Brainstem Functions

Dr Sabyasachi Das (Senior Lecturer Physiology, UM)

 LEARNING OBJECTIVES
❖ Structure and function of the brainstem regions that control respiration responses.

❖ Structure and function of the brainstem regions that control cardiovascular responses
Components of Brainstem
 Major Functions

Generalized Functions Specialized Functions

1. Cranial nerve nuclei origin & emergence (III-XII)

2. Pathway tract between cerebral cortex and

spinal cord (Conduit for ascending and
descending trCT)

3. Integrative functions
(Including consciousness)
 Clinical Implication of Airway resistance
Pons Midbrain Medulla

✓ Involved in motor ✓ Controls involuntary ✓ Controls autonomic

control eye movement functions
▪ Posture, ✓ Reflexes related to ▪ HR,
▪ Eye movement sleep and ▪ BP,
▪ Facial expression wakefulness cycles, ▪ RR
✓ Sensory analysis ✓ Alertness, ▪ Digestion
▪ Hearing ✓ Temperature ✓ Relays nerve signals
▪ Taste, regulation between brain &
✓ Consciousness spinal cord
✓ Sleep
✓ Breathing control
Integrative function
 Control of Respiration

Central Regulator
Brainstem (Pons Medulla)
Cortex

Alveolar
ventilation
(PaCO2 &PaO2)

Sensors Effectors

Central Chemoreceptor Diaphragm

Peripheral External intercostal muscle
Chemoreceptor Internal intercostal muscle
Alveolar receptor Accessory muscles

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Control of Respiration
 Control of Respiration
Respiratory Centers
❖ located bilaterally in the medulla oblongata and pons of the brain stem
Apneustic
Pontine Center
Center
Controls intensity of breathing by
promoting prolonged inhalation,
Pneumotaxic
Center

Respiratory
group nuclei
lateral
ventro
Dorsal

Dorsa Ventral
l RG RG
Inspiration Expiration
Respiratory centers of Brainstem
Rhythmicity centre
• Pre-BÖttzinger complex
in the medulla (RRG).
 Medullary respiratory Centre
Inspiratory center (Dorsal Respiratory Group, DRG)
➢ Most of its neurons are located within the nucleus of the tractus solitarius
➢ Transmit sensory signals from: ▪ more frequently they fire, more deeply you inhale
A)Peripheral chemoreceptors,
B) Baroreceptors and ▪longer duration they fire, breath is prolonged, slow rate
C) Several types of receptors in the lungs.
❖ Rhythmical Inspiratory Discharges from Dorsal Respiratory Group
❑ Basic rhythm of respiration is generated mainly in the DRG of
neurons.

❑If peripheral nerves entering in medulla have been sectioned &

the brain stem transacted both above and below the medulla, this
group of neurons still emits repetitive bursts of inspiratory
neuronal action potentials.
 Inspiratory “Ramp” Signal of DRG
Signal is not an instantaneous burst of action potential / “Ramp” Signal.
• Stimulates the Inspiratory muscles to contract (diaphragm).
• It begins weakly and increases steadily in a ramp manner for about 2 seconds.
Then it ceases abruptly for approximately
• In next 3 seconds, which turns off the excitation of the diaphragm and allows
elastic recoil of the lungs and the chest wall to cause expiration.
• Next, the inspiratory signal begins again for another cycle; this cycle repeats
again and again, with expiration occurring in between.

There are two qualities of the Inspiratory ramp that are controlled as follows,
1. Control of the rate of increase of the ramp signal, so that during heavy
respiration, the ramp increases rapidly and therefore fills the lungs
rapidly.

2. Control of the limiting point at which the ramp suddenly ceases. This is
the usual method for controlling the rate of respiration; that is, the earlier the
ramp ceases, the shorter the duration of inspiration.
 Control of Dorsal Respiratory Group
The vagus nerve and glossopharyngeal nerves receive input from:
• Peripheral chemoreceptors
• Baroreceptors
• Several pulmonary receptors
Sensory input can change 2 qualities of the ramp:
• The rate of increase (e.g., increase during heavy breathing to fill lungs
more rapidly).
• The timing of the stop (e.g., stopping the ramp sooner shortens the rate
of inspiration and expiration, thus increasing the frequency of
respiration).

❖ A pneumotaxic center, located dorsally in the nucleus parabrachialis of the upper pons, transmits signals to the
Inspiratory area.

❖ The primary effect of this center is to control the “switch-off” point of the inspiratory ramp, thus controlling the
duration of the filling phase of the lung cycle.
 Ventral respiratory group neuron
❑ Located each side of the medulla, about 5 millimeters anterior and lateral to the dorsal respiratory group of neurons, is
the ventral respiratory group of neurons, found in the nucleus ambiguus rostrally and the nucleus retroambiguus caudally.
❑ Ventral Respiratory Group neurons involved in forced expiration
• Inactive during normal, quiet respiration.
• No evidence that the ventral respiratory neurons participate in the basic
rhythmical oscillation that controls respiration.

• At times of increased ventilation, signals from the dorsal group stimulate

the ventral group nurones.

• The ventral group then stimulates both inspiratory and expiratory

muscles. e.g., it provide powerful expiratory signal to the abdominal
muscles during heavy expiration contract and help force expiration.

➢ Electrical stimulation of a few of the neurons in the ventral group causes inspiration, whereas stimulation of others
causes expiration. Therefore, these neurons contribute to both inspiration and expiration.
➢Thus, VRG operates more or less as an overdrive mechanism when high levels of pulmonary ventilation are required,
especially during heavy exercise.
 Pontine respiratory Centre
Pneumotaxic center (upper pons)
❖ Pneumotaxic center, located dorsally in the nucleus parabrachialis of the upper pons, transmits signals
to the Inspiratory area.

