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Concept of brain stem
by 生解科 黃雍協
腦幹內含 7 modalities, upper motor neuron, reticular formation
腦幹的顱神經包含有 7 個 components (modality)
4 種二級感覺核 (GSA, GVA, SVA, SSA)
3 種下運動神經元 (GVE, GSE, SVE)
腦幹切面的 level (可用第 4 腦室的空間大小判斷, open medulla 為最大的空間)
位在腦幹內的感覺核均為 2 級感覺神經元(M5T 例外), 基本上這些感覺核均位在 tegmental area 的外側
面
SSA (vestibular nu., cochlear nu.) (聽覺及平衡覺)
GSA (gracil nu., cuneate nu., lateral cuneate, trigeminal nu.)
GVA (solitary nu.)
SVA (rostral part of solitary nu.) (味覺)
Secondary
sensory
neuron
Spinal cord
medulla
Lower pons
Mid pons
Upper pons and
midbrain
Tract cells
Nucleus thoracic
1. Gracile nu.
2. Cuneate nu.
3. Lateral cuneate nu.
4. Spinal trigeminal nu.
Superior
olviary nu.
Trigeminal
main sensory
nu.
Mesencephalic
trigeminal nu.
(M5T)(primary
sensory neuron)
(S5T)
5. Solitary nu. and tract
6. Cochlear nu.(dorsal
and ventral)
7. Vestibular nu. (sup.
inf. med. and lat.)
腦幹下運動神經元, 基本上這些下運動神經元位在 tegmental area 的腹側面
GVE (CN.3,7,9,10)(parasympathetic preganglionic neuron)(E-W nu.
superior salivatory nu.
salivatory nu. DMN of X )
SVE (CN. 5,7,9,10 頭部、上消化道、上呼吸道的骨骼肌)(Trigeminal motor nu.
inferior
Facial motor nu.
Ambiguus nu.)
GSE(CN. 3, 4, 6, 11, 12)(CN11 視為脊髓頸段) (oculomotor nu. Trochlear nu.
Abducens nu.
Hypoglossal nu.) (GSE 的 neuron 均為在腦幹第 4 腦室正下方中央的位置)
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Spinal cord
Lower
motor
neuron
Medulla
Lower pons
Middle pons
Midbrain
Trigeminal motor nu.
E-W nu.
Ventral horn
Ambiguus nu.
Abducens nu.
(lamina 8, 9)
DMN of X.
Hypoglossal nu.
Facial motor nu.
Ascending tracts
(To thalamus
or to cerebellum)
ALS(or
spinothalamic tract)
(whole brain stem)
DC-ML (Dorsal
column-medial
lemnicus) internal
Oculomotor nu.
Trochlear nu.
DSCT
(to ICP)
VSCT
(to SCP)
Tapezoid body
Lateral lemniscus
arcuate fiber)(whole
brain stem)
Gracile fasciculus
Descending tracts
MLF(medial
longitudinal
fasciculus)(雙向)
Cuneate fasciculus
Tectospinal tract
(whole brain stem)
CTT (central
tegment tract)(雙向)
(whole brain stem)
(whole brain stem)
Upper motor neuron
Vestibular nu.
Sup. Colliculus
Red nu.
Pyramid (CST,
CBT, CPT)
Pyramidal
decussion
Reticular nu.
Inf. Colliculus
Reticular formation
Neurotransmitter
Raphe nu.
(brain
stem)
Ceruleus nu.
(upper pons)
(serotonin) (norepinephrine )
與小腦連繫的核及神經徑
ICP (inferior cerebellar pedicle)
MCP (middle cerebellar pedicle)
SCP (superior cerebellar pedicle)
SCP decussation
Pontine nucleus
Inferior olivary nu.
Pontocerebellar fiber
Olivocerebellar fiber
2
Substantia nigra
Compact part and
reticular part
(midbrain)
VTA
(midbrain)
PAG
(midbrain)
(dopamine)
(dopamine)
(enkephalin)
Check list of brain stem
Close medulla
Spinal trigeminal nu. (S5T)
Decussation of pyramids
Gracile nu.
Cuneate nu.
Lateral cuneate nu.
internal arcuate fiber
medial lemniscus (ML)
Open medulla
Hypoglossal nu. and hypoglossal nerve
DMN of X
Ambiguus nu.
Solitary nu. and tract
Spinal trigeminal nu. (S5T)
6. Cochlear nu.(dorsal and ventral)
7. Vestibular nu. (sup. inf. med. and lat.)
ICP (inferior cerebellar pedicle)
MLF
ML
Lower pons
Facial motor nu.
Abducens nu.
facial nerve
abducens nerve
superior olivary nu.
trapezoid body
vestibular nu. (superior)
corticospinal tract
3
Mid-pons
Trigeminal main sensory nu.
Trigeminal motor nu.
Trigeminal nerve
Superior olviary nu.
Mesencephalic trigeminal nu. and tract
MLF
ML
corticospinal tract
SCP
MCP
pontine nu.
Rostal pons
M5N, M5T
locus ceruleus
MLF
SCP
CTT
ML
ALS
LL
Midbrain-inferior colliculus
Trochlear nu.
MLF
superior cerebellar peduncle descussation
Midbrain-superior colliculus
Oculomotor nu.
oculomotor nerve
E-W nu.
PAG
red nu.
substantia nigra
raphe neuron
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