脑干（Brain_stem）医学课件.ppt

1、Brain Stem 脑干,山东大学医学院 解剖教研室,学习方法,看外形，想内部，内外结合。 看断面，想立体，上下串联。 记重点，莫贪多，整理表格。,Major Division of the brain,Brain 脑 Telencephalon 端脑 Diencephalon 间脑 Cerebellum 小脑 Brain stem 脑干 Midbrain 中脑 Pons 脑桥 Medulla oblongata 延髓,Brain stem 脑干,Consists of Midbrain 中脑 Pons 脑桥 Medulla oblongata 延髓,Brain stem 脑干,Positi

2、on The brain stem occupies the posterior cranial fossa of the skull,Gross Appearance of Brain Stem,Ventral Surface of Brain Stem,Medulla oblongata Pyramid 锥体 Composed of bundles of nerve fiber, pyramidal tract 锥体束 Decussation of pyramid 锥体交叉 Formed by crossing fibers of pyramidal tract Olive 橄榄 Prod

3、uced by underlying inferior olivary nucleus 下橄榄核 Anterolateral sulcus 前外侧沟 Emerge the roots of hypoglossal nerve posterolateral sulcus 后外侧沟 Emerge the roots of glossopharyngeal, vagus and accessory nerves,Ventral Surface of Brain Stem,Pons Basilar part 基底部 Basilar sulcus 基底沟 Bulbopontine sulcus 延髓脑桥

4、沟 There emerge, from medial to lateral, the abducent, facial and vestibulocochlear nerves Middle cerebellar peduncle 小脑中脚 Trigeminal nerve 三叉神经 Emerges from the junction of basilar part and middle cerebellar peduncles Pontocerebellar trigone 脑桥小脑三角 The junction of medulla, pons and cerebellum,Ventra

5、l Surface of Brain Stem,Midbrain Cerebral peduncle大脑脚Interpeduncular fossa 脚间窝 Oculomotor nerve emerges on the medial side crus cerebri Posterior perforated substance 后穿质,Dorsal Surface of Brain Stem,Medulla oblongata Lower portion Gracile tubercle 薄束结节 produced by underlying gracile nucleus 薄束核 Cun

6、eate tubercle 楔束结节produced by underlying cuneate nucleus 楔束核 Inferior cerebellar peduncle 小脑下脚 Upper portion: forms the lower half of rhomboid fossa,Dorsal Surface of Brain Stem,Pons Superior cerebellar peduncle 小脑上脚 Superior medullary velum 上髓帆 Trochlear nerve 滑车神经,Dorsal Surface of Brain Stem,Midb

7、rain Superior colliculus 上丘 Constitute centers for visual reflexes Inferior colliculus 下丘 Associated with auditory pathway Brachium of superior colliculus 上丘臂 Brachium of inferior colliculus 下丘臂,Fourth ventricle 第四脑室,Position Situated ventral to cerebellum, and dorsal to pons and cranial half of med

8、ulla,Central canal fourth ventricle mesencephalic aqueduct third ventricle,Floor of Fourth ventricle Rhomboid Fossa 菱形窝,Boundaries Inferolateral: gracile and cuneate tubercles, inferior cerebellar peduncle Superolateral: superior cerebellar peduncle Lateral recess外侧隐窝,Floor of Fourth ventricle Rhomb

9、oid Fossa 菱形窝,Features Median sulcus 正中沟 Sulcus limitans 界沟 Vestibular area 前庭区 Overlies vestibular nuclei Acoustic tubercle 听结节 Overlying dorsal cochlear nucleus Medial eminence 内侧隆起 Striae medullares 髓纹,Floor of Fourth ventricle Rhomboid Fossa 菱形窝,Facial colliculus 面神经丘 Overlies nucleus of abducen

10、t n. and genu of facial nerve Hypoglossal triangle 舌下神经三角 Overlies hypoglossal nucleus Vagal triangle 迷走神经三角 Overlies dorsal nucleus of vagus nerve Funiculus separans 分隔索 Area postrema 最后区 Locus ceruleus 蓝斑 Bluish-gray in color, it owes its color to a group of deeply pigmented nerve cells,Roof of Fo

11、urth ventricle,Anterior part: Formed by superior cerebellar peduncle小脑上脚 and superior medullary velum 上髓帆 Posterior part: Formed by inferior medullary velum 下髓帆 and choroid plexus of fourth ventricle 第四脑室脉络丛 Three apertures Median aperture of fourth ventricle 第四脑室正中孔 Two lateral apertures of fourth

