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What are the three parts of the basilar part of the pons
- pontine nuclei
- transverse fibers (ponto-cerebellar)
- longitudinal tracts
where is the pontine nuclei
scattered among longitudinal and transverse fibers
what does the pontine nuclei form
important part of cortico-ponto-cerebellar pathway
where does the transverse (pontocerebellar fibers begin
from pontine nuclei
what is the pathway for the transverse fibers (pontocerebellar)
cross to the opposite cerebellar hemisphere via middle cerebellar peduncle
what are the three fibers in the longitudinal tract of the pons
- cortico spinal pyramidal fibers
- crotico-bulbar pyramidal fibers
- cortico-pontine fiber
where do cortico pontine fibers arise from
cerebral cortex
where do cortico pontine fibers end
pontine nuclei
what five cranial nerve nuclei are found in the tegmentum of the pons
- trigeminal nerve nuclei
- abducent nerve nucleus
- facial nerve nucleus
- vesticulo-cochlear nerve nuclei
- superior olivary nucleus
what do the axons of the motor nucleus of the trigeminal nerve join
mandibular nerve
where is the motor nucleus of the trigeminal nerve
medial in the pons
wehre is the main sensory nucleus of the trigeminal nerve
lateral to the motor nucleus
what affernts does the main sensory nucleus of the trigeminal nerve recieve
touch and pressure from trigeminal area in face and scalp
what are the efferent for the main sensory nucleus of the trigeminal nerve
cross to join opposite trigeminal lemniscus
where is the abducent nerve nucleus
posterior aspect of lower part of pons (floor of fourth ventricle)
what encircles the abducent nerve nucleus
- fibers of facial nerve raising a bulge called facial colliculus in floor of 4th ventricle.
what are the efferents for the abducent nerve nucleus
sends efferent fibers forward and downwards traversing medial lemniscus and pyramid to emerge anteriorly at the junction between pons and medulla
what is the position of the motor nucleus for the facial nerve
lower part of pons below trigeminal motor nucleus
what are the efferents from the motor nucleus of the facial nerve
encercles abducent nucleus
wher eis the superior salivary nucleus of the facial nerve
lower part of the pons just above inferior salivary nucleus
what are the efferent fibers for the superior salivary nucleus
in facial nerve as preganglionic parasympathetic fibers to relay in the sphenopalatine and submandibular ganglia
where is the vestibular nucleus
inferior part of pons, medial to inferior cerebellar peduncle underlying vestibular trigone in floor of 4th ventricle
what are the affernts for the vestibulo nucleus
unconscious proprioception (equilibrium) from inner ear via vestibular nucleus
what are the the three effferents of the vestibular nucleus
- cerebellum via vestibulo-cerebellar fibers
- spinal cord via vestibulo-spinal fibers
- Med longitudinal bundle (associateve
what is the position of the chochlear nucleus
lower part of pons dorsal and ventral to inferior verebellar peduncle
what are the afferents for the choclear nucleus
hearing impulses from inner ear via cochlear nerve
what are the efferents for the cochlear nucleus
efferents for trapezoid body
what is the tract of the tegmentum and where does it run
- tectospinal tract which crosses the midline of the tegmentum forming forsal tegmental decussation
what are the four lemnisci of the tegmentum
- medial lemniscus
- trigeminal lemniscus
- spinal lemniscus
- lateral lemniscus
what forms the medial lemniscus
gracile and cuneate tracts
what forms the trigeminal lemniscus
sensory nucleus trigeminal
what forms the spinal lemniscus
lateral and ventral spinothalamic tract
what forms the lateral lemniscus
ascending cochlear fibers
what is the 2nd order neuron of the medial lemniscus
medulla, internal arcuate fibers, cross forming sensory decussation
what is the 2nd order neuron for the trigeminal lemniscus
cross, ascend in med lemniscus add fibers from MSN trigeminal of opposite sige
