bulbar

• adj.

• 延髄性の
• 延髄性の、延髄の、眼球の

関

eyeball、globe、medullary、ocular

関

medulla oblongata 延髄

　

WordNet

1. involving the medulla oblongata; "bulbar paralysis"
2. visible; "be sure of it; give me the ocular proof"- Shakespeare; "a visual presentation"; "a visual image" (同)visual
3. of or relating to or resembling the eye; "ocular muscles"; "an ocular organ"; "ocular diseases"; "the optic (or optical) axis of the eye"; "an ocular spot is a pigmented organ or part believed to be sensitive to light" (同)optic, optical, opthalmic
4. relating to or using sight; "ocular inspection"; "an optical illusion"; "visual powers"; "visual navigation" (同)optic, optical, visual
5. a sphere on which a map (especially of the earth) is represented
6. of or relating to the medulla of any body part
7. containing or consisting of or resembling bone marrow
8. of or relating to the medulla oblongata
9. a modified bud consisting of a thickened globular underground stem serving as a reproductive structure
10. anything with a round shape resembling a teardrop
11. a rounded part of a cylindrical instrument (usually at one end); "the bulb of a syringe"
12. a rounded dilation or expansion in a canal or vessel or organ

PrepTutorEJDIC

1. 《文》目の / 《まれ》視覚の,目で見た / (顕微鏡・望遠鏡などの)接眼レンズ,接眼鏡
2. 〈C〉『球』,球体 / 《the ~》『地球』(the earth) / 〈C〉『地球儀』 / 〈C〉球形のガラス器(ガラス鉢・ランプのほや・金魚鉢など)
3. 『球根』(ユり・タマネギなどの地下茎),りん(鱗)茎,球茎 / 球根状のもの;電球,真空管

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/01 14:11:57」(JST)

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[Wiki en表示]

Medulla oblongata
Medulla oblongata purple, part of the brain stem colored
Section of the medulla oblongata at about the middle of the olivary body.
Details
Latin	Medulla oblongata
Part of	Brain stem
Identifiers
Gray's	p.767
MeSH	A08.186.211.132.810.406
NeuroNames	hier-695
NeuroLex ID	Medulla oblongata
Dorlands /Elsevier	m_06/12519731
TA	A14.1.03.003
FMA	62004
Anatomical terms of neuroanatomy

The medulla oblongata (or medulla) is located in the hindbrain, anterior to the cerebellum. The medulla oblongata is a cone-shaped neuronal mass responsible for multiple autonomic functions ranging from vomiting to involuntary functions such as sneezing. The medulla contains the cardiac, respiratory, vomiting and vasomotor centers and therefore deals with the autonomic (involuntary) functions of breathing, heart rate and blood pressure.

The bulb is an archaic term for the medulla oblongata and in modern clinical usage the word bulbar (as in bulbar palsy) is retained for terms that relate to the medulla oblongata, particularly in reference to medical conditions. The word bulbar can refer to the nerves and tracts connected to the medulla, and also by association to those muscles innervated, such as those of the tongue, pharynx and larynx.

Anatomy

Medulla oblongata (animation)

Medulla and parts (10-16) - (10) pyramid; (11) the anterior median fissure; (15) is the choroid plexus in the fourth ventricle; (13) olive and (7) the pons

Medulla-animated as it protrudes from the foramen magnum of the skull-base, after which it gives rise to the spinal cord.

The medulla can be thought of as being in two parts:

• an open part or superior part where the dorsal surface of the medulla is formed by the fourth ventricle.
• a closed part or inferior part where the fourth ventricle has narrowed at the obex in the caudal medulla, and surrounds part of the central canal.

External surfaces

The anterior median fissure contains a fold of pia mater, and extends along the length of the medulla oblongata. It ends at the lower border of the pons in a small triangular area, termed the foramen cecum. On either side of this fissure is a raised area termed the pyramid of medulla oblongata. The pyramids house the pyramidal tracts–the corticospinal and the corticobulbar tracts of the nervous system. At the caudal part of the medulla these tracts cross over in the decussation of the pyramids obscuring the fissure at this point. Some other fibers that originate from the anterior median fissure above the decussation of the pyramids and run laterally across the surface of the pons are known as the anterior external arcuate fibers.

The region between the anterolateral and posterolateral sulcus in the upper part of the medulla is marked by a pair of swellings known as olivary bodies (also called olives). They are caused by the largest nuclei of the olivary bodies, the inferior olivary nuclei.