12、ventricle 第四脑室外侧孔,Internal Structure of Brain Stem,脑干的内部结构,组成 灰质 白质 网状结构,特点 灰质由包绕中央管渐铺展，白质渐到灰质腹侧 灰质形成相互独立的神经核 出现中继核 网状组织增多，出现网状核,灰质,脑神经核 非脑神经核,脑神经核,一般躯体运动核：,动眼神经核、滑车神经核、展神经核、舌下神经核,特殊内脏运动核：,三叉神经运动核、面神经核、疑核、副神经核,一般内脏运动核:,动眼神经副核、上泌涎核、下泌涎核、迷走神经背核,一般内脏感觉核： 特殊内脏感觉核：,孤束核下部 孤束核头端,一般躯体感觉核：,三叉神经中脑核、三叉神经脑桥核、三叉

13、神经脊束核,特殊躯体感觉核：,前庭神经核、蜗神经核,中继核,网状核,一般躯体感觉核,接受头面部皮肤、口、鼻粘膜的初级感觉纤维的传入,特殊躯体感觉核,接受内耳听和平衡觉感受器的初级感觉纤维,内脏感觉核,一般脏器和心血管的初级感觉纤维， 特殊味觉的初级感觉纤维,躯体运动柱,支配舌肌和眼球外肌,一般内脏运动核,平滑肌、心肌、腺体,特殊内脏运动核,咀嚼肌、表情肌、软腭、咽喉肌,Internal Structure of Brain Stem,Central canal Gray matter Cranial nerve nuclei 脑神经核 Non-cranial nerve nuclei 非脑神经

14、核 White matter Reticular formation of brain stem,General somatic motor nuclei,Special visceral motor nuclei,General visceral motor nuclei,General visceral sensory nuclus,General somatic sensory nuclei,Special somatic sensory nuclei,Special visceral sensory nuclus,Cranial nerve nuclei,General somatic

15、 motor nuclei 一般躯体运动核,Nucleus of oculomotor n.动眼神经核 Nucleus of trochlear n. 滑车神经核 Nucleus of abducent n. 展神经核 Nucleus of hypoglossal n.舌下神经核,一般躯体运动核,动眼神经核Nucleus of oculomotor n. ：,位于中脑上丘水平,纤维参与构成动眼神经，支配眼球外肌（除外直肌、上斜肌）,损伤表现：,上睑下垂,眼外下斜视,受双侧大脑皮质支配,滑车神经核Nucleus of trochlear n. ：,位于中脑下丘水平,纤维在上髓帆交叉后组成滑车神经

16、支配上斜肌,受双侧皮质支配,展神经核Nucleus of abducent n.,位于脑桥下部室底灰质，面神经丘的深面,纤维构成展神经，支配外直肌,损伤表现为眼内斜视,受双侧皮质控制,展神经核,舌下神经核Nucleus of hypoglossal n.,位于延髓上部舌下神经三角的深面,纤维构成舌下神经，支配舌肌,损伤表现为伸舌偏向患侧，舌肌萎缩,受对侧大脑皮质控制,舌下神经核,General somatic motor nuclei 一般躯体运动核,Nucleus of oculomotor n.动眼神经核 Nucleus of trochlear n. 滑车神经核 Nucleus of a

17、bducent n. 展神经核 Nucleus of hypoglossal n.舌下神经核,General somatic motor nuclei 一般躯体运动核,General somatic motor nuclei,Special visceral motor nuclei 特殊内脏运动核,Motor nucleus of trigeminal n. 三叉神经运动核 Nucleus of facial n. 面神经核 Nucleus ambiguus 疑核 Accessory nucleus 副神经核,特殊内脏运动核,位于脑桥中部，室底灰质腹外侧 发出三叉神经运动根加入三叉神经，支配

18、咀嚼肌、二腹肌前腹、下颌舌骨肌等 损伤表现为张口时下颌偏向患侧 受双侧皮质控制,三叉神经运动核Motor nucleus of trigeminal n.,面神经核Nucleus of facial n.,位于脑桥下部，脑桥被盖腹外侧 纤维形成面神经膝，继而构成面神经运动根，支配面部表情肌 损伤表现为面瘫（额纹消失，眼裂不能闭和，鼻唇沟变浅，口角偏向健侧） 上部接受双侧皮质控制 下部接受对侧皮质控制,位于延髓，下橄榄核背外侧 纤维加入舌咽神经、迷走神经、副神经脑根，支配腭、咽、喉肌和食管上部骨骼肌 损伤表现为吞咽、发声困难 受双侧皮质控制,疑核Nucleus ambiguus,副神经核,疑核,

