniscuslateral lemniscus
Taste (Gustatory) Pathway: Taste (Gustatory) Pathway: central tegmental tractcentral tegmental tract
Vestibular Pathway: Vestibular Pathway: medial lemniscusmedial lemniscus
![Page 29: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/29.jpg)
Ascending Cortical System Ascending Cortical System General SensationGeneral Sensation Ascending Cortical System Ascending Cortical System General SensationGeneral Sensation
Brain Stem Pathways for General SensationBrain Stem Pathways for General Sensation
Touch & Proprioception from bodyTouch & Proprioception from body
Posterior White Colum-Medial Lemniscal PathwayPosterior White Colum-Medial Lemniscal Pathway
Pain & Temperature from bodyPain & Temperature from body
Spinothalamic TractSpinothalamic Tract
cf. Spinoreticular or Spinoreticulothalamic Tractcf. Spinoreticular or Spinoreticulothalamic Tract
General Sensation from FaceGeneral Sensation from Face
Trigeminothalamic TractsTrigeminothalamic Tracts
![Page 30: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/30.jpg)
Posterior White Column - medial Lemniscal PathwayPosterior White Column - medial Lemniscal Pathway& Spinothalamic Tract& Spinothalamic Tract
![Page 31: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/31.jpg)
Posterior White Colum-Medial Lemniscal PathwayPosterior White Colum-Medial Lemniscal Pathway Posterior White Colum-Medial Lemniscal PathwayPosterior White Colum-Medial Lemniscal Pathway
Modality: Modality: Discriminative Touch Sensation (include Vibration) and Discriminative Touch Sensation (include Vibration) and Conscious Proprioception (Position Sensation, Kinesthesia)Conscious Proprioception (Position Sensation, Kinesthesia) from bodyfrom body
Receptor: Most receptors except free nerve endingsReceptor: Most receptors except free nerve endings
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion)
Posterior White ColumnPosterior White Column
2nd Neuron: 2nd Neuron: Dorsal Column NucleiDorsal Column Nuclei (Nucleus Gracilis et Cuneatus)(Nucleus Gracilis et Cuneatus)
Internal Arcuate Fiber - Lemniscal Decussation - Medial LemniscusInternal Arcuate Fiber - Lemniscal Decussation - Medial Lemniscus
3rd Neuron: 3rd Neuron: Thalamus (VPLc)Thalamus (VPLc) Internal Capsule ----- Corona RadiataInternal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I)Primary Somesthetic Area (S I)
![Page 32: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/32.jpg)
DRG: Dorsal Root GanglionDRG: Dorsal Root Ganglion
1. 1. Posterior White ColumnPosterior White Column
A. Nucleus gracilisA. Nucleus gracilis
B. Nucleus cuneatusB. Nucleus cuneatus
2. 2. Medial LemniscusMedial Lemniscus
3. 3. Corona Radiata Corona Radiata
C. Thalamus (VPLc)C. Thalamus (VPLc)
D. Cerebral Cortex (S I)D. Cerebral Cortex (S I)
Posterior White Column-Posterior White Column-
Medial Lemniscal PathwayMedial Lemniscal Pathway
DRG
D
![Page 33: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/33.jpg)
Spinothalamic TractSpinothalamic Tract Spinothalamic TractSpinothalamic Tract
Modality: Modality: Pain & Temperature Sensation, Light Touch Pain & Temperature Sensation, Light Touch from bodyfrom body
Receptor: Receptor: Free Nerve Ending Free Nerve Ending
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion)
2nd Neuron: 2nd Neuron: Dorsal Horn Dorsal Horn (Lamina I, IV, V)(Lamina I, IV, V)
Anterior White CommissureAnterior White Commissure
Spinothalamic Tract (Spinal Lemniscus)Spinothalamic Tract (Spinal Lemniscus)
3rd Neuron: 3rd Neuron: Thalamus (VPLc & CL)Thalamus (VPLc & CL) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I)Primary Somesthetic Area (S I)
![Page 34: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/34.jpg)
Spinoreticulothalamic Tract Spinoreticulothalamic Tract (Paleospinothalamic Tract)(Paleospinothalamic Tract) Spinoreticulothalamic Tract Spinoreticulothalamic Tract (Paleospinothalamic Tract)(Paleospinothalamic Tract)
Modality: Modality: Pain & Temperature Sensation, Light Touch Pain & Temperature Sensation, Light Touch from bodyfrom body
Receptor: Receptor: Free Nerve Ending Free Nerve Ending
Ist Neuron: Ist Neuron: Dorsal Root Ganglion Dorsal Root Ganglion (Spinal Ganglion)(Spinal Ganglion)
2nd Neuron: 2nd Neuron: Dorsal Horn Dorsal Horn (Lamina I, IV, V)(Lamina I, IV, V)
Anterior White CommissureAnterior White Commissure
Spinothalamic Tract (Spinal Lemniscus)Spinothalamic Tract (Spinal Lemniscus)
3rd Neuron: 3rd Neuron: Reticular FormationReticular Formation
4rd Neuron: 4rd Neuron: Thalamus (CL, Sm, POm)Thalamus (CL, Sm, POm) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Diffuse Cerebral CotexDiffuse Cerebral Cotex
![Page 35: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/35.jpg)
DRG: Dorsal Root GanglionDRG: Dorsal Root Ganglion
A. Posterior (dorsal) hornA. Posterior (dorsal) horn
1. 1. Spinothalamic tractSpinothalamic tract
B. Reticular formationB. Reticular formation
2. 2. Spinoreticular tractSpinoreticular tract
C. Thalamus (VPLc, CL)C. Thalamus (VPLc, CL)
3. 3. Corona Radiata Corona Radiata
D. Cerebral Cortex (S I)D. Cerebral Cortex (S I)
Spinothalamic TractSpinothalamic Tract(Neospinothalamic Tract)(Neospinothalamic Tract)
Spinoreticular TractSpinoreticular Tract(Paleospinothalamic Tract)(Paleospinothalamic Tract)
DRG
D
![Page 36: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/36.jpg)
Trigeminothalamic Tract Trigeminothalamic Tract Trigeminothalamic Tract Trigeminothalamic Tract
Modality: Modality: General SensationGeneral Sensation from facefrom face
Receptor: Receptor: Most receptors in the face Most receptors in the face
Ist Neuron: Ist Neuron: Trigeminal (Semilunar) GangliaTrigeminal (Semilunar) Ganglia
2nd Neuron: 2nd Neuron: Trigeminal Sensory NucleusTrigeminal Sensory Nucleus pain & temperature pain & temperature ---- pars caudalis of---- pars caudalis of
spinal tract nucleus of Vspinal tract nucleus of V
