Pons

The base of the pons (basis pontis) contains three

components:
fiber bundles of the corticospinal tracts, pontine
nuclei that have received input from the cerebral
cortex by way of the corticopontine pathway,
pontocerebellar fibers from the pontine nuclei,
which cross and project to cerebellum by way of the
large middle cerebellar peduncle.

Along the midline of the pons and part of the

medulla lie the raphe nuclei.

Serotonin-containing neurons in these nuclei project
widely to the cortex and hippocampus, basal ganglia,
thalamus, cerebellum, and spinal cord.

These cells are important in controlling the level of

arousal and modulate the sleepwake cycle.

They also modulate sensory input, particularly for
pain

Caudal pons

Caudal pons

Tegmentum

The lower pons contains the nucleus of nerve VI

(abducens nucleus) and the nuclei of nerve VII (the

facial, superior salivatory, and gustatory nuclei).
The branchial motor component of the facial nerve
loops medially around the nucleus of nerve VI.
The upper half of the pons harbors the main sensory
nuclei of nerve V

Mid pons

medial lemniscus assumes a different position (lower

body, medial; upper body, lateral)

the spinothalamic tract courses even more laterally
as it travels through the pons.

Rostral pons

The central tegmental tract contains descending

fibers from the midbrain to the inferior olivary

nucleus and ascending fibers that run from the brain
stem reticular formation to the thalamus, and runs
dorsolateral to the medial lemniscus.
The tectospinal tract (from midbrain to cervical
cord) and the medial longitudinal fasciculus are
additional components of the pontine tegmentum.

Rostral pons- near pons-midbrain junction

Middle cerebellar peduncle

The middle cerebellar peduncle is the largest of the

three cerebellar peduncles. It contains fibers that

arise from the contralateral basis pontis and end in
the cerebellar hemisphere.

Auditory system
The auditory system from the cochlear nuclei in the

pontomedullary junction includes fibers that ascend

ipsilaterally in the lateral lemniscus
It also includes crossing fibers (the trapezoid body)
that ascend in the opposite lateral lemniscus.

A small superior olivary nucleus sends fibers

into the cochlear division of nerve VIII as the

olivocochlear bundle
this pathway modifies the sensory input from the
organ of Corti in the cochlea

Trigeminal pathway
The three divisions of the trigeminal nerve

project to the brain stem.

Fine touch function is relayed by the main sensory
nucleus
pain and temperature are relayed into the
descending spinal tract of V

proprioceptive fibers form a mesencephalic tract

and nucleus in the midbrain.

The second-order neurons from the main sensory
nucleus cross and ascend to the thalamus.

The descending spinal tract of V sends fibers to the

pars caudalis (the spinal nucleus in the medulla), the

pars interpolaris (a link between trigeminal afferent
components and the cerebellum), and the pars oralis.

The masticatory nucleus, which is medial to the

main sensory nucleus, sends branchial efferent fibers

into the mandibular division of nerve V to innervate
most of the muscles of mastication and the tensor
tympani of the middle ear.

Brainstem syndromes
Name of Syndrome

Site of Lesion

Clinical Features

Medial medullary
syndrome

Ventromedial medulla,
including pyramid and
axons of hypoglossal
nerve

Ipsilateral hypoglossal
palsy with contralateral
hemiplegia/hemiparesis,
contralateral impairment
of sense of position and
movement+tactile
discrimination

Wallenberg's syndrome
Site of Lesion

Clinical Features

Lateral medulla (territory of

posterior inferior cerebellar artery),
including the vestibular nuclei
inferior cerebellar peduncle,
nucleus ambiguus, spinal
trigeminal tract and nucleus,
spinothalamic tract, and fibers
descending to preganglionic
sympathetic neurons

Vertigo, ataxia, paralysis of the

ipsilateral palate and vocal cord,
loss of pain and thermal sensation
on the same side of face and
opposite side of body, ipsilateral
Horner's syndrome, and loss of
facial sweating

Foville syndrome
Site of lesion
Dorsomedial pons,
including abducens
nucleus, facial motor
nucleus and axons, dorsal
to the descending motor
fibers

Clinical features
Ipsilateral lower motor
neuron facial paralysis,
ipsilateral conjugate gaze
paralysis, and transient
contralateral hemiparesis