系统解剖 英文版 神经系统 脑干Brain stem

1、学习方法学习方法q看外形，想内部，内外结合。看外形，想内部，内外结合。q看断面，想立体，上下串联。看断面，想立体，上下串联。q记重点，莫贪多，整理表格。记重点，莫贪多，整理表格。Gross Appearance of Brain Stem Gross Appearance of Brain StemqMedulla oblongata Attached to the 9th to 12th cranial n.Divided into an open(superior) and a closed (inferior) partqPonsAttached to 5th to 8th crania

2、l n.Divided into the basilar part and tegmentumqMidbrainAttached to the 3rd and 4th cranial n. Divided into the cerebral peduncle and tectum Ventral Surface of Medulla oblongata qPyramid 锥体锥体 Composed of bundles of nerve fiber, called pyramidal tract 锥体束锥体束 qDecussation of pyramid 锥体交叉锥体交叉 Formed by

3、 crossing fibers of pyramidal tract qOlive 橄榄橄榄 Produced by underlying inferior olivary nucleus 下橄榄核下橄榄核qAnterolateral sulcus 前外侧沟前外侧沟 Emerge the roots of hypoglossal nerve qRetroolivary sulcus 橄榄后沟橄榄后沟 Emerge the roots of glossopharyngeal, vagus and accessory nerves Dorsal Surface of Medulla oblong

4、ata qLower portionGracile tubercle 薄束结节薄束结节 produced by underlying gracile nucleus 薄束核薄束核Cuneate tubercle 楔束结节楔束结节produced by underlying cuneate nucleus 楔束核楔束核Inferior cerebellar peduncle 小脑下脚小脑下脚Obex 闩闩qUpper portion: forms the lower half of rhomboid fossa菱形窝菱形窝 Ventral Surface of PonsqBulbopontine

5、 sulcus 延髓脑桥沟延髓脑桥沟 There emerge, from medial to lateral, the abducent, facial and vestibulocochlear nervesqBasilar part 基底部基底部Basilar sulcus 基底沟基底沟qMiddle cerebellar peduncle 小脑中脚小脑中脚qTrigeminal nerve 三叉神经三叉神经 Emerges from the junction of basilar part and middle cerebellar peduncleqPontocerebellar t

6、rigone 脑桥小脑三角脑桥小脑三角 The junction of medulla, pons and cerebellum Dorsal Surface of PonsqForms the superior half of rhomboid fossa菱形窝菱形窝qSuperior cerebellar peduncle 小脑上脚小脑上脚qSuperior medullary velum 上髓帆上髓帆qTrochlear nerve 滑车神经滑车神经 Ventral Surface of MidbrainqCrus cerebri 大脑脚底大脑脚底qInterpeduncular fos

7、sa 脚间窝脚间窝 Oculomotor nerve emerges on the medial side of crus cerebriqPosterior perforated substance 后穿质后穿质 Dorsal Surface of MidbrainqSuperior colliculus 上丘上丘 Constitute the centers for visual reflexesqInferior colliculus 下丘下丘 Associated with auditory pathwayqBrachium of superior colliculus 上丘臂上丘臂q

8、Brachium of inferior colliculus 下丘臂下丘臂Fourth ventricle 第四脑室第四脑室q Position situated ventral to cerebellumdorsal to pons and cranial half of medullaqBoundariesFloor: Rhomboid Fossa 菱形窝菱形窝RoofCentral canal fourth ventricle mesencephalic aqueductthird ventricleRhomboid Fossa 菱形窝菱形窝Boundaries qInferolate

9、ral: gracile and cuneate tubercles, inferior cerebellar peduncleqSuperolateral: superior cerebellar peduncleqLateral recessRhomboid Fossa 菱形窝菱形窝 Features qStriae medullares 髓纹髓纹qMedian sulcus 正中沟正中沟qSulcus limitans 界沟界沟qVestibular area 前庭区前庭区 Overlying vestibular nucleiqAcoustic tubercle 听结节听结节 Over

