Download Brainstem \(III\) 講義 2017 [相容模式]

Brainstem (III)
李立仁 副教授
解剖學暨細胞生物學科
[email protected]
Brainstem (II)
General Arrangement
Brainstem (III)
Cranial nerves and nuclei
Branchial motor nerves --- BE (5, 7, 9, 10, 11)
Motor neurons that
innervate the branchial
structures
Often referred as special
visceral efferent (SVE)
Brainstem (III) Cranial nerves and nuclei
Branchial motor nerves
Branchial efferent (5, 7, 9, 10, 11)
Brainstem (III) Cranial nerves and nuclei
Trigeminal motor nucleus (V)
Branchial motor nerves
Brainstem (III) Cranial nerves and nuclei
Trigeminal motor nucleus (V)
Branchial motor nerves
Brainstem (III) Cranial nerves and nuclei
Branchial motor nerves
Mesencephalic trigeminal
nucleus (V)
Jaw-jerk
reflex
Brainstem (III) Cranial nerves and nuclei
Facial motor nucleus (VII)
Branchial motor nerves
Brainstem (III) Cranial nerves and nuclei
Branchial motor nerves
Facial motor nucleus (VII)
Belly’s palsy
hyperacusia
Brainstem (III) Cranial nerves and nuclei
Blink reflex
When cornea is touched by a
foreign object, both eyes blink.
Cornea is covered V1 branches
Afferents enter the spinal
trigeminal tract and form
synapse on the interneuron in
the spinal trigeminal nucleus.
The interneuron send axon to a
reticular neuron that projects
bilaterally to facial motor
neurons that control the eyelid
of both sides.
Branchial motor nerves
Brainstem (III) Cranial nerves and nuclei
Branchial motor nerves
Nucleus ambiguus (IX, X)
(X)
(IX)
(X)
Brainstem (III) Cranial nerves and nuclei
Accessory nucleus (XI)
Branchial motor nerves
Brainstem (III)
Cranial nerves and nuclei
Visceral motor nerves --- GVE (3, 7, 9, 10)
Preganglionic neurons
in the parasympathetic
system
Brainstem (III) Cranial nerves and nuclei
Visceral motor nerves
Edinger-Westphal nucleus (accessory nu. of oculomotor nerve)
Contains preganglionic parasympathetic neurons
- pupilary light reflex
- receives inputs from pretectal nucleus
- project to the ipsilateral ciliary ganglion, postganglionic neurons
innervate pupillary sphincter and
ciliary muscle
Brainstem (III) Cranial nerves and nuclei
EdingerWestphal
nucleus (III)
Cell bodies of the
postganglionic
neurons :
Ciliary ganglion
Visceral motor nerves
Brainstem (III) Cranial nerves and nuclei
Edinger-Westphal nucleus
Visceral motor nerves
Brainstem (III) Cranial nerves and nuclei
Superior salivatory nucleus (VII)
Visceral motor nerves
Brainstem (III) Cranial nerves and nuclei
Superior
salivatory
nucleus (VII)
Cell bodies of the
postganglionic
neurons :
Submandibular
ganglion
Pterygopalatine
ganglion
Visceral motor nerves
Brainstem (III) Cranial nerves and nuclei
Superior salivatory nucleus (VII)
Visceral motor nerves
Brainstem (III) Cranial nerves and nuclei
Inferior salivatory nucleus (IX)
Visceral motor nerves
Brainstem (III) Cranial nerves and nuclei
Inferior
salivatory
nucleus (IX)
Cell bodies of the
postganglionic
neurons :
Otic ganglion
Visceral motor nerves
Brainstem (III) Cranial nerves and nuclei
Dorsal motor nucleus of
vagus nerve (X)
Visceral motor nerves
Brainstem (III) Cranial nerves and nuclei
Dorsal motor nucleus of
vagus nerve (X)
Visceral motor nerves
Brainstem (III) Cranial nerves and nuclei
Dorsal motor
nucleus of
vagus nerve (X)
Cell bodies of the
postganglionic
neurons :
Within the target
tissues
Visceral motor nerves
Brainstem (III)
Cranial nerves and nuclei
Somatic sensory nerves --- SSA
Hearing (VIII),
balance (VIII)
and vision (II)
Brainstem (III) Cranial nerves and nuclei
Somatic sensory nerves
Special sensory afferents (8)
Cochlear (VIII) --- hearing ; Vestibular (VIII) --- balance
Brainstem (III) Cranial nerves and nuclei
Cochlear (VIII) --- hearing
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Cochlear (VIII) --- hearing
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Vestibular (VIII) --- balance
Somatic sensory nerves
Brainstem (III)
Cranial nerves and nuclei
Somatic sensory nerves --- GSA (5, 7, 9, 10)
Brainstem (III) Cranial nerves and nuclei
Somatic sensory nerves
Trigeminal nerve (V)
two components : larger sensory and smaller motor
emerge from
rostrolatetral pons
Brainstem (III) Cranial nerves and nuclei
Nuclei of trigeminal nerve
Main trigeminal sensory nucleus (V)
Mesencephalic trigeminal nucleus (V)
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Somatic sensory nerves
Nuclei of trigeminal nerve
Spinal trigeminal nucleus (V, VII, IX, X)
Brainstem (III) Cranial nerves and nuclei
Nuclei of trigeminal nerve
Main trigeminal sensory
nucleus (V)
- proprioception and
touch of face
Mesencephalic trigeminal
nucleus (V)
- proprioception
- jaw-jerk reflex
Spinal trigeminal nucleus
(V, VII, IX, X)
- pain and temperature
of face
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Trigeminal
nerve (V)
Cell bodies of the
general somatic
sensory afferents :
Trigeminal ganglion
Mesencephalic
trigeminal nucleus
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Main trigeminal sensory nucleus (V)
Central processes of primary afferents
with cell bodies in the trigeminal ganglion
(1st order) terminate in the main sensory
nucleus of the trigeminal nerve.
