Medulla oblongata

Medulla oblongata
 Lower part of brainstem.
 Contains central canal in the lower part
and its upper part contains IV ventricle.
 Presents pyramids on either side of the
midline anteriorly (formed by corticospinal
tracts on their way to spinal cord) and
olive produced by underlying inferior
olivary nucleus.
Gross features

On the back of medulla

are gracile and cuneate
tubercles which contain
nuclei of the same
name(2nd order neurons)
for the fasciculi of the same
name.
Fasciculus gracilis and F.cuneatus
 F.gracilis (tract of Goll) is the medial of the
two. Carries fine touch, vibration and
conscious proprioception from the lower
part of the body.
 F. cuneatus (tract of Burdach) is lateral to
the above tract and carries same
sensations from the upper part of the
body.
 Tabes dorsalis
 Tertiary syphilitic degeneration of posterior
white columns which only sensory tracts.
 There is loss of tactile discrimination,
vibration and position sense.
 structure
 The characteristic appearance of grey
matter in spinal cord is lost in medulla.
 The grey matter contains the nuclei of last
four cranial nerves and reticular formation.
 For the arrangement of grey and white
matters medulla is studied at 3 levels.
 Medulla at the level of pyramidal
decussation
 Important features are:
 1.Spinal nucleus and tract
of V in line with the
posterior horn of spinal
cord.
 2.Pyramidal
decussation(75%of fibers
cross the midline and
descend to the cord as
lat.corticospinal tracts.
 continued
 3.corresponding to
the anterior horn is
the spinal nucleus of
accessory.
 4.diffuse zone of
nerve cells and fibers
corresponding to the
lateral white column
called the reticular
formation. The reticular formation
SPECIAL FEATURES OF V nerve
 Has a large sensory nucleus (V1,V2 and
V3) and a smaller motor nucleus.
 Hence it extends throughout the brain
stem (mesencephalic nucleus, principal
nucleus and spinal tract and nucleus).
 Perhaps the only cranial nerve nucleus to
do so.
Medulla at the level of sensory decussation

 Fasciculi gracilis and

cuneatus end in
corresponding nuclei.
 Second order neurons
begin as internal arcuate
fibres,cross the midline
and form the medial
lemniscus.
 Olivary nucleus makes its
appearance.
 Pyramids on either side
of midline.
Sensory decussation
 continued
 Central grey matter
(close to the central
canal) contains
 1.hypoglossal nucleus
(close to the midline)
 2.dorsal nucleus of
vagus
(parasympathetic)
 3.nucleus of tractus
solitarius (taste)
 Purely motor cranial nerves
 3rd,4th,6th and 12th
cranial nerves lie in
the same line and
have their nuclei
close to the midline of
the brain stem.
 continued
 4.MLF appears just posterior to medial
lemniscus (this is connected to
3rd,4th,6th,8th and spinal nucleus of XI)
 Spinocerebellar and lateral spinothalamic
tracts move laterally to the lateral white
column.
 Lateral and anterior spinothalamic tracts
lie close to each other and form “spinal
lemniscus”.
 Upper medulla (open part)
 central canal opens
into IV ventricle.
 along with XII,
vestibular nuclei(2 of
the 4) appear here.
 nucleus ambiguus
(common motor
nucleus for 9th,10th
and 11th cranial
nerves) is present.
Medulla (clinical aspects)
Cranial nerves IX, X, XI and XII originate from
the medulla.

Functions of the medulla include:

1) control of somatic motor reflexes
of the larynx, pharynx and tongue
which are important in speech and
swallowing. (nucleus ambiguus)

2) control of visceral motor reflexes,

e.g., coughing, swallowing, salivating,
vomiting, secretion, sneezing;
the medulla also receives taste and other
visceral sensations.
 3) the MLF contains fibers for the
regulation of the position of the head and
neck and for coordinated eye movements;
 4) the medulla is a relay for the cochlear
and vestibular responses;
 5) the reticular formation regulates a
variety of functions including skeletal
motor activity, consciousness, visceral
functions, conduction of sensation, etc.
The features of medullary syndromes reflect
its anatomy and physiology, i.e., the
ascending sensory tracts, the descending
motor systems, cranial nerves IX - XI
exiting at this level, and the cranial nerves
that are associated at or near this level,
viz., CN VIII
 Lateral medullary syndrome
(PICA) of Wallenberg
 Dorsolateral aspect of
medulla is supplied by
PICA.
 In this area
spinothalamic tract,
spinal nucleus and
tract of V, nucleus
ambiguus, inferior
cerebellar peduncle,
vestibular nuclei are
situated.
Effects

Inferior cerebellar peduncle
Spinal tract of trigeminal
Spinothalamic tract
Nucleus ambiguus
Ipsilateral ataxia; also vertigo
from interruption of
connections of vestibular
nuclei
Loss of pain and
temperature sensation,
same side of face
Loss of pain and
temperature sensation,
opposite side of the body
Paralysis of vocal cord and
pharyngeal muscles on the
side of the lesion
 Medial medullary syndrome
(hypoglossal alternating hemiplegia)
 Due to thrombosis of
vertebral artery
branches supply
paramedian regions
of medulla.
 Structures present
here are: pyramid,
hypoglossal nerve,
medial lemniscus.

Effects
pyramid Contralateral hemiplegia

Hypoglossal Ipsilateral paralysis and

nucleus atrophy of half of tongue
(when protruded, the tip
deviates to the same side of
lesion)

Medial Contralateral loss of

lemniscus position and vibration sense