10、lying dorsal cochlear nucleusqMedial eminence 内侧隆起内侧隆起qFacial colliculus 面神经丘面神经丘 Overlying nucleus of abducent n. and genu of facial nerveRhomboid Fossa 菱形窝菱形窝qHypoglossal triangle 舌下神经三角舌下神经三角 Overlies hypoglossal nucleus qVagal triangle 迷走神经三角迷走神经三角 Overlies dorsal nucleus of vagus nerveqFuniculu

11、s separans 分隔索分隔索qArea postrema 最后区最后区qLocus ceruleus 蓝斑蓝斑 Bluish-gray in color, it owes its color to a group of deeply pigmented nerve cellsRoof of Fourth ventricleqAnterior part: Formed by superior cerebellar peduncle小脑上脚小脑上脚 and superior medullary velum 上髓帆上髓帆qPosterior part: Formed by inferior m

12、edullary velum 下髓帆下髓帆 and Tela choroidea of fourth ventricle 第四脑室脉络丛第四脑室脉络丛qThree aperturesMedian aperture of fourth ventricle 第四脑室正中孔第四脑室正中孔Lateral apertures of fourth ventricle（2） 第四脑室外侧孔第四脑室外侧孔Communication of Fourth ventriclethird ventricle mesencephalic aqueductfourth ventricleCentral canalPost

13、erior median apertureLateral aperturesSubarachnoid spaceTela choroidea and choroid plexus脉络丛和脉络组织脉络丛和脉络组织Internal structure of the brain StemqGray matterCranial nerve nuclei 脑神经核脑神经核 Non-cranial nerve nuclei 非脑神经核非脑神经核qWhite matterqReticular formation of brain stem 脑干网状结构脑干网状结构qCentral canal Cranial

14、 nerve nuclei 脑神经核脑神经核 Cranial nerve nuclei 脑神经核脑神经核 qGeneral somatic motor (efferent) nuclei (GSE)一般躯体运动核一般躯体运动核Supply striated musculature of the orbit and tongue qSpecial visceral motor (efferent) nuclei (SVE)特殊内脏运动核特殊内脏运动核To branchial arch musculature of face, jaws, palate larynx and pharynx. qG

15、eneral visceral motor (efferent) nuclei (GVE)一般内脏运动核一般内脏运动核Give rise to the cranial parasympathetic system qGeneral visceral sensory (afferent) nuclus (GVA)一般内脏感觉核一般内脏感觉核Receive stimuli from visceral territoryqSpecial visceral sensory (afferent) nuclus (SVA)特殊内脏感觉核特殊内脏感觉核Receive stimuli from taste b

16、udsqGeneral somatic sensory (afferent) nuclei (GSA)一般躯体感觉核一般躯体感觉核Receive stimuli from skin and mucous membranes of oronasofacial region, and dura materqSpecial somatic sensory (afferent) nuclei (SSA)特殊躯体感觉核特殊躯体感觉核Receive balance and hearing stimuli from inner earSSAGSASVAGVAGVESVEGSECranial nerve nu

17、cleiGeneral somatic motor nuclei 一般躯体运动核一般躯体运动核qNucleus of oculomotor n.动眼神经核动眼神经核-IIIqNucleus of trochlear n. 滑车神经核滑车神经核-IVqNucleus of abducent n. 展神经核展神经核-VIqNucleus of hypoglossal n.舌下神经核舌下神经核-XII General somatic motor nuclei 一般躯体运动核一般躯体运动核qNucleus of oculomotor n.动眼神经核动眼神经核-IIIqNucleus of trochl

18、ear n. 滑车神经核滑车神经核-IVqNucleus of abducent n. 展神经核展神经核-VIqNucleus of hypoglossal n.舌下神经核舌下神经核-XII NucleusSite Cranial n.FunctionNucleus of oculomotor n.Midbrain superior colliculiSupreior, inferior, and medial recti, inf. obliquus, levator palpebrae superiorisNucleus oftrochlear n.Midbrain inferior co