Ventral and Dorsal Trigeminothalamic TractVentral and Dorsal Trigeminothalamic Tract
3rd Neuron: 3rd Neuron: Thalamus (VPM)Thalamus (VPM) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I)Primary Somesthetic Area (S I)
![Page 37: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/37.jpg)
Trigeminothalamic TractTrigeminothalamic Tract
A. trigeminal ganglionA. trigeminal ganglion
B. trigeminal sensory B. trigeminal sensory
nucleusnucleus
C. thalamus (VPM)C. thalamus (VPM)
D. cerebral cortexD. cerebral cortex
(S I)(S I)
1. 1. spinal tract of spinal tract of
trigeminal nervetrigeminal nerve
2. 2. ventral ventral
trigeminothalamic tracttrigeminothalamic tract
3. 3. dorsal dorsal
trigeminothalamic tracttrigeminothalamic tract
4. 4. corona radiatacorona radiata
V.V. trigeminal nerve trigeminal nerve
![Page 38: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/38.jpg)
Ascending Cortical System Ascending Cortical System Special SensationSpecial Sensation Ascending Cortical System Ascending Cortical System Special SensationSpecial Sensation
Brain Stem Pathways for Special SensationBrain Stem Pathways for Special Sensation
Gustatory Sensation (Taste, SVA) Gustatory Sensation (Taste, SVA)
----- Taste Pathway----- Taste Pathway
Auditory Sensation (Hearing, SSA) Auditory Sensation (Hearing, SSA)
----- Auditory Pathway----- Auditory Pathway
Vestibular Sensation (Equilibrium, SSA)Vestibular Sensation (Equilibrium, SSA)
----- Vestibular Pathway----- Vestibular Pathway
![Page 39: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/39.jpg)
Auditory PathwayAuditory Pathway Auditory PathwayAuditory Pathway
Modality: Modality: Auditory Sensation (Hearing) Auditory Sensation (Hearing) Receptor: Receptor: Organ of Coti of Cochlear DuctOrgan of Coti of Cochlear Duct Cranial Nerve: VIIIcCranial Nerve: VIIIc
1st Neuron: 1st Neuron: Spiral GanglionSpiral Ganglion 2nd Neuron: 2nd Neuron: Cochlear Nucleus, Ventral & DorsalCochlear Nucleus, Ventral & Dorsal dorsal, intermediate and ventral acoustic striaedorsal, intermediate and ventral acoustic striae trapezoid bodytrapezoid body lateral lemniscuslateral lemniscus 3rd Neuron: 3rd Neuron: Inferior Colliculus Inferior Colliculus brachium of inferior colliculusbrachium of inferior colliculus 4th Neuron: 4th Neuron: Medial Geniculate Nucleus (MG)Medial Geniculate Nucleus (MG) auditory radiationauditory radiation Termination: Termination: Primary Auditory Area (A I)Primary Auditory Area (A I) Brodmann area 31, 32Brodmann area 31, 32
![Page 40: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/40.jpg)
Auditory PathwaysAuditory Pathways
A. spiral ganglionA. spiral ganglionB. dorsal and ventralB. dorsal and ventral cochlear nucleuscochlear nucleusC. inferior colliculusC. inferior colliculusD. medial geniculateD. medial geniculate nucleusnucleusE. Primary auditory areaE. Primary auditory areaF. superior olivary nucleusF. superior olivary nucleusG. nucleus of G. nucleus of lateral lemniscuslateral lemniscus
1. 1. acoustic striae &acoustic striae & trapezoid bodytrapezoid body2. 2. lateral lemniscuslateral lemniscus3. 3. brachium of inferiorbrachium of inferior colliculuscolliculus4. 4. auditory radiationauditory radiation5. 5. commissure ofcommissure of inferior colliculusinferior colliculusVIIIc. VIIIc. cochlear divisioncochlear division
![Page 41: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/41.jpg)
Auditory PathwayAuditory Pathway
A. spiral ganglionA. spiral ganglion
B. dorsal cochlear nucleusB. dorsal cochlear nucleus
C. ventral cochlear nucleusC. ventral cochlear nucleus
D. superior olivary nucleusD. superior olivary nucleus
1. dorsal acoustic striae1. dorsal acoustic striae
2. intermediate2. intermediate acoustic acoustic
striaestriae
3. ventral acoustic striae3. ventral acoustic striae
4. efferent cochlear bundle4. efferent cochlear bundle
5. trapezoid body5. trapezoid body
6. lateral lemniscus6. lateral lemniscus
![Page 42: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/42.jpg)
Vestibular PathwayVestibular Pathway Vestibular PathwayVestibular Pathway
Modality: Modality: Equilibrium Sensation Equilibrium Sensation
Receptor: Receptor: Macula & Crista Ampullaris Macula & Crista Ampullaris
Cranial Nerve: VIIIvCranial Nerve: VIIIv
Ist Neuron: Ist Neuron: Vestibular GanglionVestibular Ganglion
2nd Neuron: 2nd Neuron: Vestibular NucleusVestibular Nucleus vestibulothalamic fiber (medial lemniscus)vestibulothalamic fiber (medial lemniscus)
3rd Neuron: 3rd Neuron: Thalamus (VPLo, VPI?)Thalamus (VPLo, VPI?) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Vestibular AreaPrimary Vestibular Area ----- Primary Somesthetic Area ----- Primary Somesthetic Area
(Brodmann area 3a, 2v )(Brodmann area 3a, 2v )
![Page 43: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/43.jpg)
VestibularVestibular
Pathway Pathway
1. Vestibulocerebellar Tract1. Vestibulocerebellar Tract 2. Vestibulospinal Tract2. Vestibulospinal Tract
3. Vestibulothalamic Tract3. Vestibulothalamic Tract 4. Medial Longitudinal4. Medial Longitudinal fasciculus (MLF)fasciculus (MLF)
- ascending portion- ascending portion
- descending portion- descending portion
- interstitiospinal tract- interstitiospinal tract
![Page 44: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/44.jpg)
Taste (Gustatory) PathwayTaste (Gustatory) Pathway Taste (Gustatory) PathwayTaste (Gustatory) Pathway
Modality: Modality: Taste Sensation Taste Sensation
Receptor: Receptor: Taste BudTaste Bud
Cranial Nerve: VII, IX, XCranial Nerve: VII, IX, X
Ist Neuron: Ist Neuron: Geniculate Ganglion (VII)Geniculate Ganglion (VII)
Inferior Ganglion (IX, X)Inferior Ganglion (IX, X)
2nd Neuron: 2nd Neuron: Nucleus Tractus SolitariusNucleus Tractus Solitarius
(Gustatory Nucleus)(Gustatory Nucleus)
solitariothalamic fiber (central tegmental tract)solitariothalamic fiber (central tegmental tract)
