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Key Points of Lectures Study Notes

Lectures 8 - 10 additional study notes: Brain Stem (Medulla, Pons and Midbrain)

External Morphology Be able to identify the following structures on pictures, diagrams or models of the brain
The main parts and boundaries that separate them medulla, pons & midbrain
Be able to recognize and identify the following structures on the brain stem

Pyramidal decussation a slanting cleft on the ventromedial surface

Pyramids paired bulges on the ventromedial surface
Olives bulges on the ventrolateral surface
Gracile tubercles paired bulges on the dorsomedial surface
Cuneate tubercles paired bulges on the dorsal surface, not on the midline
Fourth ventricle changes shape throughout the brainstem; from the obex it gradually widens to lateral recess,
then closes down rostrally to form the cerebral aqueduct
Choroid plexus only formed in lateral ventricles, third ventricles and over the medulla where the roof is
formed by the cerebellum
Hypoglossal trigone small mounds in the midline formed by hypoglossal nuclei on the floor of the fourth
Vagal trigone small mounds formed by vagal nuclei lateral to hypoglossal trigone
Vestibular area mounds on the floor and sides of the fourth ventricle overlying the vestibular nuclei
Pons large basal bulge that is widest at mid-pons level, and thickest (dorso-ventrally) in the rostral pons
Inferior cerebellar peduncles form large shoulders on the dorsolateral surface
Middle cerebellar peduncles massive structures on the lateral surface with cerebellum attached dorsally
Superior cerebellar peduncles form roof over the fourth ventricle, separated by thin superior medullary velum
Inferior colliculi -- more egg shaped, rounder than superior colliculi
Superior colliculi wide, slightly flattened bulges on the dorsal surface over aqueduct

[See text book or a brain atlas for figures]
In cross sections of the brainstem be able to identify their levels based on the following landmarks. See
blackboard for figures



Spinal cord Central canal Gracile tubercle Decussation of

medullary junction pyramids

Caudal medulla Obex of IV Hypoglossal trigone Decussation of


Mid medulla Open IV choroid Hypoglossal and Inferior cerebellar Pyramids

plexus Vagal trigones, peduncle, Olive
vestibular area

Rostral medulla Wide IV, lateral Vestibular area Inferior cerebellar Pyramids
recess, choroid peduncle, Olive

Caudal pons Closed IV Cerebellum Pons attached to Base of pons

cerebellum by
middle and inferior

Mid pons Narrowing IV Superior cerebellar Middle cerebellar Base of pons very
peduncles, superior peduncle wide
medullary velum,
facial colliculus

Rostral pons Isthmus, IV merges Decussation of Pons large and

with aqueduct trochlear nerve thick

Caudal midbrain Aqueduct Inferior colliculi Cerebral peduncles Interpeduncular


Rostral midbrain Aqueduct Superior colliculus Cerebral peduncles, Interpeduncular

may be lateral fossa
merging of
midbrain to

Cranial Nerves:

Know the location of the cranial nerves on the brain stem and their names
Which three cranial nerves are purely sensory in function?

Which five cranial nerves are purely motor in function

What are the numbers and names of the four mixed cranial nerves

Be able to identify the cranial nerve nuclei in the table above on cross sections of the brain stem.
Also be able to locate the following fiber tracts

Fasciculus cuneatus and faciculus gracilus;

arcuate fasciculus; medial lemniscus.

Corticospinal and corticobulbar tracts;

pyramidal tracts.

Transverse pontine fibers;

Inferior, middle and superior cerebellar peduncles