19、副神经核Accessory nucleus,延髓部为疑核下端，脊髓部至颈 髓上56节前角的背外侧 副神经脑根加入迷走神经支配喉 肌；副神经脊髓根，支配胸锁乳突 肌、斜方肌 损伤表现为头不能向对侧转，肩 不能上提 受双侧皮质控制,Special visceral motor nuclei 特殊内脏运动核,Motor nucleus of trigeminal n. 三叉神经运动核 Nucleus of facial n. 面神经核 Nucleus ambiguus 疑核 Accessory nucleus 副神经核,Special visceral motor nuclei,General vi

20、sceral motor nuclei 一般内脏运动核,Accessory oculomotor nucleus 动眼神经副核 Superior salivatory nucleus 上泌涎核 Inferior salivertory nucleus 下泌涎核 Dorsal nucleus of vagus n. 迷走神经背核,一般内脏运动核,位于中脑上丘平面，动眼神经核的背内侧 副交感神经节前纤维加入动眼神经，在睫状神经节换元后，节后纤维支配瞳孔括约肌、睫状肌 损伤表现为瞳孔散大 位于脑桥最下端，面神经核尾侧 纤维加入面神经，在翼腭神经节换元后，节后纤维管理泪腺、下颌下腺、舌下腺及口鼻腔粘膜

21、腺的分泌,动眼神经副核Accessory oculomotor nucleus,上泌涎核Superior salivatory nucleus,位于延髓上部，迷走神经背核和疑核上方 纤维加入舌咽神经，至耳神经节换元后节后纤维管理腮腺分泌 位于延髓迷走神经三角的深面 纤维参与组成迷走神经，支配颈部、胸部所有脏器、腹腔大部分脏器平滑肌、心肌的活动和腺体分泌,下泌涎核Inferior salivertory nucleus,迷走神经背核Dorsal nucleus of vagus n.,迷走神经背核,下泌涎核,General visceral motor nuclei,内脏感觉核 Visceral

22、 sensory nuclei,孤束核Nucleus of solitary tract 位于延髓内，界沟外侧，迷走神经背核腹外侧 头段接受面n.、舌咽n. 和迷走n.的味觉传入纤维 其余部分接受舌咽n.和迷走n. 的一般内脏感觉传入纤维,Visceral sensory nuclei ( general and special ),General somatic sensory nuclei一般躯体感觉核,Mesencephalic nucleus of trigeminal n. 三叉神经中脑核 Pontine nucleus of trigeminal n. 三叉神经脑桥核 Spinal

23、 nucleus of trigeminal n. 三叉神经脊束核,三叉神经中脑核Mesencephalic nucleus of trigeminal n. 位中脑上丘平面到脑桥中部，功能与咀嚼肌、面肌、眼球外肌的本体感觉有关。 三叉神经脑桥核Pontine nucleus of trigeminal n. 位于脑桥中部 接受头面部触、压觉传入 三叉神经脊束核Spinal nucleus of trigeminal n. 自脑桥中下部接续三叉神经脑桥核向下延续至第1、2颈段脊髓 接受头面部皮肤粘膜和牙齿的痛、温觉传入,一般躯体感觉核,General somatic sensory nucle

24、i,Special somatic sensory nuclei特殊躯体感觉核,Cochlear nuclei 蜗神经核 Vestibular nuclei 前庭神经核,前庭神经核 Vestibular nuclei,位于前庭区的深面，分为前庭上核、下核、内侧核、外侧核,接受前庭神经传入的平衡觉,损伤表现患侧平衡觉障碍,蜗神经核 Cochlear nuclei,位于菱形窝外侧角，听结节深面。分为蜗腹侧核和蜗背侧核,接受内耳经蜗神经传入的听觉冲动,特殊躯体感觉核,Special somatic sensory nuclei,Superior colliculus 上丘 inferior coll

25、iculus下丘 Red nucleus 红核 Substantia nigra 黑质 Pretectal area 顶盖前区 Superior olivary nucleus 上橄榄核 Pontine nucleus 脑桥核 Nucleus ceruleus 蓝斑核 Gracile nucleus 薄束核 Cuneate nucleus 楔束核 Inferior olivary nucleus 下橄榄核,Non-cranial nerve nuclei 非脑神经核,延髓,薄束核与楔束核 Gracile nucleus and Cuneate nucleus：,位于延髓下部，薄束结节和楔束结节

