The brainstem is the stalk of the brain that connects the cerebrum and cerebellum to the spinal cord. It is made up of the midbrain, pons and medulla oblongata. Although only about 7 cm long, it contains the nuclei of cranial nerves III to XII, the centres that control breathing, heart rate and consciousness, and every long pathway between brain and body.
| Location | Posterior cranial fossa, resting on the clivus, extending from the diencephalon above to the foramen magnum below, in front of the cerebellum |
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| Connections |
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| Blood Supply | Vertebral arteries; Basilar artery and its pontine branches; Posterior inferior cerebellar artery; Anterior inferior cerebellar artery; Superior cerebellar artery; Posterior cerebral artery; Anterior spinal artery |
Carries all major sensory and motor pathways, controls the head and face through the cranial nerves, and maintains vital functions such as breathing, blood pressure and wakefulness.
Brainstem lesions classically cause crossed signs: cranial nerve problems on the same side as the lesion and limb weakness or sensory loss on the opposite side. Basilar artery occlusion can cause locked-in syndrome or coma. Brainstem reflexes (pupils, corneal, gag, cough, breathing) are tested when confirming death by neurological criteria.
Infarction from vertebral or basilar artery disease causing vertigo, double vision, difficulty swallowing, crossed weakness or reduced consciousness.
Damage to the front of the pons leaving a fully conscious person paralysed except for vertical eye movements and blinking.
A tumour of the brainstem, most aggressively diffuse midline glioma of the pons in children, causing cranial nerve palsies and ataxia.
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