Anatomy of brain stem and associated lesions:

PONS and MIDBRAIN

Brain stem
• Underneath the limbic system is
the brain stem.
• This structure is responsible for
basic vital life functions such as
breathing, heartbeat, and blood
pressure.
• The brain stem is made of
– Midbrain
– Pons
– Medulla.

Pons
• Forepart of the hind-brain
• Situated in front of the
cerebellum
• Behind and below, the
pons is continuous with
the medulla oblongata,
but is separated from it in
front by a furrow in which
the abducent, facial, and
acoustic nerves appear.
• Associated with cranial
nerves:
– Trigeminal (V)
chewing
– Abducens (VI) movement of eyeballs
– Facial (VII)- facial expression; secretion of saliva and tears
– Vestibulcochlear (VIII) –balance, equilibrium, hearing
Ventral or Anterior surface of pons
• Basilar sulcus
– Midline sulcus occupied by basilar artery
• Transverse running fibres on the surface: pontocerebellar fibres
which continues as Middle cerebellar peduncle.
• Trigerminal nerve emerge at lateral part of pons

Dorsal or Posterior surface of Pons

• Hidden by cerebellum
• Bounded laterally by superior cerebellar
peduncle
• Median sulcus in the midline
• Facial colliculus
– Paramedian elevation raised by
underlying abducent nerve covered by
winding fibres of facial nerve.
• Trochlear nerve

Internal structure of pons

• Basilar or ventral portion
Contains both longitudinal and transverse
fibers intermixed with pontine nuclei
• Dorsal tegmental portion Continuation of the
reticular formation of the medulla oblongata
• Structures present at the level of facial
nucleus.
• CN VI nucleus – Abducens nerve
• CN VII nucleus – Facial nerve Pontine nuclei
Project to cerebellum
• CN VIII – Vestibular Nuclei Continuation of
Pure sensory location lateral arcuate nuclei (over
pyramids)
 • Structures present at the level of
facial nucleus.
• CN VI nucleus – Abducens nerve
• CN VII nucleus – Facial nerve • Level of
facial nucleus
• CN VIII – Vestibular Nuclei (CN VII)
– Pure sensory location lateral

CN VIII – Vestibular Nuclei

Balance

4th ventricle

Connection of pons to cerebellum

Restiform body (inf. cerebellar
peduncle)
Middle cerebellar peduncle

Medial lemniscus Ascending 2nd

order sensory neurons

Descending upper motor neurons

CN VI nucleus = Abducens nerve

“somatic efferent” nerve that controls the
movement of a single muscle, the lateral rectus
muscle of the eye.
Abduction of eye

CN VII nucleus – Facial nerve

controls the muscles of facial expression, and
functions in the conveyance of taste sensations
from the anterior two-thirds of the tongue and oral
cavity
 Internal structure of pons
• Structures present at the level of middle
cerebellar peduncle.
• Medial lemniscus •Level of middle cerebellar peduncle
• Lateral lemniscus
• Trapezoid body
• Trigerminal nucleus (sensory and
motor)
• Pontine nuclei

At the level of mid pons 4th

ventricle
Lateral Medial
lemniscus lemniscus
fibers from
dorsal column
Middle cerebellar
peduncle

Trapezoid body – transverse

fibers in pontine tegmentum

Trigerminal
tract

The pontine nuclei are a part of the pons which

store the memory of intention during motor
activity
Corticospinal
tract,
corticobulbar
tract,
corticopontine
fibers
 Cranial Nerve of the Mid Pons
4th
CN V ventricle
Motor
trigeminal
nucleus Trigerminal
fascicles
Principal
trigerminal
Sensory
nucleus

Trigerminal
nerve

•Level of locus ceruleus

Internal structure of pons
• Structures present at the level of upper
pons
• MLF
• Superior cerebellar peduncle
• Locus ceruleus
• Parabrachial nucleus
• Pediculopontine nucleus
 4th
ventricle
Upper Pons
Periaqueductal gray
matter MLF

Locus
ceruleus Decussation

Superior
cerebellar
peduncle
Descending
upper motor
neurons
Transverse ponto-
cerebellar fibers

