1. Brain stem section
國防醫學院生解科
授課教師: 黃雍協

4. Brain stem components Ascending tract Descending
Fiber connecting with the cerebellum
Cranial nuclei and nerve
Integrative center---reticular formation
(monoaminergic neuron)
dopamine, catecholamine, and serotonin

5. Ascending tracts Descending tracts Fibers connecting with cerebellum
spinothalamic tract (STT)
Medial lemniscus system
Spinocerebellar tract (dorsal and ventral) ICP and SCP
spinal trigeminal tract
Descending tracts
Tectospinal tract
Rubrospinal tract
Reticulospinal tract
Vestibulospinal tract; Medial longitudinal fasciculus
Corticospinal tract
Central tegmental tract
Fibers connecting with cerebellum
cerebellar peduncles (superior, middle and inferior)
superior cerebellar peduncle decussation

6. Cranial nuclei and nerve
7個功能模組 延腦包括全部
一般體感覺(GSA) (from skin and muscle)
一般內臟感覺(GVA)(頸部以下的內臟)
特殊體感覺(SSA)(視聽平)
特殊內臟感覺(SVA) (嗅味)
一般體運動(GSE) (CN 3,4,6,11,12)
一般內臟運動(GVE) (CN 3,7,9,10)
特殊內臟運動(SVE)(咽弓發育而來的頭頸部骨骼肌) (CN 5, 7, 9, 10)

7. Cranial nuclei 7個運動核 oculomotor nu.and trochlear nu. in the midbrain
trigeminal motor nu. in the pons
facial motor nu and abducens nu. at the potomedullary junction
ambiguus and hypoglossal nu. in the medulla
4個副交感神經核(CN3,7,9,10)
Edinger-Westphal nu. Superior salvatory nu. Inferior salvatory nu. and
Dorsal nu. of vagus
4種感覺核(主要在延腦)
Trigeminal nu. (GSA)
Solitary nu.(GVA) (rostal part is the gustatory nu. (SVA)) in the medulla
two cochlear nu. (SSA) in the medulla
Four vestibular nu. (SSA) in the potomedullary junction

8. Blue—sensory nu.
Red---motor nu.

9. Cranial nuclei and nerve

11. 6. Upper pons: SCP, locus ceruleus, M5T
Anatomy of the brain stem (external features and larger internal structures).
1.Spinomedullary junction: S5N, pyramidal descussion
    2. Closed medulla:   Pyramidal decussation                                   (at the most caudal level)                                  Internal arcuate fibres                                   (at a more rostral level)    3.Open medulla:     Inferior olivary nucleus    4. Lower pons:   Abducens nucleus                                Fibres of facial nerve    5.  Mid-pontine level:   Trigeminal nerve, Pontine nuclei                                 Medial lemniscus
6. Upper pons: SCP, locus ceruleus, M5T
    7. Caudal midbrain(下丘):   Decussation of superior                                        cerebellar peduncles     8. Rostral midbrain(上丘):   Red nucleus                                    Oculomotor nerve

12. Close medulla (Caudal medulla)23
Close medulla (Caudal medulla)
Sensory nu. and tract
Nucleus gracilis (2) Nucleus cuneatus(3) Fasciculus gracilis(23) Fasciculus cuneatus(4) Internal arcuate fibers(19)
Lateral (accessory) cuneate nucleus (5)
S5N(6) and S5T(7)
Solitary tract and nucleus(21)
Motor nu.
Hypoglossal nucleus(17) and nerve(18)
Dorsal motor nucleus of X (1)
vagus nerve fibers(20)
Nucleus ambiguus(10)
Ascending tract
ML(15)
ALS(9)
Reticular formation
Raphe nu.(14)
Tracts
Pyramid(13)
Other
MLF(16)
Posterior spinocerebellar tract (8)
Anterior spinocerebellar tract (11)
Inferior olivary nu.(12)

13. Open medulla (Rostal medulla)
Sensory nu. and tract
Nucleus cuneatus (7) Lateral cuneate nucleus (8)
Internal arcuate fibers(14)
S5T(24) and S5N (25)
Solitary nucleus(5) and solitary tract (6) Inferior vestibular nucleus (26) Medial vestibular nucleus(27)
Motor nu
Hypoglossal nucleus (3) and nerve (15)
Dorsal motor nucleus of X (4) and fiber(13)
Nucleus ambiguus(11)
Ascending tracts
Medial lemniscus(18) ALS(12) PSCT entering the ICP(10)
ASCT(23)
Tract: pyramid(16)
Central tegmental tract (21)
Medial longitudinal fasciculus (MLF) (2)
Other:
Raphe magnus nu. (17)
Inferior olivary nu.(medial accessory nu. (19), (principal nu. 20, dorsal accessory nu. 22)
Olivocerebellar fibers
Inferior cerebellar peduncle(9) (includes dorsal spinocerebellar and cuneocerebellar trs.)