26、的深面。,接受来自薄束与楔束的纤维，,发出纤维形成内侧丘系，传导本体感觉和精细触觉。,损伤：本体感觉障碍,薄束,楔束,薄束核,楔束核,内侧丘系交叉,内弓状纤维,非脑神经核：中继核团,中脑,上丘Superior colliculus ：,指中脑上丘深方呈灰白质交替成层排列的结构,发出纤维至脊髓和脑干，完成视反射。,接受视束、下丘核和脊髓的传入纤维，,上丘,上丘,位于中脑下丘的深面,接受蜗神经核的纤维,发出纤维至内侧膝状体,传导听觉冲动，完成听反射。,下丘,下丘,下丘inferior olliculus ：,顶盖前区Pretectal area ：,位于中脑和间脑交界水平，,接受上丘臂的纤维，,完

27、成瞳孔对光反射。,发出纤维至双侧动眼神经副核，,顶盖前区,红核 Red nucleus：,位于中脑上丘高度的被盖中央部,接受对侧半小脑新皮质及中央核纤维，,发出纤维到脊髓、下橄榄核，,调节屈肌张力，协调运动。,红核,黑质 Substantia nigra：,位于中脑的被盖与大脑脚底之间，由多巴胺能神经元组成，,与纹状体有往返联系，,参与运动调节，,损伤引起震颤麻痹。,黑质,黑质,脑桥核 Pontine nucleus：,散在于脑桥基底部,接受同侧大脑皮质的纤维，发出纤维组成小脑中脚。 是大脑皮质与小脑联系的中继站，与运动有关。,脑桥核,小脑中脚,小脑中脚,脑桥,上橄榄核 superior ol

28、ivary nucleus:,蓝斑核,脑桥中、下部的被盖腹侧部 接受蜗腹侧核的传出纤维，发出纤维加入外侧丘系 参与声音的空间定位,蓝斑深面 与睡眠和觉醒有关,上橄榄核,下橄榄核Inferior olivary nucleus ：,位于延髓橄榄的深面，,与大脑皮质、脊髓、红核、小脑等相联系。,发出纤维组成小脑下脚，进入小脑，参与对运动的控制，尤其对运动的学习记忆起重要作用。,下橄榄核,小脑下脚,White matter,Ascending tracts Medial lemniscus 内侧丘系 Spinothalamic tract 脊髓丘脑束 （Spinal lemniscus 脊髓丘系）

29、Trigeminothalamic tract 三叉丘脑束 （Trigeminal lemniscus 三叉丘系） Lateral lemniscus 外侧丘系,上行（感觉）纤维束,内侧丘系与内侧丘系交叉：,薄束核与楔束核发出的纤维在 中央管腹侧交叉称为内侧丘系 交叉，折向上行为内侧丘系。 止于背侧丘脑腹后外侧核。,传导对侧的本体感觉与精 细触觉。,内侧丘系,位置 延髓：中线两侧，锥体后方 下肢 腹侧 上肢 背侧 脑桥：基底和被盖之间 中脑：红核背外侧 下肢 外侧 上肢 中线,内侧丘系交叉,内侧丘系,Ascending tracts,Spinal ganglion 1neuron,Fascic

30、ulus gracilis,Fasciculus cuneatus,Gracile and cuneate nuclei 2neuron,Decussation of medial lemniscus,Medial lemniscus,VPL 3neurons,Central thalamic radiation,T4,Medial lemniscus 内侧丘系,脊髓丘脑束Spinothalamic tract与脊丘系Spinal lemniscus ：,脊髓丘脑前束脊髓丘脑侧束在脑干内上行 逐渐合拢构成脊丘系，止于背侧丘脑腹后外侧核。 位置,传导对侧躯干四肢的痛、温、粗略触压觉。,脊髓丘脑束

31、,延髓：下橄榄核背外侧 脑桥中脑：内侧丘系背外侧,Spinal ganglia 1neuron,Lamina, 2neuron,Lateral spinothalamic tract,anterior spinothalamic tract,Spinal lemniscus,VPL 3neurons,Central thalamic radiation,Ascending tracts,Spinothalamic tract 脊髓丘脑束 （Spinal lemniscus脊髓丘系）,三叉神经脑桥核和脊束核发出纤维越边到对侧组成三叉丘系，止于背侧丘脑腹后内侧核。 位于内侧丘系的背外侧,传导对侧头

32、面部皮肤、粘膜及牙齿的痛、温、触压觉。,内侧丘系,三叉丘脑束Trigeminothalamic tract （三叉丘系Trigeminal lemniscus ）：,三叉丘系,Trigeminal ganglion 1neuron,Pontine nucleus of V 2neuron,Spinal nucleus of V 2neuron,Trigeminal lemniscus,Spinal tract of trigeminal n.,VPM 3neurons,Central thalamic radiation,Ascending tracts,Trigeminothalamic t