3rd Neuron: 3rd Neuron: Thalamus (VPMpc)Thalamus (VPMpc) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Gustatory AreaGustatory Area Brodmann area 43 & parainsular cortexBrodmann area 43 & parainsular cortex
![Page 45: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/45.jpg)
Taste PathwaysTaste Pathways
A. nucleus tractusA. nucleus tractus solitariussolitarius (gustatory nucleus)(gustatory nucleus)B. thalamus (VPMpc)B. thalamus (VPMpc)C. Brodmann area 43C. Brodmann area 43D. parainsular cortexD. parainsular cortexE. parabrachialE. parabrachial nucleusnucleus
1. 1. solitariothalamicsolitariothalamic fiber (central fiber (central tegmental tract)tegmental tract) 2. 2. corona radiatacorona radiataVII. VII. facial nervefacial nerveIX. IX. glossopharyngeal glossopharyngeal nervenerveX. X. vagus nervevagus nerve
![Page 46: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/46.jpg)
Cerebellar CircuitsCerebellar CircuitsCerebellar CircuitsCerebellar Circuits
Superior, Middle and Inferior Cerebellar PeduncleSuperior, Middle and Inferior Cerebellar Peduncle
VestibulocerebellumVestibulocerebellum - - Vestibular NucleusVestibular Nucleus
SpinocerebellumSpinocerebellum - - Red Nucleus and Spinal CordRed Nucleus and Spinal Cord
PontocerebellumPontocerebellum - - Cerebral Cortex and Pontine NucleiCerebral Cortex and Pontine Nuclei
Inferior Olivary Nuclear ComplexInferior Olivary Nuclear Complex
![Page 47: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/47.jpg)
Afferent ConnectionsAfferent Connections of Cerebellumof Cerebellum
Inferior Cerebellar Peduncle Inferior Cerebellar Peduncle
1. posterior spinocerebellar tract1. posterior spinocerebellar tract
2. cuneocerebellar tract2. cuneocerebellar tract
3. vestibulocerebellar tract3. vestibulocerebellar tract
Middle cerebellar PeduncleMiddle cerebellar Peduncle
- corticopontocerebellar - corticopontocerebellar pathwaypathway
Superior Cerebellar PeduncleSuperior Cerebellar Peduncle - anterior spinocerebellar tract- anterior spinocerebellar tract
![Page 48: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/48.jpg)
Efferent ConnectionsEfferent Connections of Cerebellumof Cerebellum
Superior Cerebellar PeduncleSuperior Cerebellar Peduncle
1. dentatothalamic fiber1. dentatothalamic fiber
2. interpositorubral fiber2. interpositorubral fiber
3. ascending portion of3. ascending portion of
uncinate fasciculus of Russelluncinate fasciculus of Russell
Inferior Cerebellar Peduncle Inferior Cerebellar Peduncle
1. direct fastigiovestibular fiber1. direct fastigiovestibular fiber
2. descending portion of2. descending portion of
uncinate fasciculus of Russelluncinate fasciculus of Russell
![Page 49: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/49.jpg)
Connections ofConnections of
Inferior Olivary Inferior Olivary
Nuclear Complex Nuclear Complex
1. Olivocerebellar Tract1. Olivocerebellar Tract 2. Cortico-olivary Tract2. Cortico-olivary Tract
3. Rubro-olivary Tract3. Rubro-olivary Tract 4. Vestibulo-olivary Tract4. Vestibulo-olivary Tract
5. Spino-olivary Tract5. Spino-olivary Tract
![Page 50: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/50.jpg)
Descending TractsDescending TractsDescending TractsDescending Tracts
Rubrospinal TractRubrospinal Tract
Tectospinal tractTectospinal tract
Vestibulospinal TractVestibulospinal Tract
Reticulospinal TractReticulospinal Tractpontine and medullarypontine and medullary
Descending Autonomic PathwayDescending Autonomic Pathway
![Page 51: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/51.jpg)
Brain Stem Descending TractsBrain Stem Descending Tracts Brain Stem Descending TractsBrain Stem Descending Tracts
Descending Tracts from Brain StemDescending Tracts from Brain Stem
Dorsolateral (Motor) PathwayDorsolateral (Motor) Pathway
Rubrospinal TractRubrospinal Tract
Ventromedial (Motor) PathwayVentromedial (Motor) Pathway
Tectospinal TractTectospinal Tract
Vestibulospinal TractVestibulospinal Tract
MLF (Medial Longitudinal Fasciculus)MLF (Medial Longitudinal Fasciculus)
- interstitiospinal tract- interstitiospinal tract
Sensory Modulation pathwaysSensory Modulation pathways
Raphespinal & Cerulospinal PathwaysRaphespinal & Cerulospinal Pathways
Descending Autonomic PathwaysDescending Autonomic Pathways
![Page 52: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/52.jpg)
Composite BundleComposite BundleComposite BundleComposite Bundle
Medial Longitudinal Fasciculus (MLF)Medial Longitudinal Fasciculus (MLF)
Dorsal Longitudinal Fasciculus (DLF)Dorsal Longitudinal Fasciculus (DLF)
Central Tegmental TractCentral Tegmental Tract
![Page 53: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/53.jpg)
Components of Components of Medial Longitudinal Fasciculus (MLF)Medial Longitudinal Fasciculus (MLF)
Descending ComponentsDescending ComponentsMedial Vestibulospinal TractMedial Vestibulospinal Tract
from medial and inferior vestibular nucleusfrom medial and inferior vestibular nucleusInterstitiospinal TractInterstitiospinal Tract
from interstitial nucleus of Cajalfrom interstitial nucleus of Cajal
Ascending ComponentsAscending Components Efferents from Medial Vestibular NucleusEfferents from Medial Vestibular Nucleus contralateral contralateral III, IV, interstitial nucleusIII, IV, interstitial nucleus bilateral bilateral VI nucleusVI nucleusEfferents from Superior Vestibular Nucleus Efferents from Superior Vestibular Nucleus ipsilateralipsilateral III, IV, interstitial nucleus III, IV, interstitial nucleus
![Page 54: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/54.jpg)
Ascending ComponentsAscending Componentssolitariohypothalamic fibersolitariohypothalamic fiber
(visceral afferent fiber)(visceral afferent fiber)
ascending serotonergic fiberascending serotonergic fiber
Descending Component Descending Component descending fibers from hypothalamusdescending fibers from hypothalamus to periaqueductal gray and to periaqueductal gray and dorsal tegmental nucleusdorsal tegmental nucleus