what are the second order neurons for the speinal lemniscus
SGR + nucleus prprius cross forming spinal lemniscus
what are the second order neurons for the lateral lemniscus
- cochlear nucleus, cross forming trapezoid body, ascend lateral lemniscus
what is the function of the medial lemniscus
proprioception and fine touch on the opposite side below head
what is the fucntion of the trigeminal lemniscus
pain, temp and touch opposite side of head
what is the function of hte lateral lemniscus
pain, temp, touch on the opposite sife below the head
what is the function of the lateral lemniscus
hearing, both ears (more common on the opposite side)
where does the medial lemniscus end
ascend to the PLVNT
where does the trigeminal lemniscus end
ascends to PMVNT
where does the spinal lemniscus end
ascend to PLVNT
where does the lateral lemniscus end
- most end in medial geniculate body which is the 4th order nueurone that transmits teh auditory impulses to auditory areas 41 and 42 in teh temporal lobe
- some fibers end in teh inferior colliculus of midbrain
what is the inferior colliculus of the midbrain used for
center of auditory reflexes
what is the medial longitudinal bundle
ascending and descending associated and coordinative tract in all levels of the brain stem
what is the position of the medial longitudinal bundle
posterior part of the brain stem close to cranial nerve nuclei
what does the medial longitudinal bundle end as
spinal cord as anterior intersegmental tracts
what are the three afferents of the medial longitudinal bundle
- vestibular nuclei
- nuclei of lateral lemniscus
- superior collculus
what are the efferents for the medial longitudinal bundle
- all extraocular muscles supplied by (3, 4, 6 CN)
- spinal accessory N (11)
- Hypolossal nerve (12)
what are the 6 main function so fthe medial longitudinal bundle
- controls synergistic or cordniated movements of eyes
- adjusts eye position in response to movements of the head
- vestibular reflex function
- auditory reflex function
- associative internuclear
- extra pyramidal
what is medial pontine syndrom called
- raymond syndrom
- foville syndrome
what is the cause of pontine syndrome
occlusion of paramedian branches of basilar artery
what 7 things are damaged in medial pontine syndrome
- corticospinal fibers
- medial lemniscus
- abducent nerve
- Facial nerve or nucleus
- ventral/ lateral spinothalamic fibers
- trigeminal nerve
- reticular formation
what does damage to corticospinal fibers in basilar pons cause
contralateral hemiplegia in upper and lower limbs and trunk
what does damage to the medial lemniscus cause
contralateral loss of proprioception in the upper and lower limbs and trunk
what does damage to abducent nerve or nucleus cause
ipsilateral lateral rectus paralysis and diplopia
what doe sdamage to the facial nerve or nucleus cause
ipsilateral paralysis of facial muscles
what does ventral/lateral fiber damage cause
contralateral loss of pain and temp and crude touch in upper and lower limbs and trunk
what does damage to trigemnial nerve in pons cause
ipsilateral paralysis of facial muscles of mastication and ipsilateral los of pain and temp to face
what does damage to reticular formation in paramedian pontine area cause
paralysis of conjugate gaze towards the size of lesion
what is lateral pontine syndrom also called
- gubler syndrom
- millard guber syndrom
what is the cause of lateral potine syndrome
occlusion of the long circumferential branches of basilar artery
what are the 8 things damaged in lateral pontine syndrome
- coricospinal fibers
- trigeminal cranial nerve
- middle and superior cerebellar peduncles
- VII and VII (vestibular and cochlear) nerves and nuclei
- spinal trigeminal tract and nucleus
- descending hpothalamospinal fibers
- ventral or lateral spinothalamic fibers
- reticular formation
what does damage to the middle and superior cerebellar peducncles (caudal and cranial) levels
ataxia, unsteady gait, falls toward side of lesion
what does damage to cranial nerves 7 and 8 cause
