About Cerebellum and Brainstem

Finding the Best Care for a Loved One in a Coma

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This page continues our functional guide, to the areas of Cerebellum and Brain Stem. These lower brain structures not only control movement and the involuntary nervous system, but are more interrelated than once thought. While our charts give a localized view of the function of the brain, the more we learn from medical science, the clearer it becomes that the brain is a synergistic organ, where the all of its structures working together is key for even the most primitive functions.

Brain Structure	Function	Associated Signs and Symptoms
Cerebellum	Coordination and control of voluntary movement.	Tremors. Nystagmus (Involuntary movement of the eye). Ataxia, lack of coordination.
Brain Stem:
Midbrain	Nerve pathway of cerebral hemispheres. Auditory and Visual reflex centers. Cranial Nerves: CN III - Oculomotor (Related to eye movement), [motor]. CN IV - Trochlear (Superior oblique muscle of the eye which rotates the eye down and out), [motor].	Weber's: CN III palsy and ptosis (drooping) ipsalateral (same side of body). Pupils: Size: Midposition to dilated. Reactivity: Sluggish to fixed. LOC (Loss of consciousness): Varies Movement: Abnormal extensor ( muscle that extends a part). Respiratory: Hyperventilating. CN (Cranial Nerve) Deficits: CN III, CN IV.
Pons	Respiratory Center. Cranial Nerves: CN V - Trigeminal (Skin of face, tongue, teeth; muscle of mastication), [motor and sensory]. CN VI - Abducens (Lateral rectus muscle of eye which rotates eye outward), [motor]. CN VII - Facial (Muscles of expression), [motor and sensory]. CN VIII - Acoustic (Internal auditory passage), [sensory].	Pupils: Size: Pinpoint LOC: Semi-coma "Akinetic Mute". "Locked In" Syndrome. Movement: Abnormal extensor. Withdrawal. Respiratory: Apneustic (Abnormal respiration marked by sustained inhalation). Hyperventilation. CN Deficits: CN VI, CN VII.
Medulla Oblongata	Crossing of motor tracts. Cardiac Center. Respiratory Center. Vasomotor (nerves having muscular control of the blood vessel walls) Center Centers for cough, gag, swallow, and vomit. Cranial Nerves: CN IX - Glossopharyneal (Muscles and mucous membranes of pharynx, the constricted openings from the mouth and the oral pharynx and the posterior third of tongue.), [mixed]. CN X - Vagus (Pharynx, larynx, heart, lungs, stomach), [mixed]. CN XI - Accessory (Rotation of the head and shoulder), [motor]. CN XII - Hypoglossal (Intrinsic muscles of the tongue), [motor].	Movement: Ipsilateral (same side) plegia (paralysis). Pupils: Size: Dilated. Reactivity: Fixed. LOC: Comatose. Respiratory: Abnormal breathing patterns. Ataxic. Clustered. Hiccups. CN Palsies (Inability to control movement): Absent Cough. Gag.

Brain Structure

Function

Associated Signs and Symptoms

Cerebellum

Coordination and control of voluntary movement.

Tremors.
Nystagmus (Involuntary movement of the eye).
Ataxia, lack of coordination.

Brain Stem:

Midbrain

Nerve pathway of cerebral hemispheres.

Auditory and Visual reflex centers.

Cranial Nerves:

CN III - Oculomotor (Related to eye movement), [motor].

CN IV - Trochlear (Superior oblique muscle of the eye which rotates the eye down and out), [motor].

Weber's: CN III palsy and ptosis (drooping) ipsalateral (same side of body).
Pupils:

Size: Midposition to dilated.

Reactivity: Sluggish to fixed.

LOC (Loss of consciousness): Varies
Movement: Abnormal extensor ( muscle that extends a part).
Respiratory: Hyperventilating.
CN (Cranial Nerve) Deficits: CN III, CN IV.

Pons

Respiratory Center.

Cranial Nerves:

CN V - Trigeminal (Skin of face, tongue, teeth; muscle of mastication), [motor and sensory].

CN VI - Abducens (Lateral rectus muscle of eye which rotates eye outward), [motor].

CN VII - Facial (Muscles of expression), [motor and sensory].

CN VIII - Acoustic (Internal auditory passage), [sensory].

Pupils:

Size: Pinpoint

LOC:

Semi-coma

"Akinetic Mute".

"Locked In" Syndrome.

Movement:

Abnormal extensor.

Withdrawal.

Respiratory:

Apneustic (Abnormal respiration marked by sustained inhalation).

Hyperventilation.

CN Deficits: CN VI, CN VII.

Medulla Oblongata

Crossing of motor tracts.

Cardiac Center.

Respiratory Center.

Vasomotor (nerves having muscular control of the blood vessel walls) Center

Centers for cough, gag, swallow, and vomit.

Cranial Nerves:

CN IX - Glossopharyneal (Muscles and mucous membranes of pharynx, the constricted openings from the mouth and the oral pharynx and the posterior third of tongue.), [mixed].

CN X - Vagus (Pharynx, larynx, heart, lungs, stomach), [mixed].

CN XI - Accessory (Rotation of the head and shoulder), [motor].

CN XII - Hypoglossal (Intrinsic muscles of the tongue), [motor].

Movement: Ipsilateral (same side) plegia (paralysis).
Pupils:

Size: Dilated.

Reactivity: Fixed.

LOC: Comatose.
Respiratory:

Abnormal breathing patterns.

Ataxic.

Clustered.

Hiccups.

CN Palsies (Inability to control movement):

Absent Cough.

Gag.

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Finding the Best Care for a Loved One in a Coma

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Return To Brain Anatomy

Intracranial Pressure

Understanding Coma

Rancho Los Amigos Scale/ The Levels of Coma

Objectives of Neurosurgery

A Glossary of Terms

Attorney Gordon S. Johnson, Jr.

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