Components of Components of Dorsal Longitudinal Fasciculus Dorsal Longitudinal Fasciculus (DLF, fasciculus of Sch(DLF, fasciculus of Schüütz)tz)
![Page 55: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/55.jpg)
Components of Components of Central Tegmental TractCentral Tegmental Tract
Ascending ComponentsAscending Componentsreticulothalamic fiberreticulothalamic fiber
solitariothalamic fibersolitariothalamic fiber
(secondary taste fiber)(secondary taste fiber)
Descending Component Descending Component rubro-olivary tractrubro-olivary tract
![Page 56: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/56.jpg)
Spinomedullary Transition Spinomedullary Transition (Level of Pyramidal Decussation)(Level of Pyramidal Decussation)
Spinomedullary Transition Spinomedullary Transition (Level of Pyramidal Decussation)(Level of Pyramidal Decussation)
Roof Plate - Roof Plate - fasciculus gracilis and fasciculus cuneatusfasciculus gracilis and fasciculus cuneatus
TegmentumTegmentum Cranial and Spinal Nerve NucleiCranial and Spinal Nerve Nuclei
Supraspinal NucleusSupraspinal NucleusSpinal Nucleus of Trigeminal Nerve, Pars CaudalisSpinal Nucleus of Trigeminal Nerve, Pars Caudalis
Reticular FormationReticular FormationCentral Nucleus of Medulla OblongataCentral Nucleus of Medulla Oblongata (Ventral Reticular Nucleus) (Ventral Reticular Nucleus)
Unclassified NucleiUnclassified NucleiRetroambiguus NucleusRetroambiguus Nucleus
TractsTractsSpinal Tracts of Trigeminal NerveSpinal Tracts of Trigeminal Nerve
Basal Part Basal Part - - Pyramid, Pyramidal DecussationPyramid, Pyramidal Decussation
![Page 57: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/57.jpg)
Cranial & Spinal N. NucleiCranial & Spinal N. Nuclei
1. Supraspinal Nucleus1. Supraspinal Nucleus
2. Spinal Accessory Nucleus2. Spinal Accessory Nucleus
Cranial & Spinal NerveCranial & Spinal Nerve XI. XI. Accessory NucleusAccessory Nucleus
C1. C1. motor root ofmotor root of 1st cervical nerve1st cervical nerve
Spinomedullary Transition Spinomedullary Transition (Level of Pyramidal Decussation)(Level of Pyramidal Decussation)
![Page 58: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/58.jpg)
Lower Medulla Lower Medulla (Level of Lemniscal Decussation)(Level of Lemniscal Decussation)Lower Medulla Lower Medulla (Level of Lemniscal Decussation)(Level of Lemniscal Decussation)
Roof Plate - Roof Plate - nucleus gracilis and nucleus cuneatusnucleus gracilis and nucleus cuneatus
TegmentumTegmentum Cranial and Spinal Nerve NucleiCranial and Spinal Nerve Nuclei
Hypoglossal Nucleus, Ambiguus NucleusHypoglossal Nucleus, Ambiguus NucleusSolitary Tract Nucleus, Dorsal Motor Nucleus of XSolitary Tract Nucleus, Dorsal Motor Nucleus of X
Reticular FormationReticular FormationLateral Reticular Nucleus Lateral Reticular Nucleus
Precerebellar NucleiPrecerebellar NucleiInferior Olivary Nuclear Complex Inferior Olivary Nuclear Complex
TractsTractsVentral Trigeminothalamic TractVentral Trigeminothalamic TractInternal Arcuate Fiber, Lemniscal DecussationInternal Arcuate Fiber, Lemniscal Decussation
Basal Part Basal Part - - Pyramid, Pyramidal DecussationPyramid, Pyramidal Decussation
![Page 59: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/59.jpg)
Lower MedullaLower Medulla(Level of Lemniscal(Level of Lemniscal
Decussation)Decussation)
Roof PlateRoof Plate A. Nucleus GracilisA. Nucleus GracilisB. Nucleus CuneatusB. Nucleus Cuneatus
Cranial Nerve NucleiCranial Nerve Nuclei1. Hypoglossal Nucleus1. Hypoglossal Nucleus
2. Nucleus Ambiguus2. Nucleus Ambiguus
3. Dorsal Motor Nucleus of X3. Dorsal Motor Nucleus of X
4. Nucleus Tractus Solitarius4. Nucleus Tractus Solitarius
5. Spinal Tract Nucleus of5. Spinal Tract Nucleus of
Trigeminal NerveTrigeminal Nerve
![Page 60: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/60.jpg)
Lower MedullaLower Medulla(Level of Lemniscal(Level of Lemniscal
Decussation)Decussation)
Precerebellar NucleusPrecerebellar Nucleus1. Inferior Olivary Nuclear Complex1. Inferior Olivary Nuclear Complex 1a. Principal Inferior1a. Principal Inferior
Olivary NucleusOlivary Nucleus 1b. Medial Accessory1b. Medial Accessory
Olivary NucleusOlivary Nucleus 1c. Dorsal Accessory1c. Dorsal Accessory Olivary NucleusOlivary Nucleus2. Nucleus Intercalatus2. Nucleus Intercalatus3. Nucleus Conterminalis3. Nucleus Conterminalis4. Arcuate Nucleus4. Arcuate Nucleus
![Page 61: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/61.jpg)
Lower MedullaLower Medulla(Level of Lemniscal(Level of Lemniscal
Decussation)Decussation)
Reticular FormationReticular Formation
1. Lateral Reticular Nucleus1. Lateral Reticular Nucleus
2. Central Nucleus of2. Central Nucleus of
Medulla OblongataMedulla Oblongata
2d. subnucleus dorsalis2d. subnucleus dorsalis
2v. subnucleus ventralis2v. subnucleus ventralis
![Page 62: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/62.jpg)
Clinical Syndromes Clinical Syndromes of Lower Medullaof Lower Medulla
A. HypoglossalA. Hypoglossal Alternating HemiplegiaAlternating Hemiplegia
B. Avelis SyndromeB. Avelis Syndrome
C. Jackson SyndromeC. Jackson Syndrome
D. Tapia SyndromeD. Tapia Syndrome
1. pyramidal tract1. pyramidal tract
2. hypoglossal nerve2. hypoglossal nerve
3. spinothalamic tract3. spinothalamic tract
4. nucleus ambiguus4. nucleus ambiguus
![Page 63: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/63.jpg)
HypoglossalHypoglossalPalsyPalsy
Lower Motor Lower Motor NeuronNeuron
SyndromeSyndrome
HypoglossalHypoglossalPalsyPalsy
Lower Motor Lower Motor NeuronNeuron
SyndromeSyndrome Deviation of Tongue to affected sideDeviation of Tongue to affected side
Atrophy of Tongue MusclesAtrophy of Tongue Muscles
![Page 64: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/64.jpg)
