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Clinical Neuroanatomy pp 211–247Cite as

The Reticular Formation and Some Related Nuclei

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Abstract

Almost a century ago, Constantin von Economo observed that in patients with encephalitis lethargica, lesions in the upper brain stem and posterior hypothalamus impaired consciousness. From lesion studies in cats and anatomical data, the idea arose that the brain stem reticular formation is the origin of the ascending reticular activating system (ARAS) that would operate through the intralaminar nuclei and activate widespread regions of the cerebral cortex. This view of the reticular formation has been extensively modified and nowadays four main components of the brain stem reticular formation can be distinguished: (1) the classic reticular nuclei (Sect. 5.2); (2) monoaminergic nuclei such as the serotonergic raphe nuclei, the noradrenergic locus coeruleus and noradrenergic cell groups of the lower brain stem (Sect. 5.3); (3) cholinergic nuclei in the mesopontine tegmentum, including the laterodorsal and pedunculopontine tegmental nuclei (Sect. 5.4) and (4) autonomic nuclei such as the parabrachial nucleus, the periaqueductal grey and the nucleus of the solitary tract.

Although the basic notion of the ARAS concept, that structures in the brain stem regulate states of consciousness, still holds true, a much more complex picture has emerged. Experimental work in laboratory animals suggests that the following structures play key roles in the maintenance and modulation of wakefulness: cholinergic nuclei in the upper brain stem and basal forebrain; noradrenergic nuclei, in particular the locus coeruleus; a histaminergic projection from the tuberomammillary nucleus in the posterior hypothalamus; and dopaminergic and serotonergic pathways from the ventral tegmental area and raphe nuclei, respectively. These nuclei all participate in an ascending activating system to the cerebral cortex (Sect. 5.5). The hypothalamus also contains orexinergic neurons, that are crucial for maintaining normal wakefulness, and a sleep-promoting region in the ventrolateral preoptic area. These groups have mutually inhibiting connections, known as the sleep switch (Sect. 5.6). Some sleep disorders in which these structures are involved are discussed in Clinical cases (Sect. 5.7). Damage to the upper brain stem reticular formation is known to cause the most radical disturbance of consciousness, i.e. coma, as illustrated in several Clinical cases (Sect. 5.7).

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    Hans J. ten Donkelaar

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ten Donkelaar, H.J. (2011). The Reticular Formation and Some Related Nuclei. In: Clinical Neuroanatomy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-19134-3_5

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