19、lliculiSuperior obliquusNucleus of abducent n.Pons, facial colliculusLateral rectusNucleus of hypoglossal n.MedullaMuscles of tongue General somatic motor nucleiGeneral somatic motor nuclei 一般躯体运动核一般躯体运动核 Special visceral motor nuclei 特殊内脏运动核特殊内脏运动核qMotor nucleus of trigeminal n. 三叉神经运动核三叉神经运动核-VqNu

20、cleus of facial n. 面神经核面神经核-VIIqNucleus ambiguus 疑核疑核-IX、X、XIqAccessory nucleus 副神经核副神经核-XI Special visceral motor nuclei 特殊内脏运动核特殊内脏运动核qMotor nucleus of trigeminal n. 三叉神经运动核三叉神经运动核-VqNucleus of facial n. 面神经核面神经核-VIIqNucleus ambiguus 疑核疑核-IX、X、XIqAccessory nucleus 副神经核副神经核-XISpecial visceral motor

21、 nuclei 特殊内脏运动核特殊内脏运动核 Special visceral motor nucleiNucleusSiteCranial n.FunctionMotor nucleus of trigeminal n.PonsMasticatory muscles, anterior belly of digastric, mylohyoid, tensor tympani Nucleus of facial n.PonsFacial m., platysma, posterior belly of digastric, stylohyoid, stapediusNucleus ambig

22、uusMedulla, Skeletal m. of pharynx, larynx and upper part of esophagusAccessory nucleusMedulla C1-5/6Sternocleidomastoid, trapezius General visceral motor nuclei 一般内脏运动核一般内脏运动核qAccessory oculomotor nucleus 动眼神经副核动眼神经副核-IIIqSuperior salivatory nucleus 上泌涎核上泌涎核-VIIqInferior salivatory nucleus 下泌涎核下泌涎核

23、-IXqDorsal nucleus of vagus n. 迷走神经背核迷走神经背核-XGeneral visceral motor nuclei 一般内脏运动核一般内脏运动核qAccessory oculomotor nucleus 动眼神经副核动眼神经副核-IIIqSuperior salivatory nucleus 上泌涎核上泌涎核-VIIqInferior salivatory nucleus 下泌涎核下泌涎核-IXqDorsal nucleus of vagus n. 迷走神经背核迷走神经背核-X General visceral motor nucleiNucleusSiteC

24、ranial n.FunctionAccessory oculomotor nucleusMidbrainSphincter pupillae and ciliary m.Superior salivatory nucleusPonsSubmandibular, sublingual and lacrimal glandsInferior salivertory nucleusMedullaParotid glandDorsal nucleus of vagus n.medullaMany cervical, thoracic and abdominal viscera Visceral se

25、nsory nuclei ( general and special ) qNucleus of solitary tract 孤束核孤束核 -VII、IX、X Visceral sensory nuclei ( general and special )NucleusSiteCranial n.FunctionNucleus of solitary tractMedulla,Taste and visceral sensation General somatic sensory nuclei一般躯体感觉核一般躯体感觉核qMesencephalic nucleus of trigeminal

26、n. 三叉神经中脑核三叉神经中脑核-VqPontine nucleus of trigeminal n. 三叉神经脑桥核三叉神经脑桥核-VqSpinal nucleus of trigeminal n. 三叉神经脊束核三叉神经脊束核-VGeneral somatic sensory nuclei一般躯体感觉核一般躯体感觉核qMesencephalic nucleus of trigeminal n. 三叉神经中脑核三叉神经中脑核-VqPontine nucleus of trigeminal n. 三叉神经脑桥核三叉神经脑桥核-VqSpinal nucleus of trigeminal n.