Open Medulla Open Medulla (Mid-olivary Level)(Mid-olivary Level) Open Medulla Open Medulla (Mid-olivary Level)(Mid-olivary Level)
TegmentumTegmentum Cranial Nerve NucleiCranial Nerve Nuclei
Medial Vestibular NucleusMedial Vestibular NucleusSpinal Tract Nucleus of V, pars interpolarisSpinal Tract Nucleus of V, pars interpolaris
Precerebellar Nuclei Precerebellar Nuclei Accessory Cuneate NucleusAccessory Cuneate NucleusNucleus of Roller, Nucleus Interfascicularis HypoglossiNucleus of Roller, Nucleus Interfascicularis Hypoglossi
Reticular FormationReticular FormationLateral Reticular Nucleus, subtrigeminal portionLateral Reticular Nucleus, subtrigeminal portion
Unclassified NucleiUnclassified NucleiArea PostremaArea Postrema
Tracts: Tracts: Inferior Cerebellar Peduncle, DLFInferior Cerebellar Peduncle, DLF
Basal Part Basal Part - - PyramidPyramid
![Page 65: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/65.jpg)
Cranial Nerve NucleiCranial Nerve Nuclei
1. Hypoglossal Nucleus1. Hypoglossal Nucleus2. Nucleus Ambiguus2. Nucleus Ambiguus
3. Dorsal Motor Nucleus of X3. Dorsal Motor Nucleus of X
4. Nucleus Tractus Solitarius4. Nucleus Tractus Solitarius
5. Spinal Tract Nucleus, 5. Spinal Tract Nucleus,
pars interpolarispars interpolaris
6. Medial Vestibular Nucleus6. Medial Vestibular Nucleus
Open MedullaOpen Medulla(Mid-olivary Level)(Mid-olivary Level)
![Page 66: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/66.jpg)
Open MedullaOpen Medulla(Mid-olivary Level)(Mid-olivary Level)
Precerebellar NucleusPrecerebellar Nucleus1. Accessory Cuneate Nucleus1. Accessory Cuneate Nucleus2. Inferior Olivary Nuclear Complex2. Inferior Olivary Nuclear Complex 2a. Principal Inferior Olivary Nuc. 2a. Principal Inferior Olivary Nuc. 2b. Medial Accessory Olivary Nuc. 2b. Medial Accessory Olivary Nuc. 2c. Dorsal Accessory Olivary Nuc. 2c. Dorsal Accessory Olivary Nuc.
3. Nucleus Intercalatus3. Nucleus Intercalatus4. Nucleus of Roller4. Nucleus of Roller5. Nucleus Interfascicularis 5. Nucleus Interfascicularis HypoglossiHypoglossi6. Nucleus Conterminalis6. Nucleus Conterminalis
![Page 67: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/67.jpg)
Open MedullaOpen Medulla (Mid-olivary Level)(Mid-olivary Level)
XII. Hypoglossal NerveXII. Hypoglossal Nerve
1. Hypoglossal Nucleus1. Hypoglossal Nucleus
X. Vagus NerveX. Vagus Nerve
2. Nucleus Ambiguus2. Nucleus Ambiguus
3. Dorsal Motor Nucleus of X3. Dorsal Motor Nucleus of X
4. Nucleus Tractus Solitarius4. Nucleus Tractus Solitarius
5. Spinal Tract Nucleus of V5. Spinal Tract Nucleus of V
![Page 68: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/68.jpg)
A. Dejerine’s SyndromeA. Dejerine’s Syndrome
1. pyramidal tract1. pyramidal tract
2. hypoglossal nerve2. hypoglossal nerve
3. medial lemniscus3. medial lemniscus
B. Wallenberg SyndromeB. Wallenberg Syndrome
4. spinothalamic tract4. spinothalamic tract
5. spinal tract of trigeminal nerve5. spinal tract of trigeminal nerve
6. nucleus ambiguus6. nucleus ambiguus
7. 7. descending autonomicdescending autonomic pathwaypathway
Clinical Syndromes Clinical Syndromes
of Open Medullaof Open Medulla
![Page 69: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/69.jpg)
Wallenberg SyndromeWallenberg Syndrome
Spinothalamic tractSpinothalamic tract
- contralateral loss of pain and - contralateral loss of pain and
temperature sensation at the bodytemperature sensation at the body
Spinal tract of trigeminal nerveSpinal tract of trigeminal nerve - ipsilateral loss of pain and - ipsilateral loss of pain and
temperature sensation at the facetemperature sensation at the face
Nucleus ambiguusNucleus ambiguus - dysphageia, dysarthria, hoarseness- dysphageia, dysarthria, hoarseness
DDescending autonomic pathwayescending autonomic pathway
- Horner’s syndrome - Horner’s syndrome
(meiosis, ptosis, anhydrosis)(meiosis, ptosis, anhydrosis)
![Page 70: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/70.jpg)
Open Medulla Open Medulla (Upper Level of Medulla)(Upper Level of Medulla) Open Medulla Open Medulla (Upper Level of Medulla)(Upper Level of Medulla)
TegmentumTegmentum Cranial Nerve NucleiCranial Nerve Nuclei
Inferior Vestibular NucleusInferior Vestibular NucleusDorsal Cochlear NucleusDorsal Cochlear Nucleus
Precerebellar Nuclei Precerebellar Nuclei Nucleus Prepositus HypoglossiNucleus Prepositus Hypoglossi
Reticular FormationReticular FormationGigantocellular Reticular NucleusGigantocellular Reticular NucleusParagigantocellular Reticular NucleusParagigantocellular Reticular NucleusParvocellular Reticular NucleusParvocellular Reticular NucleusRaphe NucleiRaphe Nuclei
Unclassified NucleiUnclassified Nucleiretrofacial, supravestibular nucleus, nucleus interpositusretrofacial, supravestibular nucleus, nucleus interpositus
Tracts: Tracts: stria medullaris of 4th ventriclestria medullaris of 4th ventricle
Basal Part Basal Part - - PyramidPyramid
![Page 71: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/71.jpg)
Cranial Nerve NucleiCranial Nerve Nuclei
1. Nucleus Ambiguus1. Nucleus Ambiguus
2. Nucleus Tractus Solitarius2. Nucleus Tractus Solitarius
3. Spinal Tract Nucleus, 3. Spinal Tract Nucleus,
pars oralispars oralis
4. Medial Vestibular Nucleus4. Medial Vestibular Nucleus
5. Inferior Vestibular Nucleus5. Inferior Vestibular Nucleus
6. Dorsal Cochlear Nucleus6. Dorsal Cochlear Nucleus
Open MedullaOpen Medulla(Upper Level of Medulla)(Upper Level of Medulla)
![Page 72: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/72.jpg)
Open MedullaOpen Medulla(Upper Level of Medulla)(Upper Level of Medulla)
Precerebellar NucleusPrecerebellar Nucleus
1. Inferior Olivary Nuclear Complex1. Inferior Olivary Nuclear Complex 2a. Principal Inferior Olivary Nuc. 2a. Principal Inferior Olivary Nuc. 2b. Medial Accessory Olivary Nuc. 2b. Medial Accessory Olivary Nuc. 2c. Dorsal Accessory Olivary Nuc. 2c. Dorsal Accessory Olivary Nuc.
