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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