27、 三叉神经脊束核三叉神经脊束核-VVTheir axons cross the median plane to the opposite side, ascend and form the trigeminothalamic lemniscus三叉丘系三叉丘系 General somatic sensory nucleiNucleusSiteCranial n.FunctionMesencephalic nucleus of trigeminal n.MidbrainProprioception of headPontine nucleus of trigeminal n.PonsTactil

28、e sensation of headSpinal nucleus of trigeminal n.MedullaPain and temperature sense of head Special somatic sensory nuclei 特殊躯体感觉核特殊躯体感觉核qCochlear nuclei 蜗神经核蜗神经核qVestibular nuclei 前庭神经核前庭神经核VIIIThe cochlear nuclei send axons mainly cross the median plane, ascend and form the lateral lemniscus 外侧丘系

29、Special somatic sensory nucleiNucleusSiteCranial n.FunctionCochlear nucleiPons and medulla Sense of hearingVestibular nucleiPons and medullaSense of equilibriumPosition Motor nu. Cranial n. Seneory Nu.Nu. of oclomotor n.Accessory Nu of oculomotor n.Nu. of trochear n.Motor Nu of trigeminal n. Nu. of

30、abducent n.Nu of facial n.Superior salivatory nu.Inferior salivatory nu.Nu.ambiguusDorsal nu. of vagus n.Nu. of accessory n.Nu. of hypoglossal nMesencephalic NuPontine NuSpinal NuCochlear nucleusVestibular nucleiNu. of solitary tractof trigeminal n.MidbrainPonsMO Nucleus ambiguus(superior and inferi

31、or) Non-cranial nerve nuclei 非脑神经核非脑神经核qGracile nucleus 薄束核薄束核qCuneate nucleus 楔束核楔束核qAccessory cuneate nucleus 楔束副核楔束副核qInferior olivary nucleus 下橄榄核下橄榄核q Gracile nucleus 薄束核薄束核 and Cuneate nucleus 楔束核楔束核Both recieve fibre from Fasciculi gracilis and cuneatus, send fibre cross the median plane to t

32、he opposite side, ascend and form the medial lemniscus. Conveys deep and fine touch sensation to VPL(thalamus)qInferior olivary nucleus 下橄榄核下橄榄核 Non-cranial nerve nuclei 非脑神经核非脑神经核Non-cranial nerve nuclei 非脑神经核非脑神经核qSuperior olivary nucleus上橄榄核上橄榄核Relay nucleus of auditory pathwayq Pontine nucleus 脑

33、桥核脑桥核Relay nucleus from cortex to cerebellumTheir axons cross the median plane and form the middle cerebellar peduncle Non-cranial nerve nuclei 非脑神经核非脑神经核q Nucleus of inferior colliculus下丘核下丘核Relay station of auitory pathwayq Gray matter layers of superior colliculus上丘灰质层上丘灰质层Reflex center of light

34、(visual sense) and sound(auditory sense)Non-cranial nerve nuclei 非脑神经核非脑神经核q Red nucleus红核红核q Substantia nigra黑质黑质q Pretectal area 顶盖前区顶盖前区Reflex center of pupillary light reflex Non-cranial nerve nuclei 非脑神经核非脑神经核NucleusSiteGracile nucleusMedulla(underneath gracile tubercle)Cuneate nucleusMedulla(u

35、nderneath cuneate tubercle)Inferior olivary nucleus MedullaAccessory cuneate nucleus MedullaSuperior olivery nucleusPons Pontine nucleusPons Nucleus of lateral lemniscus Pons Inferior colliculus MidbrainSubstantia nigraMidbrain Ventral tegmental area MidbrainSuperior colliculusMidbrain Red nucleusMi