2. Nucleus Prepositus Hypoglossi2. Nucleus Prepositus Hypoglossi
3. Pontobulbar Body3. Pontobulbar Body
4. Arcuate Nucleus4. Arcuate Nucleus
5. Medial Vestibular Nucleus5. Medial Vestibular Nucleus
6. Inferior Vestibular Nucleus6. Inferior Vestibular Nucleus
![Page 73: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/73.jpg)
Open MedullaOpen Medulla(Upper Level of Medulla)(Upper Level of Medulla)
Reticular FormationReticular Formation 1. Paramedian reticular Nucleus1. Paramedian reticular Nucleus2. Gigantocellular Reticular Nucleus2. Gigantocellular Reticular Nucleus3. paragigantocellular 3. paragigantocellular Reticular NucleusReticular Nucleus4. Parvocellular Reticular Nucleus4. Parvocellular Reticular Nucleus5. Nucleus raphe Obscrus (B5. Nucleus raphe Obscrus (B22))
6. Nucleus Raphe Pallidus (B6. Nucleus Raphe Pallidus (B11))
7. Nucleus Raphe Magnus (B7. Nucleus Raphe Magnus (B33))
Unclassifiied NucleiUnclassifiied NucleiA. Nucleus RetrofacialisA. Nucleus RetrofacialisB. Supravestibular NucleusB. Supravestibular NucleusC. Nucleus Interpositus C. Nucleus Interpositus
![Page 74: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/74.jpg)
IX. glossopharyngeal IX. glossopharyngeal NerveNerve
1. Nucleus Ambiguus1. Nucleus Ambiguus
2. Inferior Salivatory Nucleus2. Inferior Salivatory Nucleus
3. Nucleus Tractus Solitarius3. Nucleus Tractus Solitarius
4. Spinal Tract Nucleus of V4. Spinal Tract Nucleus of V
Open Medulla Open Medulla (Upper Level of Medulla)(Upper Level of Medulla)
![Page 75: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/75.jpg)
Pontomedullary JunctionPontomedullary Junction Pontomedullary JunctionPontomedullary Junction
TegmentumTegmentum Cranial Nerve NucleiCranial Nerve Nuclei
Facial Motor NucleusFacial Motor NucleusVentral Cochlear NucleusVentral Cochlear Nucleus
Precerebellar Nuclei Precerebellar Nuclei Reticular FormationReticular Formation Unclassified NucleiUnclassified Nuclei
nucleus ovalisnucleus ovalis TractsTracts
Basal Part Basal Part - - PyramidPyramid
Cranial Nerve -Cranial Nerve - Vestibulocochlear Nerve (VIII)Vestibulocochlear Nerve (VIII)
Facial Nerve (VII)Facial Nerve (VII)
![Page 76: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/76.jpg)
Cranial Nerve NucleiCranial Nerve Nuclei
1. Facial Motor Nucleus 1. Facial Motor Nucleus
2. Nucleus Ambiguus2. Nucleus Ambiguus
3. Spinal Tract Nucleus, 3. Spinal Tract Nucleus,
pars oralispars oralis
4. Medial Vestibular Nucleus4. Medial Vestibular Nucleus
5. Inferior Vestibular Nucleu5. Inferior Vestibular Nucleu
ss
6. Ventral Cochlear Nucleus6. Ventral Cochlear Nucleus
PontomedullaryPontomedullaryJunctionJunction
![Page 77: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/77.jpg)
PontomedullaryPontomedullaryJunctionJunction
Precerebellar NucleusPrecerebellar Nucleus
1. Principal Inferior1. Principal Inferior Olivary NucleusOlivary Nucleus
2. Nucleus Prepositus2. Nucleus Prepositus HypoglossiHypoglossi
3. Pontobulbar Body3. Pontobulbar Body
4. Arcuate Nucleus4. Arcuate Nucleus
5. Medial Vestibular Nucleus5. Medial Vestibular Nucleus
6. Inferior Vestibular Nucleus6. Inferior Vestibular Nucleus
![Page 78: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/78.jpg)
PontomedullaryPontomedullaryJunctionJunction
Reticular FormationReticular Formation 1. Paramedian reticular Nucleus1. Paramedian reticular Nucleus2. Gigantocellular2. Gigantocellular Reticular NucleusReticular Nucleus3. paragigantocellular 3. paragigantocellular Reticular NucleusReticular Nucleus4. Parvocellular Reticular Nucleus4. Parvocellular Reticular Nucleus7. Nucleus Raphe Magnus (B7. Nucleus Raphe Magnus (B33))
Unclassifiied NucleiUnclassifiied NucleiA. Nucleus InterpositusA. Nucleus InterpositusB. Nucleus OvalisB. Nucleus Ovalis
![Page 79: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/79.jpg)
Lower Pons Lower Pons (Level of Abducens Nucleus)(Level of Abducens Nucleus) Lower Pons Lower Pons (Level of Abducens Nucleus)(Level of Abducens Nucleus)
TegmentumTegmentum Cranial Nerve NucleiCranial Nerve Nuclei
Abducens Nucleus, Main Sensory Nucleus of VAbducens Nucleus, Main Sensory Nucleus of V Nuclei of Auditory PathwayNuclei of Auditory Pathway
Superior Olivary Nuclear ComplexSuperior Olivary Nuclear Complex Reticular FormationReticular Formation
Caudal Pontine Reticular & Subceruleus NucleusCaudal Pontine Reticular & Subceruleus Nucleus TractsTracts
Trapezoid Body, lateral Lemniscus, Trapezoid Body, lateral Lemniscus, Central tegmental TractCentral tegmental Tract
Basal Part: Pons Proper:Basal Part: Pons Proper: Pontine NucleiPontine Nuclei,,Transverse Pontine Fiber, Transverse Pontine Fiber, Longitudinal Pontine Fiber (Pyramidal Tract)Longitudinal Pontine Fiber (Pyramidal Tract)
![Page 80: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/80.jpg)
Lower PonsLower Pons (Level of Abducens Nucleus)(Level of Abducens Nucleus)
Cranial Nerve NucleiCranial Nerve Nuclei
1. Abducens Nucleus1. Abducens Nucleus
2. Main Sensory Nucleus of V2. Main Sensory Nucleus of V
3. Lateral vestibular Nucleus3. Lateral vestibular Nucleus
4. Superior Vestibular Nucleus4. Superior Vestibular Nucleus
Auditory Relay NucleiAuditory Relay Nuclei A. Superior Olivary NucleusA. Superior Olivary Nucleus
B. Nucleus of Trapezoid bodyB. Nucleus of Trapezoid body
![Page 81: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/81.jpg)
Lower PonsLower Pons (Level of Abducens Nucleus)(Level of Abducens Nucleus)
Reticular FormationReticular Formation
1. Gigantocellular1. Gigantocellular
Reticular NucleusReticular Nucleus