vertigo, nausea, deafness, tinnitus and vomiting
what does damage to the descending hypothalamospinal fibers cause
ipsilateral horners syndrom
what deso damage to the spinal trigeminal tract and nucleus cause
ipsilateral loss of pain and temp from face
what is middle alternating hemiplegia
a combination of corticospinal lesion on one side of the body + cranial nerve motor lesion on the opposite side and same level of the lesion
what is midpontine base syndrome
a combination of basilar pontine lesion and trigeminal root leasion
what is the most common tumor of the pons
astrocytoma in childhood
what are the 9 things damaged in astrocytoma of the pons
- facial nerve nucleus
- abducent nerve nucleus
- vestibular nerve nucleus
- trigeminal nerve nucleus
- cholear nucleus
- corticospinal fibers
- main sensory sensory nucleus of trigeminal nerve
- medial and spinal lemniscus
- corticopontocerebellar tract
what are the main symptoms of astrocytoma of the pons
ipsilateral cranial nerve paralysis and crontralateral hemipareisis
what does damage to corticospinal fibers cause
contralateral hemiparesis or quadriparesis
what doe damage to the main sensory nucleus of the trigeminal nerve cause in astrocytoma of pons
loss of fine touch and proprioception on the face, spinal nucleus of trigeminal is intact so pain on teh face is intact
what does damage to the corticopontocerebellar tract cause
- ipsilateral cerebellar manifestations
what three arteries can be damaged in a pontine hemorrhage
- basilar
- anterior inferior cerebellar
- superior cerebellar
what three things are damaged in a unilateral pontine hemorrhage
- facial n nucleus
- corticospinal fibers
- abducent nerve nucleus
- medial longitufdinal bundle
what does damage to the abducent nerve nucleus and medial longitudinal budle cause
paralysis of conjugate ocular deviation
what are the three structures damaged in a bilateral pontine hemorrhage
- ocular sympathetic fibers
- facial nerve + corticospinal fibers
- damage to heat regulating centers in hypothalamus
what are the three symptoms of bilateral pontine hemorrhage
- pinpoint pupils
- bilateral paralysis of face and limb mucles
- poikilothermia
what is the main cause of pontine infacrtion
- thrombosis or embolism in basilar artery or its branches
what three things are damaged in a medial pontine infarct
- corticospinal tract
- pontine nucleus
- middle cerebellar peduncle fibers
what four things are damaged in a lateral pontine infarct
- trigeminal nerve
- medial lemniscus
- middle cerebellar meduncle
- corticospinal fibers to limbs
what are the three things damaged in a lesion in the cerebellopointne angle
- facial nerve
- vestibulocochlear nerve
- cerebellar peduncles
what is damage in a lesion in the dorsal part of the (7)
- four lemnisci
- motor nuclei of cranial nerves 5, 6, 7
what two things are damaged in a lesion in the basilar part of the pons
- pyramidal fibers (UMN)
- Abducent nerve (LMN)
what are the two symptoms of lesion in basilar part of pons
- contralateral hemiplegia and paralysis of lateral recutus muscle on same side causing medial squint
what are the two symptoms of lesion in dorsal part of pons
- loss of all sennsations on opposite side including face
- LMN paralysis in muscles supplied by cranial nerves 5, 6, 7
what are the symptoms of lesion in cerebellopontine angle (5)
- facial paralysis of motor, parasympthetic and taste on same side
- deafness and disturbed equilibrium on same side
- ataxia and cerebellar manifestations
what are the symptoms of lateral infarct of pontine
- weakness in the muscles of mastication
- contralateral loss of proprioception in the upper and lower limb and trunk
- ipsilateral cerebellar manifestation, ataxia, nystagmus and tendcy to fall o fipsilateral side
- contralateral muscle paralysiss
what are the symptoms of medial pontine infarct
- contralateral muscle paralysis
- cranial nerve 5-8 damage
- ipsilateral cerebellar manifestations, ataxia, nystagmus and tendency to fall on ipsilateral side