The posterior part of the medulla between the posterior median sulcus and the posterolateral sulcus contains tracts that enter it from the posterior funiculus of the spinal cord. These are the gracile fasciculus, lying medially next to the midline, and the cuneate fasciculus, lying laterally. These fasciculi end in rounded elevations known as the gracile and the cuneate tubercles. They are caused by masses of gray matter known as the gracile nucleus and the cuneate nucleus. The perikarya or cell bodies in these nuclei are the second-order neurons of the posterior column-medial lemniscus pathway, and their axons, called the internal arcuate fibers or fasciculi, decussate from one side of the medulla to the other to form the medial lemniscus.

Just above the tubercles, the posterior aspect of the medulla is occupied by a triangular fossa, which forms the lower part of the floor of the fourth ventricle. The fossa is bounded on either side by the inferior cerebellar peduncle, which connects the medulla to the cerebellum.

The lower part of the medulla, immediately lateral to the cuneate fasciculus, is marked by another longitudinal elevation known as the tuberculum cinereum. It is caused by an underlying collection of gray matter known as the spinal trigeminal nucleus. The gray matter of this nucleus is covered by a layer of nerve fibers that form the spinal tract of the trigeminal nerve.

The base of the medulla is defined by the commissural fibers, crossing over from the ipsilateral side in the spinal cord to the contralateral side in the brain stem; below this is the spinal cord.

Blood supply

Blood to the medulla is supplied by a number of arteries.

• Anterior spinal artery: This supplies the whole medial part of the medulla oblongata.
• Posterior inferior cerebellar artery: This is a major branch of the vertebral artery, and supplies the posterolateral part of the medulla, where the main sensory tracts run and synapse. It also supplies part of the cerebellum.
• Direct branches of the vertebral artery: The vertebral artery supplies an area between the other two main arteries, including the solitary nucleus and other sensory nuclei and fibers.

Development

The medulla oblongata forms in fetal development from the myelencephalon. The final differentiation of the medulla is seen at week 20 gestation.

Neuroblasts from the alar plate of the neural tube at this level will produce the sensory nuclei of the medulla. The basal plate neuroblasts will give rise to the motor nuclei.

• Alar plate neuroblasts give rise to:
  • The solitary nucleus, which contains the general visceral afferent fibers for taste, as well as the special visceral afferent column.
  • The spinal trigeminal nerve nuclei which contains the general somatic afferent column.
  • The cochlear and vestibular nuclei, which contain the special somatic afferent column.
  • The inferior olivary nucleus, which relays to the cerebellum.
  • The dorsal column nuclei, which contain the gracile and cuneate nuclei.
• Basal plate neuroblasts give rise to:
  • The hypoglossal nucleus, which contains general somatic efferent fibers.
  • The nucleus ambiguus, which form the special visceral efferent.
  • The dorsal nucleus of vagus nerve and the inferior salivatory nucleus, both of which form the general visceral efferent fibers.

Function

The medulla oblongata connects the higher levels of the brain to the spinal cord, and is responsible for several functions of the autonomous nervous system, which include:

• Respiration – chemoreceptors. These chemoreceptors detect changes in acidity of the blood, thus if the blood is considered too acidic by the medulla oblongata electrical signals are sent to intercostal and phrenical muscle tissue increasing their contraction rate in order to reoxygenate the blood.
• Cardiac center – sympathetic, parasympathetic nervous system
• Vasomotor center – baroreceptors
• Reflex centers of vomiting, coughing, sneezing, and swallowing. These reflexes which include the pharyngeal reflex, the swallowing reflex (also known as the palatal reflex), and the masseter reflex can be termed, bulbar reflexes.

Clinical significance

A blockage (such as in a stroke) will injure the pyramidal tract, medial lemniscus, and the hypoglossal nucleus. This causes a syndrome called medial medullary syndrome.

Lateral medullary syndrome can be caused by the blockage of either the posterior inferior cerebellar artery or of the vertebral arteries.

Other animals

Both lampreys and hagfish possess a fully developed medulla oblongata. Since these are both very similar to early agnathans, it has been suggested that the medulla evolved in these early fish, approximately 505 million years ago. The status of the medulla as part of the primordial reptilian brain is confirmed by its disproportionate size in modern reptiles such as the crocodile, alligator, and monitor lizard.

Additional images

• Lobes

• Anteroinferior view of the medulla oblongata and pons.

• Section of the medulla oblongata through the lower part of the decussation of the pyramids

• Section of the medulla oblongata at the level of the decussation of the pyramids.