14. Lower pons Sensory nu. Solitray nu. and tract(9)
Spinal trigeminal nu. (11)
Superior olivary nu.(22)
Lateral vestibular nu.(26)
Medial vestibular nu.(28)
Motor nu.
abducens nu.(5) and fiber (8)
facial motor nu. (23) and nerve(25)
internal genu of facial n.(29)
Reticular formation
raphe magnus nu. (4)
Ascending tracts
Spinal trigeminal nu. and tract(10 and 11)
(S5N & S5T, 10,11)
ML(20)
ALS(14)
LL(13)
Trapezoid body(19)
Tract
CST, CBT, CPT(16)
Other:
MLF(3)
CTT(21)
SCP (6)
MCP (2)
ICP (7)
pontine nu, (18)

15. Mid-pons 22 Sensory nu. SCP Trigeminal main sensory nu. (6)
and trigeminal nerve(10)
M5N and M5T(5)[mesencephalic]
Superior vestibular nu.(20)
Superior olivary nu.(16)
Motor nu.
Trigeminal motor nu.(7)
Reticular formation
Superior central nu.(19)
Ascending tracts:
ML(9)
ALS(8)
Trapezoid body(14)
LL(17)
ASC(4)
Tract:
MLF(2), CTT(15), Pyramidal(12)
Pontocerebellar fiber(11)
SCP
Other:
SCP(3)
MCP (18)
Anterior spinocerebellar tract(4)
Pontine nu.(13)
Superior medullary velum (22)

16. Upper pons 1 2 5 Motor: Trochlear decussation (1) Sensory: M5N and M5T
(mesencephalic nu. and tract)(2)
Reticular formation
Locus ceruleus (3)
Dorsal raphe nu. (4)
PAG (periaqueductal gray)(5)
around 4th ventricle
Basal pons:
Pontine nu. (6)
Pontocerebellar fibers (7)
Descending system (8)
Corticospinal, corticobulbar, cortireticular, cortiopontine 13 3 4 11 12 14 10 9 7 6 8
Ascending tracts:
Medial lemnicus (9)
spinal lemnicus (10)
lateral lemnicus(11)
Other tracts:
MLF (12)
SCP (13)
central tegmental tract (14)

17. Caudal midbrain--inf. colliculus level
Sensory nu:
Inferior colliculus (5)
M5N and M5T (15)
Motor nu.:
Trochlear nu (3) and fiber (4)
Substantia nigra (10)
Reticular formation
Dorsal raphe nu(2)
PAG (16)
Ascending tract
ML (8)
ALS (7)
LL (6)
Cerebral peduncle: (9) descending tract:
corticospinal, corticobulbar(and corticoreticular)
Corticopontine(位在兩側)
Other:
Central tegmental tract(13)
MLF(14)
decussation of SCP(11)(cerebello-rubro
thalamic pathway)
Pontine nu. (12)
Cerebral aqueduct(1)

18. Rostal midbrain—sup. colliculus level
Sensory nu:
Superior colliculus (3)
M5N and M5T(4)
Motor nu:
Oculomotor nu.(18) and nerve(11)
EW nu.
Substantia nigra(compact part,9)
(reticular part, 10)
Red nu.(15)
Ascending tract
ML(7)
ALS(6)
Brachium of inferior colliculus (5)
Cerebral peduncle(8)
MLF(16)
CTT(17)
Reticular formation
PAG(2)
Other:
Ventral tegmental area(13)

19. Special somatic sensory nu.
Four vestibular nu.
Two cochlear nu.
                                             
The level of Cranial Nerve VIII and IX looks a lot like a butterfly. “Neuroanatomy: An Atlas of Structures, Sections, and Systems.” (Haines 117). 
The level of Cranial Nerve VIII and IX looks a lot like a butterfly. “Neuroanatomy: An Atlas of Structures, Sections, and Systems.” (Haines 117). 

21. Reticular formation Monoamergic system
dopamine, serotonin and noradrenalin
Pain inhibitory center
periaqueductal gray

22. Dopaminergic neurons

23. Serotonergic
neurons

24. Noradrenergic neurons

25. Pain inhibitory
pathway