❖The primary effect of this center is to control the “switch-off” point of the Inspiratory ramp.

❖ Sends continual inhibitory impulses to inspiratory center of medulla oblongata.

❖ As impulse frequency rises, breathe faster and slower

Apneustic center (lower pons)

• Stimulation causes apneusis

• Integrates Inspiratory cutoff information
 Pneumotaxic Center
❖ The function of the pneumotaxic center is primarily to limit inspiration.
❖ This has a secondary effect of increasing the rate of breathing, because limitation of inspiration also shortens
expiration and the entire period of each respiration.

❖ When the pneumotaxic signal is strong, inspiration might last for as little as 0.5 second, thus filling the lungs
only slightly; but if the signal is weak than inspiration might continue for 5 or more seconds, thus filling the lungs
with a excess of air.

• Controls stopping point of the dorsal group ramp.

• Strong pneumotaxic stimulation shortens the duration of inspiration
and expiration. Therfore increases the breathing rate.
• Strong pneumotaxic stimulation can increase the rate of breathing to 30-40
breaths/min and weak pneuomotaxic stimulation can decrease the
breathing rate to 3-5 breaths/min.
 Chemical Control of Respiration
• Central Chemoreceptors
– Responsive to increased arterial PCO 2

– Act by way of CSF [H ] .

+

• Peripheral Chemoreceptors
– Responsive to decreased arterial PO 2

– Responsive to increased arterial PCO 2

– Responsive to increased H ion concentration.

+

❖ Excess CO2 or excess H ions in the blood mainly act directly on the respiratory center itself, causing
greatly increased strength of both the inspiratory and the expiratory motor signals to respiratory muscles.

❖ O2, in contrast, does not have a significant direct effect on the respiratory center of the brain in controlling
respiration. Instead, it acts almost entirely on peripheral chemoreceptors located in the carotid and aortic
bodies, and these in turn transmit appropriate nervous signals to the respiratory center for control of
respiration.
 Chemoreceptors in the brainstem:
Dorsal respiratory group of neurons,
CO2
Ventral respiratory group, and X
Pneumotaxic center H2

❖ Instead, an additional neuronal area, a chemosensitive area is located

bilaterally, lying only 0.2 mm beneath the ventral surface of the medulla.
❖ This area is highly sensitive to changes in either blood PCO2 or hydrogen
ion concentration
❖ Hydrogen ions stimulate the chemo-sensitive area, but carbon dioxide
in the fluid gives rise to most of the hydrogen ions.
❖ CO2 easily penetrate the blood brain barrier combining with water to
form H2CO3 which dissociate to give H+ and HCO3. Hydrogen ion stimulate
receptors sensitive to it, stimulating respiration, leading to loss of CO2 and
consequently a drop in PaCO2.

❖Sever drop in PaO2 (<60) stimulate these receptors.

 Peripheral Chemoreceptors
• Carotid chemoreceptors:

Near carotid bifurcation. It has two types of cells I & II. Impulses carried
by the glossopharyngeal nerve & carotid sinus to the medulla.
• More sensitive to drop of O2 by type I cells.
• Type I cells contain dopamine which is released in response to low O2.
• When the oxygen concentration in the arterial blood falls below normal,
the chemoreceptors become strongly stimulated.

❖ Impulse rate is particularly

sensitive to changes in arterial Po2 in
the range of 60 down to 30 mm Hg, a
range in which Hb saturation with
oxygen decreases rapidly

❑ The exact means by which low Po2 excites the nerve endings in the carotid and aortic bodies is still unknown
Control of Respiration of Brain stem
Control Respiration of Brain stem Summary

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 Brain-Heart Axis

❑ Baroreceptors in CVS can detect changes in pH or

stretch response and send signals to the CVC.

❑ Blood pressure = Cardiac output (CO) x TPR

= (HR x SV ) x TPR

Cardiac output = BP/TPR

 Brain stem control on Heart

1. Baroreceptors located in the aortic

arch and internal carotid arteries detect
a rise in blood pressure and increase
their firing rate

2. These signals reach the nucleus

tractus solitarius in the medulla;

3. Nucleus tractus solitarius sends

signals to the sinoatrial node of the
heart via the vagus nerve to slow its
rate of contraction.
Blood pressure regulation
Role of Brainstem in Blood pressure control
1. Baroreceptors are located in aortic arch and carotid sinuses.
2. The baroreceptors send afferent fibers via glossopharyngeal
nerve to the nucleus tractus solitarius in the dorsal medulla in
the brainstem.
3. Efferent cardiovascular neurons send projections to the
medulla and spinal cord.
4. Baroreflex loop results in activation of sympathetic or
parasympathetic fibers to the heart, the smooth muscle of the
peripheral blood vessels, and other organs such as the kidney
to maintain arterial pressure at normal levels.
5. Increased pressure stimulates baroreceptors, which
attenuates the sympathetic outflow to the peripheral vessels
and the heart, restoring pressure to normal levels.
6. The parasympathetic influence will dominate which is
mediated by acetylcholine.
7. Decrease in pressure relieves baroreceptors and increases
sympathetic outflow. Sympathetic activation causes a release
of noradrenaline that leads to vasoconstriction and increased
cardiac output and hence an increased blood pressure
Brain stem control on Heart

@ Kind curtesy from Dr. Maziah Mat Rosly

Medullary regulation of BP

@ Kind curtesy from Dr. Maziah Mat Rosly

Thanks