2. Caudal Pontine2. Caudal Pontine
Reticular Nucleus Reticular Nucleus
3. Parvocellular 3. Parvocellular
Reticular NucleusReticular Nucleus
4. Nucleus Subceruleus4. Nucleus Subceruleus
![Page 82: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/82.jpg)
VII. Facial NerveVII. Facial Nerve
1. Facial Motor Nucleus1. Facial Motor Nucleus
2. Superior Salivatory Nucleus2. Superior Salivatory Nucleus
3. Nucleus Tractus Solitarius3. Nucleus Tractus Solitarius
4. Spinal Tract Nucleus of V4. Spinal Tract Nucleus of V
VI. Abducens NerveVI. Abducens Nerve
5. Abducens Nucleus 5. Abducens Nucleus
![Page 83: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/83.jpg)
A. Facial PalsyA. Facial PalsyB. A + B. A + decreased salivationdecreased salivationC. A + B + C. A + B + hyperacusishyperacusisD. A + B + C + D. A + B + C + decrased decrased lacrimal secretionlacrimal secretionE. Central Type Facial PalsyE. Central Type Facial Palsy
1. Facial Motor Nucleus1. Facial Motor Nucleus2. Superior Salivatory Nucleus2. Superior Salivatory Nucleus3. Solitary Nucleus3. Solitary Nucleus4. Spinal Tract Nucleus of4. Spinal Tract Nucleus of Trigeminal NerveTrigeminal Nerve
![Page 84: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/84.jpg)
FacialFacial PalsyPalsy
(Bell’s Palsy)(Bell’s Palsy)
Lower MotorLower MotorNeuronNeuron
SyndromeSyndrome
FacialFacial PalsyPalsy
(Bell’s Palsy)(Bell’s Palsy)
Lower MotorLower MotorNeuronNeuron
SyndromeSyndromeTriple W SignTriple W Sign - Wrinkle, Wink, Whistle - Wrinkle, Wink, Whistle
![Page 85: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/85.jpg)
Right facial paralysisRight facial paralysis
FacialFacial Palsy (Bell’s Palsy)Palsy (Bell’s Palsy)
![Page 86: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/86.jpg)
Central TypeCentral TypeFacialFacial PalsyPalsy
Upper MotorUpper MotorNeuronNeuron
SyndromeSyndrome
Central TypeCentral TypeFacialFacial PalsyPalsy
Upper MotorUpper MotorNeuronNeuron
SyndromeSyndromefacial motor nucleus neuronsfacial motor nucleus neuronssupplying forehead musclesupplying forehead muscle
Bilateral Corticobulbar TractBilateral Corticobulbar Tract
![Page 87: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/87.jpg)
AbducensAbducensPalsyPalsy
Lower Motor Lower Motor NeuronNeuron
SyndromeSyndrome
AbducensAbducensPalsyPalsy
Lower Motor Lower Motor NeuronNeuron
SyndromeSyndrome Lateral Gaze ParalysisLateral Gaze Paralysis
![Page 88: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/88.jpg)
Upper Pons Upper Pons (Level of Trigeminal Motor Nucleus)(Level of Trigeminal Motor Nucleus)Upper Pons Upper Pons (Level of Trigeminal Motor Nucleus)(Level of Trigeminal Motor Nucleus)
TegmentumTegmentum Cranial Nerve NucleiCranial Nerve Nuclei
Trigeminal Motor Nucleus,Trigeminal Motor Nucleus,Mesencephalic Tract Nucleus of Trigeminal NerveMesencephalic Tract Nucleus of Trigeminal Nerve
Nuclei of Auditory PathwayNuclei of Auditory PathwayNucleus of Lateral LemniscusNucleus of Lateral Lemniscus
Reticular FormationReticular FormationReticular Tegmental NucleusReticular Tegmental Nucleus
Unclassified NucleusUnclassified NucleusPontine Central Gray: Ch6Pontine Central Gray: Ch6
TractsTractsTrigeminal Nerve FiberTrigeminal Nerve Fiber
Basal Part: Pons ProperBasal Part: Pons Proper
![Page 89: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/89.jpg)
Upper Pons Upper Pons (Level of Trigeminal Motor Nucleus)(Level of Trigeminal Motor Nucleus)
Cranial Nerve NucleiCranial Nerve Nuclei
1. Trigeminal Motor Nucleus1. Trigeminal Motor Nucleus
2. Main Sensory Nucleus of V2. Main Sensory Nucleus of V
3. Mesencephalic Tract3. Mesencephalic Tract
Nucleus of VNucleus of V
4. Superior Vestibular Nucleus4. Superior Vestibular Nucleus
Auditory Relay NucleiAuditory Relay Nuclei A. Nucleus of Lateral LemniscusA. Nucleus of Lateral Lemniscus
![Page 90: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/90.jpg)
Upper Pons Upper Pons (Level of Trigeminal Motor Nucleus)(Level of Trigeminal Motor Nucleus)
Reticular FormationReticular Formation
1. Caudal Pontine1. Caudal Pontine
Reticular Nucleus Reticular Nucleus
2. Nucleus Subceruleus2. Nucleus Subceruleus
3. Reticular Tegemntal3. Reticular Tegemntal
Nucleus of BekhterewNucleus of Bekhterew
(Nucleus Papilloformis of(Nucleus Papilloformis of
Olszewski and Baxter)Olszewski and Baxter)
![Page 91: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/91.jpg)
A. Millard-Gubler SyndromeA. Millard-Gubler SyndromeB. Raymond SyndromeB. Raymond SyndromeC. Foville SyndromeC. Foville SyndromeD. Raymond-Cestan SyndromeD. Raymond-Cestan SyndromeE. Marie-Poix SyndromeE. Marie-Poix Syndrome
1. pyramidal tract1. pyramidal tract2.2. MLFMLF3. 3. medial lemniscusmedial lemniscus4. spinothalamic tract4. spinothalamic tract5. trigeminal motor nucleus5. trigeminal motor nucleus6. main sensory nucleus of V6. main sensory nucleus of V7. spinal tract of trigeminal nerve7. spinal tract of trigeminal nerve8. 8. middle cerebellar pedunclemiddle cerebellar peduncle
Clinical Syndromes Clinical Syndromes of Ponsof Pons
![Page 92: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/92.jpg)
Trigeminal NeuralgiaTrigeminal Neuralgia(tic douloureux)(tic douloureux)
- - excruciating episodic painexcruciating episodic pain
in the area supplied by in the area supplied by
trigeminal nerve, especiallytrigeminal nerve, especially
second and third divisionsecond and third division
- - trigger pointtrigger point
- intense pain makes the- intense pain makes the
patient grimace (tic)patient grimace (tic)
