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As the so-called "brain stem is small, nuclei are complete", brainstem injury can present a variety of clinical symptoms and signs
.
The brainstem includes the midbrain, pons, and medulla
.
Understanding the complex function and anatomy of this region is key to understanding the disease
.
Today we will learn about the anatomy of the medulla oblongata and the common syndromes that are damaged in different parts
.
Compiled by Yimaitong, please do not reprint without authorization.
Anatomy of the medulla ➤ The medulla transmits information from the spinal cord to the brain and consists of the ventral part and the dorsal tegment (Figures 1 and 2)
.
➤ The ventral part includes the vertebral and olive bodies
.
The inferior olive nucleus is part of the oligocerebellar system and functions in cerebellar motor learning
.
The upper olive nucleus plays a role in sound perception
.
➤ The dorsal tegment contains the nuclei of the glossopharyngeal (IX), vagus (X), accessory (XI), and hypoglossal (XII) nerves, as well as the white matter tracts (medial longitudinal tract, medial lemniscus, spinothalamic tract, Cover the continuation of the central tract, the spinocerebellar tract)
.
➤ The medulla is supplied by the anterior spinal artery, perforating arteries of the vertebral artery, and the posterior inferior cerebellar artery
.
Fig.
1 ventral portion pyramidal tract pyramidal tract olive dorsal tegmentum dorsal tegmentumFig.
2 medial lemniscus tectospinal tract tectospinal tract nmedial longitudinal fascisulus medial accessory olivary nucleus medial accessory olive nucleus dorsal accessory olivary nucleusinferior cerebellar peduncleinferior cerebellar pedunclenucleus ambiguousposterior cochlear nucleusdorsal vagal nucleusnucleus of tractus solitariusanterior spinocerebellar tractspinothalamic tractinferior olivary nucleus Inferior olive nucleus, medial vestibular nucleus, hypoglossal nucles, hypoglossal nucleus, medullary common syndromes caused by infarction
.
The inferior cerebellar peduncle, vestibular nucleus, trigeminospinal nucleus, and nucleus doubtus are usually affected (Figs 3, 4)
.
➤Clinical manifestations: Vestibular cerebellar symptoms such as vertigo, deviation to one side of the lesion, diplopia, polytropic nystagmus, ipsilateral Horner syndrome, hiccups, contralateral pain and loss of temperature sensation, hoarseness, dysphonia, swallowing Difficulty, dysarthria, and decreased gag reflex
.
Figure 3 (green) Wallenberg Syndrome lesion areaFigure 4 Wallenberg Syndrome, axial DWI (a, c) and T2-weighted images (b) show changes in signal intensity and restricted diffusion in the right lateral medulla, with no blood flow in the right vertebral artery Hollow, consistent with acute lateral medullary infarction caused by right vertebral body dissection
.
➤ Dejerine Syndrome ➤ Etiology: Medial medullary infarction due to occlusion of small perforating branches proximal to the vertebral or basilar artery or occlusion of the anterior spinal artery, affecting the hypoglossal nucleus (Figure 5)
.
➤Clinical manifestations: Contralateral weakness and semi-sensory disturbance, accompanied by ipsilateral hypoglossal nerve palsy
.
Figure 5 (green) Dejerine Syndrome lesion area ➤ Babinski-Nageotte Syndrome ➤ Etiology: medial and lateral medullary infarcts caused by partial occlusion of the vertebral artery (Figures 6, 7)
.
➤Clinical manifestations: Includes a combination of medial and lateral medulla symptoms, such as ipsilateral cerebellar ataxia, facial sensory deficits, Horner syndrome, contralateral hemiparesis, and hemianesthesia
.
Fig.
6 (green) Babinski-Nageotte Syndrome lesion areaFig.
7 Babinski-Nageotte Syndrome, axial susceptibility-weighted (a) and T2-weighted (b) images showing hemorrhage from right inferior medullary cavernoma, resulting in Babinski-Nageotte syndrome sign
.
➤Hypertrophic Olivary Degeneration ➤Etiology: A rare disease characterized by lesions located in the triangle of Guillain and Mollaret, consisting of the red nucleus, the inferior olive nucleus, and the contralateral dentate nucleus (Fig.
8)
.
Inferior olive hypertrophy is caused by synaptic degeneration of the dentate red nucleus or central tegmental tract (between the red nucleus and the ipsilateral inferior olive nucleus) (Fig.
9)
.
➤Clinical manifestations: palatal myoclonus, possibly related to cerebellar or brainstem dysfunction
.
Figure 8 (green) Guillain-Mollaret triangle: The inferior olivary nucleus, the cerebellar dentate nucleus, and the midbrain red nucleus form a neuronal circuit, also known as the "myoclonic triangle"
.
Figure 9 Hypertrophic Olivary Degeneration, Axial T2-weighted image at the medulla (a) and pontine (b) levels and FLAIR image at the medulla (c) level showing hypertrophic degeneration of the right olive due to previous pontine hemorrhage
.
Compiled from: Sciacca S, Lynch J, Davagnanam I, Barker R.
Midbrain, Pons, and Medulla: Anatomy and Syndromes.
Radiographics.
2019 Jul-Aug;39(4):1110-1125.
doi: 10.