• Base of brain.

• Diagram showing the positions of the three principal subarachnoid cisternæ.

• Medulla oblongata

• Spinal cord. Brachial plexus. Cerebrum.Inferior view.Deep dissection

• Micrograph of the posterior portion of the open part of the medulla oblongata, showing the fourth ventricle (top of image) and the nuclei of CN XII (medial) and CN X (lateral). H&E-LFB stain.

References

• Haycock DE (2011). Being and Perceiving. Manupod Press. ISBN 978-0-9569621-0-2. 

External links

• Stained brain slice images which include the "medulla" at the BrainMaps project

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 筋萎縮性側索硬化症およびその他の運動ニューロン疾患の臨床的特徴 clinical features of amyotrophic lateral sclerosis and other forms of motor neuron disease
• 2. 重症筋無力症の臨床症状 clinical manifestations of myasthenia gravis
• 3. 神経筋疾患による呼吸筋の筋力低下：臨床症状および評価 respiratory muscle weakness due to neuromuscular disease clinical manifestations and evaluation
• 4. 筋萎縮性側索硬化症およびその他の運動ニューロン疾患の診断 diagnosis of amyotrophic lateral sclerosis and other forms of motor neuron disease
• 5. 男性における尿道狭窄疾患の治療 treatment of urethral stricture disease in men

English Journal

• Reversible tongue muscle atrophy accelerated by early initiation of immunotherapy in anti-MuSK myasthenia gravis: A case report.

• Kitamura E1, Takiyama Y2, Nakamura M3, Iizuka T4, Nishiyama K5.
• Journal of the neurological sciences.J Neurol Sci.2016 Jan 15;360:10-2. doi: 10.1016/j.jns.2015.11.032. Epub 2015 Nov 18.
• PMID 26723963

• Anxiety- and Depression-Like States Lead to Pronounced Olfactory Deficits and Impaired Adult Neurogenesis in Mice.

• Siopi E1, Denizet M1, Gabellec MM1, de Chaumont F2, Olivo-Marin JC2, Guilloux JP3, Lledo PM4, Lazarini F4.
• The Journal of neuroscience : the official journal of the Society for Neuroscience.J Neurosci.2016 Jan 13;36(2):518-31. doi: 10.1523/JNEUROSCI.2817-15.2016.
• Numerous clinical reports underscore the frequency of olfactory impairments in patients suffering from major depressive disorders (MDDs), yet the underlying physiopathological mechanisms remain poorly understood. We hypothesized that one key link between olfactory deficits and MDD lies in hypercorti
• PMID 26758842

• MiR-298 Counteracts Mutant Androgen Receptor Toxicity in Spinal and Bulbar Muscular Atrophy.

• Pourshafie N1, Lee PR2, Chen KL1, Harmison GG1, Bott LC1,3, Katsuno M4, Sobue G4,5, Burnett BG6, Fischbeck KH1, Rinaldi C1,7.
• Molecular therapy : the journal of the American Society of Gene Therapy.Mol Ther.2016 Jan 12. doi: 10.1038/mt.2016.13. [Epub ahead of print]
• Spinal and bulbar muscular atrophy (SBMA) is a currently untreatable adult-onset neuromuscular disease caused by expansion of a polyglutamine repeat in the androgen receptor (AR). In SBMA, as in other polyglutamine diseases, a toxic gain of function in the mutant protein is an important factor in th
• PMID 26755334

Japanese Journal

• Stereoscopic Three-Dimensional Images of an Anatomical Dissection of the Eyeball and Orbit for Educational Purposes

• Matsuo Toshihiko,Takeda Yoshimasa,Ohtsuka Aiji
• Acta Medica Okayama 67(2), 87-91, 2013-04-00
• … The upper and lower eyelids were removed to expose the bulbar conjunctiva and to insert three 25-gauge trocars for vitrectomy at the location of the pars plana. …
• NAID 120005232497

• 急性期に咽後膿瘍様の所見を呈した川崎病の一例

• 時沢 亜佐子[他]
• 長崎醫學會雜誌 : Nagasaki Igakkai zasshi 88(1), 65-70, 2013-03-25
• 咽後膿瘍は主要症状が揃わない、いわゆる不全型川崎病に合併することがあり、しばしば診断に苦慮する。今回の症例は5歳男児。発熱2日目(2病日)に頸部痛、嚥下痛を主訴に来院し、炎症反応高値のため入院した。入院時に認めた川崎病主要症状は発熱、両側頸部リンパ節腫脹、軽度の眼球結膜充血のみであり、心エコーでも異常を認めなかった。化膿性頸部リンパ節炎と考え抗菌薬を投与するも解熱せず、3病日に頭頸部CTを実施した …
• NAID 110009577960