36、dbrain Pretectal areaMidbrain White matter Ascending tractsqMedial lemniscus 内侧丘系内侧丘系qSpinothalamic tract 脊髓丘脑束脊髓丘脑束 （Spinal lemniscus 脊髓丘系）脊髓丘系）qTrigeminothalamic tract 三叉丘脑三叉丘脑束束 （Trigeminal lemniscus 三叉丘三叉丘系系）qLateral lemniscus 外侧丘系外侧丘系 Ascending tractsSpinal ganglion 1neuron Fasciculus gracilis

37、Fasciculus cuneatus Gracile and cuneate nuclei2neuron Decussation of medial lemniscusMedial lemniscusVPL 3neurons Central thalamic radiation T4 Medial lemniscus内侧丘系内侧丘系Spinal ganglia1neuron Lamina, 2neuron Lateral spinothalamic tract anterior spinothalamic tract Spinal lemniscusVPL 3neurons Central

38、thalamic radiationAscending tracts Spinothalamic tract （Spinal lemniscus脊髓丘系脊髓丘系） Trigeminal ganglion1neuron Pontine nucleus of V 2neuronSpinal nucleus of V 2neuronTrigeminal lemniscus Spinal tract of trigeminal n. VPM 3neurons Central thalamic radiation Ascending tracts Trigeminothalamic tract （Tri

39、geminal lemniscus三叉三叉丘系丘系）Trigeminal lemniscus三叉丘系三叉丘系 Ascending tracts Lateral lemniscus外侧丘系外侧丘系Coclear nulcei(2neuron)Coclear ganglia(1neuron)Trapziod bodySuperior olivary nuclearLateral lemniscusMedial geniculte body3neuronInferior colliculusAuditory radiationLateral lemniscus 外侧丘系外侧丘系Cochlea gag

40、lionAnterior and posterior spinocerebellar tractsSpinal ganglion Posterior spinocerebellar tract Anterior Spinocerebellartract Lamina - Inferior cerebellar peduncleSuperior cerebellar peduncleNucleus thoracicusDescending tractsqPyromidal tract 锥体束锥体束Corticospinal tract 皮质脊髓束皮质脊髓束Corticonuclear tract

41、 皮质核束皮质核束qRubrospinal tract 红核脊髓束红核脊髓束qTectospinal tract 顶盖脊髓束顶盖脊髓束qVestibulospinal tract 前庭脊髓束前庭脊髓束qReticulospinal tract 网状脊髓束网状脊髓束qMedial longitudinal fasciculus 内侧纵束内侧纵束q Corticospinal tract 皮质脊髓束皮质脊髓束Originate principally from the pyramidal neurons in the homolateral precentral gyrusDescend thro

42、ugh the internal capsule (hemispheres), the lateral part of middle 3/5 of crus cerebri and the basilar part of the pons to form the pyramid in the medulla oblongata. Then most of the fibres cross in the decussation of pyramid to form the lateral corticospinal tract, the reminder descend in the anter

43、ior funiculus as the anterior corticospinal tract q Corticonuclear tract 皮质核束皮质核束Arise from the pyramidal neurons in homolateral cerebral cortexDescend through the internal capsule (hemispheres), the medial part of middle 3/5 of crus cerebri and the basilar part of the pons,and pyramid of medulla ob

44、longataMost fibre leave the pyramid tract to the motor cranial nerve nucleus on both sides(bilateral oculomotor, trochlear, trigeminal motor, abducens, superior part of facial, ambiguus and accessory nuclei)Few fibre terminate only on contralateral inferior part of facial and hypoglossal nucleMedial

45、 longitudinal fasciculus 内侧纵束内侧纵束Reticular Formation of Brain StemqIn the central part of the tegmentum of the brain stem, scattered among the more conspicuous fibre bundle and nuclei of brain stem are extensive field of intermingled grey and white matter collectively termed the reticular formation.

