Midbrain
(Mesencephalon)
Upper and shortest part
of brain stem(2.5cm
long and 2.5cm wide).
Passes through
tentorial notch.
Related on each side to
optic tract,
parahippocampal gyrus,
posterior cerebral
artery.
Anteriorly related to
interpeduncular structures
the optic chiasm, the
tuber cinereum and the
infundibulum, the
mamillary bodies, the
posterior perforated
substance.
(in that order from
before backwards)
Interpeduncular fossa and contents
Posterior relations
Posterior ends of
thalami (pulvinar).
Pineal body.
Splenium of corpus
callosum.
External features
Ventrally presents two
crura which converge to
enter the pons and form
the posterior boundaries
of interpeduncular fossa.
Oculomotor nerves
emerge between the
crura.
Trochlear nerves curve
round the lateral borders
of crura.
Dorsal surface
Colliculi (superior and
inferior pairs).
Superior and inferior
brachia.
Pineal body (gland).
Cerebral aqueduct(of Sylvius)
Tectum
Cerebral peduncle
TS of midbrain
Internal structure
tectum– is the dorsal
part-- made up of
D
colliculi.
cerebral peduncle—
is the ventral part -- Tg
(made up of SN
tegmentum,
substantia nigra and
V
crus cerebri)
Crus cerebri
Contains
corticonuclear and
corticospinal fibers
in the middle2/3.
Medially
frontopontine
fibers and laterally cn,cs
fibers from other fp
lobes of cerebrum.
Tectum and tegmentum differ in
structure.
Therefore the midbrain is studied at two
levels;
[Link] the level of inferior colliculus
[Link] the level of superior colliculus
TS at the level of inferior colliculus
Grey matter around the
aqueduct (central grey)
contains, IV nerve
nucleus and
mesencephalic nucleus of
V
Trochlear nerve fibers
decussate and emerge
dorsally and enter the
cavernous sinus.
This is the only cranial
nerve to emerge
dorsally!!!
T.S at the level of inferior colliculus
(contd)
Decussation of superior
cerebellar peduncle is the
notable feature at this
level.
The lemnisci are
arranged in a curved
manner and lateral
lemniscus ends in the
inferior colliculus.
MLF, tectospinal and
rubrospinal tracts are
close to the midline from
dorsal to ventral.
T.S at the level of superior
colliculus
Grey matter here
contains:
Oculomotor nucleus
which also has a
parasympathetic nucleus
called the “Edinger-
Westphal nucleus (pupillo
constrictory center),
mesencephalic nucleus of
V, and the red nucleus.
contd
E-W nucleus supplies the sphincter pupillae
and ciliaris muscle (for accommodation).
Superior colliculus receives afferents from
retinae and gives efferents called tectospinal
tracts.
Pretectal nucleus
Small group of neurons lying superior to superior
colliculus. It gives fibers to the E-W nucleus of
both sides.
It is an important part of the pathway for pupillary
light reflex and consensual light reflex.
Any injury to this nucleus causes
“Argyll-Robertson’s pupil” where the light reflex
is lost but accommodation reflex is present.
(ARP)
White matter at this level
Decussation of
tectospinal tracts forms
dorsal tegmental
decussation (of Meynert).
Decussation of
rubrospinal tracts forms
ventral tegmental
decussation (of Forel).
Tegmentum contains all
the lemnisci except the
lateral lemniscus.
MLF
Contains fibers coming from vestibular
nuclei (mainly) and interconnects the
nuclei of 3rd,4th,5th,6th and spinal
accessory.
Coordinates the movement of the
eyes, head and neck in response to
the stimulation of vestibulocochlear
nerve.
Blood supply
Superior
cerebellar, basilar and posterior
communicating arteries.
Clinical aspects
Weber’s syndrome- injury to oculomotor
nerve and the crus cerebri due to the
occlusion of posterior cerebral artery.
Effects:
Ipsilateral lateral squint (unopposed action
of the lateral rectus).
Contralateral hemiplegia
Contralateral paralysis of lower face and
tongue (corticonuclear fiber damage)
Weber’s syndrome (contd)
Drooping of upper eyelid (ptosis) due to
paralysis of levator palpebrae superioris.
Dilated pupil and loss of accommodation
reflex (damage to E-W nucleus).
Benedikt’s syndrome
Ischemia of tegmentum involves the
lemnisci, superior peduncle, red nucleus
and 3rd nerve.
Effects:
Ipsilateral lateral squint.
Contralateral loss of pain and temperature
Contra lateral loss of tactile, muscle, joint
and vibration sense.
Parinaud’s syndrome
Due to compression of superior colliculus
by a tumour of pineal gland.
Feature is the loss of upward gaze only
other movements of the eye remain
normal (anatomical basis is obscure).
Parinaud’s
Benediktt”s
Weber’s
Areas involved in these three syndromes