• Expression of vascular endothelial growth factor C in human pterygium

• Fukuhara Junichi,Kase Satoru,Ohashi Tsutomu,Ando Ryo,Dong Zhenyu,Noda Kousuke,Ohguchi Takeshi,Kanda Atsuhiro,Ishida Susumu
• Histochemistry and Cell Biology 139(2), 381-389, 2013-02-00
• … Methods: Fifteen primary nasal pterygia and three normal bulbar conjunctivas, surgically removed, were examined in this study. …
• NAID 120005228265

Related Links

• bulbar - 辞書すべて - goo辞書

bulbarの意味は？goo辞書は無料で使える日本最大級の辞書サービスです。国語辞典、英和辞典、和英辞典、類語辞典、中国語辞典、百科事典などを提供しています。 ... シラー 名言一覧 | Wiki 迷い、夢見ることをはばかるな。高い志向は ...

• bulbarの意味 - 英和辞書 - goo辞書

bulbarとは。意味や和訳。[形]球状[球根, 鱗茎(りんけい), 延髄]の. - goo辞書は国語、英和、和英、中国語、百科事典等からまとめて探せる辞書検索サービスです。 ... 辞書すべて 国語 類語 英和 和英 中日 日中 ※「説明文に含む ...

Related Pictures

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★リンクテーブル★

リンク元	「100Cases 14」「ocular」「globe」「medullary」「延髄性」
拡張検索	「pseudobulbar syndrome」「juvenile progressive bulbar paralysis」
関連記事	「bulb」

「100Cases 14」

　　[★]

☆case14　複視

■glossary

diplopia n. 複視

筋力低下、筋無力、筋脱力 muscle weakness, muscular weakness

sunken

vt. sinkのpp.

adj.

沈没した、沈んだ、水中の

沈下した、一段低いところにある

落ち込んだ、くぼんだ

3,4-ジアミノピリジン 3,4-diaminopyridine 3,4-DAP K+チャネル阻害薬;ランバート・イートン筋無力症治療

■症例

43-year-old woman

cheif complaint: diplopia

present history: diplopia and holding her head up ; more marked in the evenings, for the last 3 months. difficulty of chewing. voice has become quieter. weight loss (3kg / 6months). non-smoker. drinks about 15 units/week. no regular medication.

past history: no significant previous medical illnesses.

family history: lives with her husband and three children.

・診察 examination

looks well.

organ systems: normal; cardiovascular, respiratory, and abdominal systems.

muscle power; grossly normal. decrease after testing a movement repetitively.

motor function: normal; tone, coordination, reflexes and sensation.

bilateral ptosis. exacerbated by prolonged upward gaze

eye: normal; pupillary reflexes, eye movements, and funduscopy

■答え

diagnosis: myathenia gravis

differential diagnoses:

CASES

上位and/or下位運動ニューロン motor neurone disease　運動ニューロン疾患：線維束性攣縮。進行例では筋力低下

筋 muscular dystrophy　筋ジストロフィー：ある種の筋肉が選択的に筋力低下する。家族歴がある。

筋 dystrophia myotonica　強直性筋ジストロフィー：咬筋、側頭筋、胸鎖乳突筋の筋萎縮、四肢遠位端の筋萎縮。顔貌が特徴的(前頭部脱毛、無表情、窪んだ頬)。家族歴ある。筋電図が診断に有用(急降下爆撃音)。

筋 polymyositis　多発筋炎：普通は皮疹と関節痛が出現。CKが上昇。筋生検が診断に有用

筋 myopathy　ミオパチー：甲状腺中毒性ミオパチー、甲状腺機能低下症によるミオパチー、クッシング症候群によるミオパチー、アルコール性のミオパチー

神経筋接合部？ non-metastatic associations of malignancy (paraneoplastic syndrome(傍腫瘍性症候群 = 腫瘍随伴症候群)のこと)：胸腺腫の症例の10%に重症筋無力症がみられる。ランバート・イートン筋無力症症候群は小細胞癌と関連がある。

HIM.2674

• 神経筋接合部 congenital myasthenia syndrome　先天性筋無力症症候群
• 神経筋接合部 drug-induced myasthenia　薬剤性筋無力症

Treatment with penicillamine (used for scleroderma or rheumatoid arthritis) may result in true autoimmune MG, but the weakness is usually mild, and recovery occurs within weeks or months after discontinuing its use.