46、 It forms the central core through the brain.qThe neurons contributed to the RT are arranged in ill-defined group(nuclei), according to their functions, they are divided into three groups:Raphes nuclei Lateral nuclei: receptive area Medial nuclei: effective areaReticular Formation of Brain StemqFunc

47、tions of RTThe regulation of motor responses-Control of skeletal muscle The coordination of autonomic functionslVital centersCardiovascular center Respiratory centerThe control of consciousnesslAscending reticular activating system (ARAS) 上行网状激动系统上行网状激动系统The modulation of pain sensation Reticular Fo

48、rmation of Brain StemqAscending reticular activating system (ARAS) 上行网状激动系统上行网状激动系统Essential for the state of consciousnessThe characters of internal structure of brain stemDecussations of pyramid 锥体交叉锥体交叉Decussations of medial lemniscus内侧丘系交叉内侧丘系交叉inferior olivary nuculeus下橄榄核下橄榄核inferior cerebella

49、r peduncle小脑下脚小脑下脚fourth ventricle floor第四脑室第四脑室Tegmentum of pons 脑桥被盖脑桥被盖Basilar part 基底部基底部Rectum of midbrain 中脑顶盖中脑顶盖Cerebral peduncle 大脑脚大脑脚Tegmentum 被盖被盖 Substentia nigra 黑质黑质Crus cerebri 大脑脚底大脑脚底Medulla oblongataLower part (closed part)qTwo decussations（两个交叉）（两个交叉） Decussations of medial lemni

50、scus内侧丘系交叉内侧丘系交叉 Decussations of pyramid 锥体交叉锥体交叉Medulla oblongataUpper part (open part) qAppearance of inferior olivary nuculeus下橄榄核下橄榄核 and inferior cerebellar peduncle小脑下脚小脑下脚 qEnlargement of central canal to form the fourth ventricle floor第四脑室第四脑室Medulla oblongataPons Devided by the trapezoid bo

51、dy into：qTegmentum of pons 脑桥被盖脑桥被盖 Directed upward continuation of medulla oblongataqBasilar part 基底部基底部 Contain both longitudinal and transverse fibers intermixed with pontine nucleiPonsMidbrain qRectum of midbrain 中脑顶盖中脑顶盖 Includes superior and inferior colliculiqCerebral peduncle 大脑脚大脑脚Tegmentum

52、 被盖被盖 contain ascending tracts, mesencephalic aqueduct, central gray matter, recticular formationSubstentia nigra 黑质黑质Crus cerebri 大脑脚底大脑脚底 lPyramidal tract 锥体束锥体束lFrontopontine tract 额桥束额桥束 lPariatotempopontine tract 顶顶颞桥束颞桥束 MidbrainMedial medullary syndrome 延髓内侧综合征延髓内侧综合征qContralateral hemiparesi

53、s (pyramidal tract)qContralateral impaired sensation of position and movement and tactile discrimination (medial lemniscus)qIpsilateral paralysis of tongue muscles with deviation to the paralyzed side when the tongue is protruded (hypoglossal nerve)Lateral medullary syndrome 延髓外侧综合征延髓外侧综合征qAnalgesia

54、 and thermoanesthesia on the ipsilateral side of the face (nucleus and spinal tract of the trigeminal nerve)qContralateral loss of sensations of pain and temprature (spinal lemniscus-spinothalamic tract)qDysphagia and dysarthria due to paralysis of the ipsilateral palatal and laryngeal muscles (inne

55、rvated by the nucleus ambiguus)qIpsilateral Horners syndrome (descending sympathetic fibers)qIpsilateral cerebellar signs-gait and limb ataxia (cerebellum or inferior cerebellar peduncle)qVertigo, nausea, vomiting, and nystagmus (vestibular nuclei)Basal pontine syndrome 脑桥基底部综合征脑桥基底部综合征qContralateral hemiparesis (pyramidal tract)qIpsilateral paralysis of lateral rectus muscle (abducent nerve nucleus)Dorsal pons syndrome 脑桥背侧部综合征脑桥背侧部综合征qIpsilat