Axons of 2nd neurons cross the midline,
join the medial lemniscus, and ascend to
the ventral posteromedial nucleus (VPM)
of the thalamus.
3rd neurons in VPM in turn project to the
face area of the postcentral gyrus.
Touch and proprioception of face
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Spinal trigeminal nucleus (V, VII, IX, X)
Primary afferents with cell bodies in
the trigeminal ganglion (1st order)
descend through the spinal trigeminal
tract and terminate in caudal part of
the spinal trigeminal nucleus.
Axons of 2nd neurons cross the midline,
join the spinothalamic tract and ascend
to the ventral posteromedial nucleus
(VPM) of the thalamus.
3rd neurons in VPM in turn project to
the face area of the postcentral gyrus.
Pain and temperature of face
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Facial nerve (VII)
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Facial nerve (VII)
Cell bodies of the
general somatic
sensory afferents :
Geniculate ganglion
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Glossopharyngeal nerve (IX)
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Glossopharyngeal
nerve (IX)
Cell bodies of the
general somatic
sensory afferents :
Superior ganglion
of IX
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Vagus nerve (X)
Somatic sensory nerves
Brainstem (III) Cranial nerves and nuclei
Vagus nerve (X)
Cell bodies of the
general somatic
sensory afferents :
Superior ganglion
of X
Somatic sensory nerves
Brainstem (III)
Cranial nerves and nuclei
Visceral sensory nerves
--- GVA (7, 9, 10)
--- SVA (7, 9, 10)
Brainstem (III) Cranial nerves and nuclei
Visceral sensory nerves
Nucleus of solitary tract
-- receives general and special visceral afferents
solitary
tract
Brainstem (III) Cranial nerves and nuclei
Facial nerve (VII)
Visceral sensory nerves
Brainstem (III) Cranial nerves and nuclei
Glossopharyngeal nerve (IX)
Visceral sensory nerves
Brainstem (III) Cranial nerves and nuclei
Vagus nerve (X)
Visceral sensory nerves
Brainstem (III)
Brainstem damages
Medial medullary
Syndrome –
Ant. spinal a.
Lateral medullary
syndrome –
Post. Inf. cerebellar a.
Medial inferior
pontine syndrome –
Basilar a.
Medial midbrain
syndrome –
Post. cerebral a.
Brainstem (III)
Brainstem damages
Medial medullary Syndrome –
Occlusion :
Ant. spinal a.
Affected areas / symptom :
corticospinal tract / contralateral hemiparesis
medial lemniscus / contralateral loss of tactile
hypoglossal nerve / tongue deviates toward the
affected side
Brainstem (III)
Brainstem damages
Lateral medullary
(Wallenberg’s) syndrome –
Occlusion :
Post. Inf. cerebellar a.
Affected areas / symptom :
spinal trigeminal tract / ipsilateral loss of pain and
temperature (face)
spinothalamic tract / contralateral loss of pain and
temperature (below neck)
nu. ambiguus / ipsilateral pharyngeal, laryngeal and
palatal hemiparalysis
Brainstem (III)
Brainstem damages
Medial inferior pontine
syndrome –
Occlusion :
Basilar a.
Affected areas / symptom :
corticospinal tract / contralateral hemiparesis
abducens nerve / ipsilateral lateral rectus paralysis
(medial strabismus)
Brainstem (III)
Brainstem damages
Medial midbrain
(Weber’s) syndrome –
Occlusion :
Post. cerebral a.
Affected areas / symptom :
corticospinal tract / contralateral hemiparesis
corticobulbar fibers / contralateral weakness of lower
face (VII), tongue (XII) and palate (X)
oculomotor nerve / paralysis of 4 extraocular
muscles and levator palpebrae superioris (lateral
strabismus and ptosis), dilation of pupil