- - antiepileptic drugantiepileptic drug (phenytoin, (phenytoin,
carbamazepinecarbamazepine) is effective) is effective
- surgical treatment- surgical treatment
![Page 93: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/93.jpg)
Lower Midbrain Lower Midbrain (Level of Inferior Colliculus)(Level of Inferior Colliculus) Lower Midbrain Lower Midbrain (Level of Inferior Colliculus)(Level of Inferior Colliculus)
Roof Plate - Roof Plate - Tectum:Tectum: Inferior ColliculusInferior Colliculus
TegmentumTegmentum Cranial Nerve NucleiCranial Nerve Nuclei
Trochlear NucleusTrochlear Nucleus Reticular FormationReticular Formation
Cuneiform, Pedunculopontine, Parabrachial Cuneiform, Pedunculopontine, Parabrachial and Median Raphe (Superior Central) Nucleusand Median Raphe (Superior Central) Nucleus
Unclassified NucleiUnclassified NucleiPeriaqueductal GrayPeriaqueductal Gray
TractsTractsDecussation of Superior Cerebellar PeduncleDecussation of Superior Cerebellar Peduncle
Basal Part Basal Part - - Crus Cerebri,Crus Cerebri, Pons ProperPons Proper
![Page 94: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/94.jpg)
Lower MidbrainLower Midbrain (Level of Inferior(Level of Inferior
Colliculus)Colliculus)
Roof PlateRoof Plate A. Inferior ColliculusA. Inferior Colliculus
Cranial Nerve NucleiCranial Nerve Nuclei
1. Mesencephalic Tract1. Mesencephalic Tract Nucleus ofNucleus of Trigeminal NerveTrigeminal Nerve
2. Trochlear Nucleus2. Trochlear Nucleus
![Page 95: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/95.jpg)
Lower MidbrainLower Midbrain (Level of Inferior(Level of Inferior
Colliculus)Colliculus) Reticular FormationReticular Formation 1. Cuneiform Nucleus1. Cuneiform Nucleus2. Pedunculopontine Nucleus2. Pedunculopontine Nucleus3. Nucleus Locus ceruleus3. Nucleus Locus ceruleus4. Parabrachial Nucleus4. Parabrachial Nucleus5. Dorsal Raphe Nucleus5. Dorsal Raphe Nucleus6. Median Raphe Nucleus6. Median Raphe Nucleus
Unclassified NucleiUnclassified NucleiA. Periaqueductal GrayA. Periaqueductal GrayB. Dorsal Tegmental Nucleus B. Dorsal Tegmental Nucleus of Guddenof GuddenC. Interpeduncular NucleusC. Interpeduncular NucleusD. Parabigeminal NucleusD. Parabigeminal Nucleus
C
6
5
![Page 96: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/96.jpg)
Upper Midbrain Upper Midbrain (Level of Superior Colliculus)(Level of Superior Colliculus) Upper Midbrain Upper Midbrain (Level of Superior Colliculus)(Level of Superior Colliculus)
Roof Plate - Roof Plate - Tectum:Tectum: Superior ColliculusSuperior Colliculus
TegmentumTegmentum Cranial Nerve NucleiCranial Nerve Nuclei
Oculomotor and Edinger-Westphal NucleusOculomotor and Edinger-Westphal Nucleus Reticular Formation - Reticular Formation - Subcuneiform NucleusSubcuneiform Nucleus Precerebellar Nuclei Precerebellar Nuclei
Red NucleusRed Nucleus Unclassified NucleiUnclassified Nuclei
Substantia Nigra, Substantia Nigra, Paranigral, ParalemniscalParanigral, Paralemniscal NucleusNucleusVentral Tegmental Area (VTA)Ventral Tegmental Area (VTA)
TractsTractsBrachium of Inferior ColliculusBrachium of Inferior Colliculus
Basal Part Basal Part - - Crus CerebriCrus Cerebri
![Page 97: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/97.jpg)
Upper MidbrainUpper Midbrain (Level of Superior(Level of Superior
Colliculus)Colliculus)
Roof PlateRoof Plate A. Superior ColliculusA. Superior Colliculus
Precerebellar NucleusPrecerebellar NucleusB. Red NucleusB. Red Nucleus
Cranial Nerve NucleiCranial Nerve Nuclei1. Mesencephalic Tract1. Mesencephalic Tract Nucleus of VNucleus of V2. Oculomotor Nucleus2. Oculomotor Nucleus3. Edinger-Westphal Nucleus3. Edinger-Westphal Nucleus
![Page 98: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/98.jpg)
Upper MidbrainUpper Midbrain (Level of Superior(Level of Superior
Colliculus)Colliculus) Reticular FormationReticular Formation A. Cuneiform NucleusA. Cuneiform NucleusB. Subcuneiform NucleusB. Subcuneiform Nucleus
Unclassified NucleiUnclassified Nuclei1. Periaqueductal Gray1. Periaqueductal Gray2. Paralemniscal Nucleus2. Paralemniscal Nucleus 3. Substantia Nigra3. Substantia Nigra 3a. Pars Compacta3a. Pars Compacta 3b. Pars Reticulata3b. Pars Reticulata4. Paranigral Nucleus4. Paranigral Nucleus5. Ventral Tegmental Area5. Ventral Tegmental Area
![Page 99: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/99.jpg)
Clinical Syndromes Clinical Syndromes of Upper Midbrainof Upper Midbrain A. Weber SyndromeA. Weber SyndromeB. Foix SyndromeB. Foix SyndromeC. Benedikt’s SyndromeC. Benedikt’s SyndromeD. Claude SyndromeD. Claude SyndromeE. Parinaud’s SyndromeE. Parinaud’s Syndrome
1. pyramidal tract1. pyramidal tract2. superior cerebellar peduncle2. superior cerebellar peduncle 3. red nucleus3. red nucleus4. medial lemniscus4. medial lemniscus5. superior colliculus5. superior colliculus6. cerebral aqueduct6. cerebral aqueduct7. MLF7. MLF8. oculomotor nucleus8. oculomotor nucleus
![Page 100: Nabeel Kouka, MD, DO, MBA](https://reader035.vdocuments.site/reader035/viewer/2022062304/56649f3c5503460f94c5b21f/html5/thumbnails/100.jpg)
Weber SyndromeWeber Syndrome
Pyramidal tractPyramidal tract
- contralateral UMN syndrome - contralateral UMN syndrome
at the body and lower faceat the body and lower face
(contralateral hemiparesis)(contralateral hemiparesis)
Oculomotor Nerve Oculomotor Nerve - ipsilateral ocular palsy- ipsilateral ocular palsy
- external strabismus- external strabismus
- mydriasis- mydriasis
- loss of accommodation- loss of accommodation
- normal consensual light reflex- normal consensual light reflex