Midbrain
•
• Landmarks
• Cerebral peduncles
• Optic chiasm
• Interpeduncular fossa
• (Superior colliculi)
• (Inferior colliculi)
• (Superior cerebellar peduncle)
• Cranial Nerves
• III, IV
• Midbrain is divided at the level of
cerebral aqueduct into
• Dorsal portion called tectum which
largely consists of inferior and superior
colliculi
• Ventral portion, known as tegmentum
External Structure of Midbrain
• Optic chiasm 1
• Interpeduncular fossa 2
• Oculomotor nerve (CN III) 3
• Trochlear nerve (CN IV) 4
• Pons 5
• Cerebral peduncles (crus cerebri) 6

Cranial Nerves of the Midbrain

• Anterior exit
• CN III (1)
• CN VI (5)
• Posterior exit
• CN IV (2)
• MLF - Medial longitudinal fasciculus (7)
• Vestibular nuclei (6)
• Pons (3)

Internal divisions of
midbrain
• Tegmentum is bounded ventrally by the
massive fibre system of the crus cerebri
• The term cerebral peduncle is sometimes
used as a synonym for crus cerebri
• Cerebral peduncle refers to the whole
midbrain on either side excluding the tectum
• Ventral to the colliculi the cerebral aqueduct
runs the length of the midbrain
• Surrounding the aqueduct is a pear shaped
arrangement of grey matter called periaqueductal grey
 Substantia nigra
• These neurones project to the caudate nucleus and
putamen of the basal ganglia in the forebrain
• Degeneration of the pars compacta of the substantia nigra
is associated with Parkinson’s disease
• Other non pigmented subdivision of the substantia nigra is
called the pars reticulata
• Pars reticulata is considered to be a functional homologue
of the medial segment of the globus pallidus which is also
part of the basal ganglia

Internal Structure of Midbrain

• Cross section at the level of inferior
colliculus
• CN IV Trochlear nerve
• MLF
• Dorsal raphe nucleus •Level of inferior colliculus
• Substantia nigra
• Mesencephalic nucleus of V

Lower Midbrain
Cerebral
Mesencephalic nucleus of V aqueduct
analogous to dorsal root
ganglion
but within CNS Inferior
colliculus
CN IV
Trochlear nerve

MLF
Substantia
nigra
Basis
peduncularis
Crus
cerebri
(cerebral
peduncle)
Caudal part of
midbrain
• In the caudal part of the midbrain
the inferior colliculus constitutes
part of the ascending acoustic
projection
• Ascending auditory fibres run in
the lateral lemniscus which
terminates in the inferior colliculus
• Efferent fibres from the colliculus
terminate in the medial geniculate
nucleus of the thalamus
• This nucleus projects to the
auditory cortex of the temporal lobe

Internal Structure of
Midbrain
• Cross section at the level of superior
colliculus:
• Medial geniculate body •Level of superior colliculus
• Superior colliculus
• Crus cerebri (cerebral peduncle)
• Red nucleus –Controls arm movement
• Substantia nigra
 Superior
colliculus
Upper midbrain

Medial geniculate
body Substantia
hearing nigra

Red nucleus – relay from cortex

and cerebellum to spinal cord,
inferior olive, reticular
formation, cerebellum Crus
Controls arm movement cerebri
(cerebral
peduncle)

Cranial Nerves of Upper Midbrain

CN III Oculomotor
nucleus

Edinger Westfal nucleus

Parasympathetic to ciliary MLF
ganglion
Pupillary sphincter ciliary
muscles
Rostral part of midbrain
• The superior colliculus of the
rostral area of the midbrain is
part of the visual system
• Its main afferents are
corticotectal fibres originating
from the visual cortex of the
occipital lobe and from the
frontal eye field of the frontal
lobe
• These inputs are concerned with
controlling movements of the
eyes

Pontine hemorrhage
• Pons supplied by basilar artery, anterior,
inferior and superior cerebellar arteries.
• If hemorrhage is unilateral
– Facial paralysis on the side of lesion
(facial nerve nucleus)
– Paralysis of limbs on opposite side
(corticospinal fibres)
– Paralysis of conjugate ocular deviation
(abducent nerve nucleus)
• If bilateral
– Pinpoint pupils (ocular sympathetic fibres)
– Bilateral paralysis of face and limbs
– poikilothermia

Tumors of pons
• Astrocytoma of pons, most common tumor of brainstem

Blockage of cerebral aqueduct

• Cerebral aqueduct is one of the narrowest part of
ventricular system.
• In congenital hydrocephalus, or tumors of midbrain,
aqueduct may be blocked which blocks the flow of CSF.