Red Nucleus

The red nucleus occupies a large portion of the ventral midbrain tegmentum rostrally and contains very large

Stroke Red Nucleus

Figure 9 Blood supply of the midbrain. (A) Sagittal section of the human brain showing the horizontal plane of the brain stem sections of (B) and (C). (B) and (C) show serial sections of a patient who suffered a midbrain stroke (arrows) resulting from hemorrhage of a perforating branch of the P2 segment of the posterior cerebral artery on the left (L). Initially the patient experienced bilateral loss of eye movement, bilateral inability to open the eyes (ptosis), and mild weakness of the right upper extremity. The blood has cleared by the time of the MRI study and there is no evidence of infarction of the occipital lobes or other regions supplied by this artery. (D, E, and F) Caudal to rostral outline drawings showing the differential blood supply of the midbrain. (G) Schematic drawing of blood supply to the midbrain. Paramedian branches arise directly from the basilar artery, whereas the remaining blood supply arises from proximal (P1) and distal (P2) branches of the posterior cerebral artery. See Table I.

Figure 9 Blood supply of the midbrain. (A) Sagittal section of the human brain showing the horizontal plane of the brain stem sections of (B) and (C). (B) and (C) show serial sections of a patient who suffered a midbrain stroke (arrows) resulting from hemorrhage of a perforating branch of the P2 segment of the posterior cerebral artery on the left (L). Initially the patient experienced bilateral loss of eye movement, bilateral inability to open the eyes (ptosis), and mild weakness of the right upper extremity. The blood has cleared by the time of the MRI study and there is no evidence of infarction of the occipital lobes or other regions supplied by this artery. (D, E, and F) Caudal to rostral outline drawings showing the differential blood supply of the midbrain. (G) Schematic drawing of blood supply to the midbrain. Paramedian branches arise directly from the basilar artery, whereas the remaining blood supply arises from proximal (P1) and distal (P2) branches of the posterior cerebral artery. See Table I.

cells. It is primarily involved in limb control especially during reaching movements. The dentate and interposed nuclei of the cerebellum provide a large number of afferents to the red nucleus via the superior cerebellar peduncle (brachium conjuctivum). The other major input to the red nucleus comes from the motor cortex. Outputs of the red nucleus include two major descending tracts, one to the spinal cord (crossed) and one to the inferior olive (uncrossed).

Lesions within the red nucleus lead to fascicular third nerve palsies, which can involve separate divisions of the oculomotor nerve, as well as contralateral ataxia (Benedikt's syndrome). The ataxia is thought to develop from interruption of both the rubro-olivary and the dentatothalamic fibers, which travel in the adjacent brachium conjunctivum. More ventral strokes that spare the red nucleus may produce a fascicular third nerve palsy and a contralateral hemi-paresis (Weber's syndrome).

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