1. Brain Stem Anterior View Posterior View 3 4 9,10,11 5 Adducent
Facial colliculus
7 & 8th 12
Striae Medullare

2. Medulla Oblongata
Nuclei in the medulla are associated w/ autonomic control, cranial nerves, and motor/sensory relay.
Autonomic nuclei:
Cardiovascular centers
Cardioinhibitory/cardioacceleratory centers alter the rate and force of cardiac contractions
Vasomotor center alters the tone of vascular smooth muscle
Respiratory rhythmicity centers
Receive input from the pons
Additional Centers
Emesis, deglutition, coughing, hiccupping, and sneezing

3. Medulla….

4. Medulla Sagittal Section And Cranial Nuclei

5. Cranial Nuclei

6. Section of Medulla

7. Section of Medulla At the level of Pyramid

8. Medullary syndromes
Medial
Lateral medullary syndromes

9. Medial Medullary Syndrome
Cranial Nerves
Tongue Paralysis -Hypoglossal Nerve
Motor Pathways
Contralateral Spastic Paralysis -- Pyramids
Sensory Pathways
Contralateral loss Fine Touch and Proprioception -- Medial Lemniscus
Alternating hemiplegia

10. Deviation of Tongue to affected side Atrophy of Tongue Muscles
Hypoglossal
Palsy
Lower Motor
Neuron
Syndrome
Deviation of Tongue to affected side
Atrophy of Tongue Muscles

11. Lateral medullary syndrome (Wallenberg's syndrome)
This is the commonest of the brain stem strokes. Involvement of the spinothalamic tract results in contralateral loss of pain and temperature sensation below the neck.
Involvement of the descending nucleus and tract of V results in loss of pain and temperature sensation on the face ipsilateral to the lesion.

12. Lateral medullary syndrome
Involvement of descending autonomic fibers results in an ipsilateral Horner's syndrome (ptosis, meiosis, and anhidrosis). Involvement of the nucleus ambiguus causes palatal weakness and dysphagia.
Involvement of the inferior cerebellar peduncle (restiform body) causes ipsilateral ataxia.
Alternating hemianaesthesia

13. Brain stem Anterior view

14. Brain stem Posterior view

15. Section of Pons at the level of Facial colliculus

16. Section of pons at the level of trigeminal nuclei

17. Vestibular component of VIII Nerve

18. Cochlear component of VIII Nerve

19. Pontine syndromes Medial pontine Syndrome
Sign
Contralateral spastic hemiparesis of the body
Contralateral loss of position and vibration of the body
Medial strabismus
Raymond's Syndrome
Alternating abducent hemiplegia
Miller-gubler syndrome
Alternating Facial hemiplegia.
Structures Associated
CST
Medial lemniscus
6th nerve fibers
7th nerve fibres

20. Lateral pontine syndrome
Structure
ICP
Spinal 5
Spinothalamic
Fibers of 7
Fibers of 8
Sign
Ipsilateral limb ataxia
Ipsilateral pain and temp loss - Face
Contralateral pain and temp-Body
Horner’s syndrome (Ipsilateral)
Hearing loss
Ipsilateral facial paralysis

21. Section of Mid Brain at Inferior colliculus

22. Section of Mid Brain at superior colliculus

23. At Superior colliculus

24. Ventromedial Superior Midbrain Syndrome (Weber’s Syndrome)
Contralateral
paralysis of face, arm and leg
Ipsilateral
III palsy (fascicular)
Artery
paramedian perforators of terminal basilar, or
peduncular perforating branches of posterior cerebral artery

25. Paracentral (Tegmental) Superior Midbrain Syndromes (Claude’s and Benedikt’s syndromes)
Contralateral
ataxia with tremor (red nucleus) ± hemichorea (subthalamic nucleus)
Ipsilateral
III fascicular palsy
Artery
paramedian perforators of terminal basilar, or
interpeduncular branches of Posterior Cerebral Artery

26. Dorsal Superior Midbrain Syndrome (Parinaud’s, of Sylvian Aqueduct)
Paralysis of upgaze ± convergence
Light/near dissociation
Eyelid retraction
Convergence/retraction nystagmus
Artery - posterior choroidal/quadrigeminal
(Note - usually not vascular)

27. “Top of the Basilar” Syndrome
Usually due to embolic occlusion
Posterior Cerebral Artery cortical territory infarction (unilateral or bilateral)
hemianopia/cortical blindness
amnesia
Basilar/Posterior Cerebral Artery thalamic/midbrain territory infarction
impairment of ocular movements (e.g. skew deviation, vertical gaze palsies)
pupillary abnormalities (various)