1148/rg .
2019180126.
PMID: 31283463.
.
The brainstem includes the midbrain, pons, and medulla
.
Understanding the complex function and anatomy of this region is key to understanding the disease
.
Today we will learn about the anatomy of the medulla oblongata and the common syndromes that are damaged in different parts
.
Compiled by Yimaitong, please do not reprint without authorization.
Anatomy of the medulla ➤ The medulla transmits information from the spinal cord to the brain and consists of the ventral part and the dorsal tegment (Figures 1 and 2)
.
➤ The ventral part includes the vertebral and olive bodies
.
The inferior olive nucleus is part of the oligocerebellar system and functions in cerebellar motor learning
.
The upper olive nucleus plays a role in sound perception
.
➤ The dorsal tegment contains the nuclei of the glossopharyngeal (IX), vagus (X), accessory (XI), and hypoglossal (XII) nerves, as well as the white matter tracts (medial longitudinal tract, medial lemniscus, spinothalamic tract, Cover the continuation of the central tract, the spinocerebellar tract)
.
➤ The medulla is supplied by the anterior spinal artery, perforating arteries of the vertebral artery, and the posterior inferior cerebellar artery
.
Fig.
1 ventral portion pyramidal tract pyramidal tract olive dorsal tegmentum dorsal tegmentumFig.
2 medial lemniscus tectospinal tract tectospinal tract nmedial longitudinal fascisulus medial accessory olivary nucleus medial accessory olive nucleus dorsal accessory olivary nucleusinferior cerebellar peduncleinferior cerebellar pedunclenucleus ambiguousposterior cochlear nucleusdorsal vagal nucleusnucleus of tractus solitariusanterior spinocerebellar tractspinothalamic tractinferior olivary nucleus Inferior olive nucleus, medial vestibular nucleus, hypoglossal nucles, hypoglossal nucleus, medullary common syndromes caused by infarction
.
The inferior cerebellar peduncle, vestibular nucleus, trigeminospinal nucleus, and nucleus doubtus are usually affected (Figs 3, 4)
.
➤Clinical manifestations: Vestibular cerebellar symptoms such as vertigo, deviation to one side of the lesion, diplopia, polytropic nystagmus, ipsilateral Horner syndrome, hiccups, contralateral pain and loss of temperature sensation, hoarseness, dysphonia, swallowing Difficulty, dysarthria, and decreased gag reflex
.
Figure 3 (green) Wallenberg Syndrome lesion areaFigure 4 Wallenberg Syndrome, axial DWI (a, c) and T2-weighted images (b) show changes in signal intensity and restricted diffusion in the right lateral medulla, with no blood flow in the right vertebral artery Hollow, consistent with acute lateral medullary infarction caused by right vertebral body dissection
.
➤ Dejerine Syndrome ➤ Etiology: Medial medullary infarction due to occlusion of small perforating branches proximal to the vertebral or basilar artery or occlusion of the anterior spinal artery, affecting the hypoglossal nucleus (Figure 5)
.
➤Clinical manifestations: Contralateral weakness and semi-sensory disturbance, accompanied by ipsilateral hypoglossal nerve palsy
.
Figure 5 (green) Dejerine Syndrome lesion area ➤ Babinski-Nageotte Syndrome ➤ Etiology: medial and lateral medullary infarcts caused by partial occlusion of the vertebral artery (Figures 6, 7)
.
➤Clinical manifestations: Includes a combination of medial and lateral medulla symptoms, such as ipsilateral cerebellar ataxia, facial sensory deficits, Horner syndrome, contralateral hemiparesis, and hemianesthesia
.
Fig.
6 (green) Babinski-Nageotte Syndrome lesion areaFig.
7 Babinski-Nageotte Syndrome, axial susceptibility-weighted (a) and T2-weighted (b) images showing hemorrhage from right inferior medullary cavernoma, resulting in Babinski-Nageotte syndrome sign
.
➤Hypertrophic Olivary Degeneration ➤Etiology: A rare disease characterized by lesions located in the triangle of Guillain and Mollaret, consisting of the red nucleus, the inferior olive nucleus, and the contralateral dentate nucleus (Fig.
8)
.
Inferior olive hypertrophy is caused by synaptic degeneration of the dentate red nucleus or central tegmental tract (between the red nucleus and the ipsilateral inferior olive nucleus) (Fig.
9)
.
➤Clinical manifestations: palatal myoclonus, possibly related to cerebellar or brainstem dysfunction
.
Figure 8 (green) Guillain-Mollaret triangle: The inferior olivary nucleus, the cerebellar dentate nucleus, and the midbrain red nucleus form a neuronal circuit, also known as the "myoclonic triangle"
.
Figure 9 Hypertrophic Olivary Degeneration, Axial T2-weighted image at the medulla (a) and pontine (b) levels and FLAIR image at the medulla (c) level showing hypertrophic degeneration of the right olive due to previous pontine hemorrhage
.
Compiled from: Sciacca S, Lynch J, Davagnanam I, Barker R.
Midbrain, Pons, and Medulla: Anatomy and Syndromes.
Radiographics.
2019 Jul-Aug;39(4):1110-1125.
doi: 10.
1148/rg .
2019180126.
PMID: 31283463.
