1. Neuroanatomy Lab 1 Module 1.2: The Pons and Midbrain Neuroscience Block Drs. Georgia Bishop and Chris Pierson Jacobus Sylvius Thomas Willis Santiago Ramón y Cajal Paul Edinger

2. Module Purpose To facilitate small group learning by providing step-by-step guidance to assist in the identification of important neuroanatomic structures and relationships while providing a foundation on which to build clinical knowledge and skills

3. Learning Outcomes/ Competencies At the end of this module you will have enhanced your vocabulary and understanding of important neuroanatomical relationships of the pons and midbrain in preparation for more detailed and complicated topics later in the Neuroscience Block and for future clinical applications.

4. Objectives 9971: Explain basic terminology related to the organization of the central and peripheral nervous system. 10020: Describe the location and relationships of relevant nuclei in the CNS on gross brain specimens, cross sectional material, and radiographic images. 10046: Describe the location and relationships of relevant descending tracts in the CNS on gross brain specimens, cross sectional material, and radiographic images.

5. Structures of the pons: Anterior Figure 11.3: J. Nolte The Human Brain: An Introduction to its Functional Anatomy 6 th ed

6. Structures of the pons: Lateral Figure 11.3: J. Nolte The Human Brain: An Introduction to its Functional Anatomy 6 th ed

7. Clinical correlation 10 year old girl, 1 week history of gait changes and headache; Physical examination shows left cranial nerve VI palsy MRI revealed a tumor in the pons Worsening hearing, hyperreflexia, Babinski sign, weakness with ataxia and dysmetria over time

8. Pons Corticospinal tract (CST) Crossing fibers or transverse pontine fibers (TP) Middle cerebellar peduncle Abducens nucleus and nerve fibers

9. DIPG Diffusion Tensor Imaging CST MCP CTT TP Donaldson SS, et al JCO 2006 Anterior A B C MCP CTT CST TP tumor

10. Structures of the midbrain: Anterior Figure 11.3: J. Nolte The Human Brain: An Introduction to its Functional Anatomy 6 th ed

11. Structures of the midbrain: Posterior Figure 11.3: J. Nolte The Human Brain: An Introduction to its Functional Anatomy 6 th ed

12. In conclusion…. You should now be able to recognize key neuroanatomic landmarks and structures of the pons and midbrain At the end of the lab you should understand a number of important neuroanatomical relationships of the pons and midbrain The relationships emphasized in lab are relevant to actual clinical problems you will encounter in your Neurology clerkship and throughout your career You will be expected to use this new vocabulary fluently in the Neuroscience Block as more detailed and complicated topics are introduced and in future clinical applications such as your Neurology clerkship

13. Thanks! Please address questions to: Chris Pierson Christopher.pierson@nationwidechildrens.org Christopher.pierson@nationwidechildrens.org Georgia Bishop Georgia.Bishop@osumc.edu

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