33、ract 三叉丘脑束 （Trigeminal lemniscus三叉丘系）,外侧丘系Lateral lemniscus,蜗神经核和上橄榄核发出的大部分纤维在脑桥基底部与被盖部之间横行越过中线，穿过纵行的内侧丘系，形成斜方体，再折向上行构成外侧丘系，小部分纤维加入同侧外侧丘系上行。 位置 脑桥:被盖的腹外侧边缘部，于中脑下部进入下丘核,传导听觉信息,内侧丘系和斜方体,外侧丘系,外侧丘系,Ascending tracts,Lateral lemniscus 外侧丘系,Descending tracts,Pyromidal tract 锥体束 Corticospinal tract 皮质脊髓束 Co

34、rticonuclear tract 皮质核束 Rubrospinal tract 红核脊髓束 Tectospinal tract 顶盖脊髓束 Vestibulospinal tract 前庭脊髓束 Reticulospinal tract 网状脊髓束,大部分终止双侧脑神经运动核，支配双侧眼外肌、咀嚼肌、面部肌、咽喉肌、胸锁乳突肌、斜方肌,小部分终止于对侧面神经核下部和舌下神经核，支配对侧的面下部肌、舌肌,皮质核束,起于中央前回下部的锥体细胞,脑干的网状结构,网状结构：,脑干内除了境界明确的神经核和纤维束以外，还有分布广泛的黑、白质交错排列的网状区，即为网状结构。,网状结构,主要核团：,中缝核

35、群,内侧核群,外侧核群,Reticular Formation of Brain Stem,Ascending reticular activating system (ARAS) 上行网状激动系统 Motor central and vital centres Reticulospinal tract Cardiovascular center Respiratory center Serotonergic rapheal nuclei,Characters of internal structure of brain stem,Medulla oblongata,Lower part (c

36、losed part) Two decussations Decussations of medial lemniscus Decussations of pyramid,Medulla oblongata,Upper part (open part) Appearance of inferior olivary nuculeus and inferior cerebellar peduncle Enlargement of central canal to form the fourth ventricle floor,Pons,Tegmentum of pons 脑桥被盖 Directed

37、 upward continuation of medulla oblongata Basilar part 基底部 Contain both longitudinal and transverse fibers intermixed with pontine nuclei,Midbrain,Tectum of midbrain 中脑顶盖 Includes superior and inferior colliculi Cerebral peduncle 大脑脚 Tegmentum 被盖 contain ascending tracts, mesencephalic aqueduct, cen

38、tral gray matter, recticular formation and so on Substentia nigra 黑质 Crus cerebri 大脑脚底 Pyramidal tract 锥体束 middle three-fifths of the crus Frontopontine tract 额桥束 medial one-fifth Pariatotempopontine tract 顶颞桥束 lateral one-fifth,Midbrain,Rectum of midbrain 中脑顶盖 Includes superior and inferior collicu

39、li Cerebral peduncle 大脑脚 Tegmentum 被盖 contain ascending tracts, mesencephalic aqueduct, central gray matter, red nucleus, recticular formation and so on Substentia nigra 黑质 Crus cerebri 大脑脚底 Pyramidal tract 锥体束 middle three-fifths of the crus Frontopontine tract 额桥束 medial one-fifth Pariatotempopont

40、ine tract 顶颞桥束lateral one-fifth,Medial medullary syndrome 延髓内侧综合征,Contralateral hemiparesis (pyramidal tract) Contralateral impaired sensation of position and movement and tactile discrimination (medial lemniscus) Ipsilateral paralysis of tongue muscles with deviation to the paralyzed side when the

41、tongue is protruded (hypoglossal nerve),Lateral medullary syndrome 延髓内侧综合征,Analgesia and thermoanesthesia on the ipsilateral side of the face (nucleus and spinal tract of the trigeminal nerve) Contralateral loss of sensations of pain and temprature (spinal lemniscus-spinothalamic tract) Dysphagia an

42、d dysarthria due to paralysis of the ipsilateral palatal and laryngeal muscles (innervated by the nucleus ambiguus) Ipsilateral Horners syndrome (descending sympathetic fibers) Ipsilateral cerebellar signs-gait and limb ataxia (cerebellum or inferior cerebellar peduncle) Vertigo, nausea, vomiting, and nystagmus (vestibular nuclei),Basal pontine syndro