　重症筋無力症の誘発：ペニシラミン(強皮症や関節リウマチの治療に用いられる)。

　　mildだし、薬剤の中断で改善する。

Aminoglycoside antibiotics or procainamide can cause exacerbation of weakness in myasthenic patients; very large doses can cause neuromuscular weakness in normal individuals.

　重症筋無力症の悪化：アミドグリコシド系抗菌薬、プロカインアミド

　　MGの患者の筋脱力が悪化する。

• 神経筋接合部 Lambert-Eaton myasthenic syndrome　ランバート・イートン筋無力症症候群：全身の筋肉が冒されるが、特に下肢の近位筋が冒される。MGと同じように～70%の患者で脳神経所見(眼瞼下垂、複視など)が認められる。MGと違うのは(1)反射が消失・減弱すること、(2)自律神経系の変化(口渇、勃起不全)を生じる、(3)神経刺激検査で漸増(waxing)が見られることである。病因は神経筋接合部のP/Q type calcium channelsに対する抗体の出現であり、85%の患者で見いだされる。治療はMGのように血漿交換や免疫抑制薬が使われる。3,4-DAPやpyridostigmineは症状に対する治療のために用いる。前者は運動神経の終末部でカルシウムチャネルをブロックし活動電位を延長させる。後者はアセチルコリンエステラーゼを阻害してシナプスにおける神経伝達物質の濃度を上げる。
• 精神疾患 neurasthenia　神経衰弱症：歴史的な用語。器質的な障害を伴わない筋無力症のような脱力を伴う症候群。患者は筋脱力や疲労を訴えてやってくる。筋肉の検査では器質的変化は認めないが"jerky release"あるいは"give-away weakness"が認められる。患者の主訴は反復動作による筋力低下よりむしろ疲労や感情鈍麻である。
• 内分泌疾患 hyperthyroidism　甲状腺機能亢進症：MGが疑われる患者にはthyroid function testをルーチンにやる。甲状腺機能異常は筋無力症の筋力低下を大きくすることがある。
• 神経筋接合部 botulism　ボツリヌス症：ボツリヌス毒素はシナプス前膜からの神経伝達物質の開口分泌を妨げる。症状はbulbar weakness (複視、構音障害、嚥下困難)。感覚障害はない。深部腱反射は初期には保たれている。進行すれば反射は見られなくなる。筋脱力は全身性。呼吸困難に陥ることがある。精神状態は正常。自律神経症状(麻痺性イレウス、便秘、urinary retention、瞳孔の散大、瞳孔の反応性低下、口渇)。確定診断は血清中の毒素の検出だけど、見つかることはまれ。神経伝導検査(nerve conduction studies)：compound muscle action potentials (CMAPs)の低下。高頻度の刺激で振幅が増加。治療：intubation for airway protection、呼吸補助、aggressive inpatient supportive care(e.g., nutrition, DVT prophylaxis)。馬の抗毒素を検査結果が帰ってくる前に投与する(？)。
• 上位運動ニューロン intracranial mass lesions　頭蓋内占拠病変：複視はintracranial mass lesionが外眼筋の神経を圧迫することにより生じる。
• 筋 progressive external ophthalmoplegia　進行性外眼筋麻痺：外眼筋の筋脱力を伴う。四肢の近位筋の筋力低下やそのほかの全身症状を伴うことがある。ミトコンドリアの異常を有する。

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「ocular」

　　[★]

• adj.

• 視覚の、眼球の、接眼の、接眼レンズ

関

bulbar、eyeball、eyepiece、globe、optic、vision、visual

　 　 　 　

「globe」

　　[★]

• 球、眼球、地球

関

ball、bulb、bulbar、earth、eyeball、globus、ocular、sphere

　 　

「medullary」

　　[★]

• adj.

• 延髄の、延髄性の、髄質の、髄質性の

関

bulbar、medulla、medulla oblongata

　 　 　

「延髄性」

　　[★]

英

medullary、bulbar

関

延髄、眼球、髄質、髄質性

「pseudobulbar syndrome」

　　[★]

仮性球麻痺症候群、偽性球麻痺症候群

関

pseudobulbar palsy

「juvenile progressive bulbar paralysis」

　　[★] 若年性進行性球麻痺

「bulb」

　　[★]

• n.

• 球、(植物)鱗茎

関

ball、globe、globus、sphere、olfactory bulb