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Hi, everyone. Thank you for joining us this evening. Um So today we'll be going through cranial nerve with Mister Pit. We're trying a slightly different layout this time. So you'll all be able to unmute yourselves during the session and answer any questions the speaker may um ask and you can also ask any questions that you may have. So we're trying to make this a bit more interactive. Um I'll pass on to re pole now and we'll soon be start. Hi. Yeah. Thank you everyone for joining. So, for the first year running, we're running this series on metal, which means we have a live audience from all over the world and we also decided to really the structure of the talk slightly. So last week, for those of you who joined us, we had the spinal cord and this week we're working up anatomically from this to the brain stem and then in future talks upwards integrating clinical cases into all of our sessions and in the and clinical cases within each session. And it's my pleasure this week to introduce Mister Pandit, we will continue our deep dive into neuroanatomy by exploring by exploring cranial nerve and spinal ba and skull base anatomy. Sorry. Uh Mr Pandit is a senior academic neurosurgical registrar National Hospital. And his research specializes in the use of advanced imaging complemented by machine learning methods to better neuroscience education. And I will hand over to him now. Thank you. Uh Thanks for the kind introduction and um the opportunity to teach on this course. Again, I enjoyed it last time and I think the students who came or the few who did actually enjoyed it as well. Uh This is a bit of a different, um set up to the usual sort of zoom and teams thing. Um As I think the speakers have said, II can't really see the chat. I won't be looking at the chat. So if you do have a question, just mute and um and ask, um also I can't see your faces because I guess it's, you know, your viewers or I don't know, ers or peers or how you, however you wanna call it. So it's a bit difficult to work out. Um who's doing what the, the way I learn anatomy is and ma many of do this is through drawing. Uh And I will ask you to draw. Um That's sort of the point. I mean, you can obviously read lots of textbooks and look at things online and watch videos. But um obviously you're here to sort of learn a bit more as well. So what I would suggest is that. I've got two videos up. One is me chatting here. It's not the interesting one. it's not my face, it's the one which is down here where you can probably see my hand in a piece of paper and that's where I'm gonna be drawing a few things to sort of illustrate concepts. So I'll just give you like, 30 seconds just to grab, um, you know, a piece of paper and a pen pencil, blood, er, biro, er, crayon, whatever it is, but you'll need something to draw with. Otherwise this is gonna become a really tedious session if you're just having to listen to me. Um, and so hopefully by the end of this, you'll have taken this away and obviously you have, you'll take away some artwork that you can give your Children or parents or whatever it is as well. But uh hopefully it's something you can take away to learn from. So I'll just give you 30 seconds to do that. I can see a few familiar faces in the participant list. Almost certainly gonna be picking on you. I'm just joking. Ok. So hopefully you got a piece of paper. Uh, um, if you just joined, er, please just get one, soon. So we're looking at the anatomy of the cranial nerves. This is obviously a massive tasker in terms of the potential content. And um, maybe I can use some of the features here. I've never done this before. So you'll have to, excuse me. But, uh, where is this? Um, I'm just gonna do a quick poll. Uh, what level are you at? And I've got pre glen med student, clean Med student and, er, graduate. So if you just um, vote, er, now, er, that'll be useful for me so I can tailor the, the talk accordingly. I'll just give that about 10 seconds. Ok. So it looks like a mixture of clinical medical students. Ok. There's some pre clinical medical students as well. Ok, cool. So if you haven't voted already, that's fine. So it looks like there's actually equal numbers of each which is a bit annoying. So I'll try and um I'll try my best to sort of appeal to everyone as you've probably seen. I mean, cranial nerves is enormous. Um And I think there's a good way and a bad way of learning it. II would say the good way is that you try and interlace like bits like knowledge and one on top of each other. And I think it's very easy to do that with cranial nerves and you can repeat but repeat the information in different ways and we'll do that today and I'll hopefully give you a framework by which to learn about them and then never forget it. Um There will always be some bit of cranial nerves you always remember from medical school. Um or if you've graduated or if you're within medical school that gets you remember. And the aim is to sort of use that as a hanger to, to attach your knowledge, um, to build up er, your knowledge in other areas. And so what I mean by that is, is that if you take your, you know, cranial nerve, uh, let me just turn this a little bit to make it easier on myself. Uh, yeah. So cranial nerves, you can sort of divide it into different areas which you're trying to understand. The simplest thing that most people remember is the tests. So you remember your cranial nerve exam, doing your neurological examination as part of your Aussies or your finals or you know, if you're on the wards. So we call that, you know, your functional tests and obviously, with function, I don't know if you can see that. Hopefully you can, I think you can zoom in the, the what test individual screen. So make sure you do that otherwise it's gonna be really difficult to see. And then if you've got function, then of course, you've got dysfunction. Um So if you remember the test of how to assess the cranial nerves, then of ob obviously, there will be abnormalities which are associated with that. And most people can remember this and that's probably like the top level of their knowledge. The other thing which is superficial is that they can also remember the names using various sordid and politically incorrect and correct types of names. But that's obviously one level, then you have the brainstem nuclei, you have the pathways, you have the targets, you have the sources, you have embryology and what I, what I would also call sort of atlas structures. And this is more of those who are interested in neurosurgery, particularly, like exactly how does the nerve form as it exits from the nuclei and er goes via its pathway either intracranially or extracranially towards its target. And so that's like, you know, here, we've got sort of nine different ways that you can learn the nerve and you just need to like stick with it one and everything else will sort of come about. And hopefully, this is a model by which you can use to sort of learn any of the cranial nerves and then associated nuclei. And with that, you can sort of build up your knowledge. And that would be the best way I would recommend we're obviously not gonna have time for everything. But uh hopefully you'll get an idea of this sort of type of model and this is kind of the way that I learnt it. Um but it gets it much, much easier with time. So let's take the absolutely most obvious that everyone starts off with in terms of the names. So, yeah, II remember the 1234341234. OK. So you probably remember this is probably the starting point. It's, this is very obvious I'm obviously, yeah, I'll be, you know, I'm not trying to make you suck eggs or anything but there'll be, there'll be a reason behind this. So there's different, um, mnemonics you can use. Obviously there's ones that everyone, I always remember the most, er, like darkest humor just because that was the nature of my medical school and that's the way we were taught. Um, but I think there's like politically correct ones and I think you can say there's 000 to touch and feel er very green vegetables. Uh He, so that's the names of your nerves. So let's just be obvious. So, olfactory, optic oculomotor trochlear, er trigeminal abducens, facial, er vestibulo cochlear, glossopharyngeal vagus, er accessory ie er spinal and cranial accessory and hypoglossal nerve. I'm sure everyone on this call knows that. Super, super easy. So let's take this a step forward. There's another mono mnemonic, which is quite useful as well. And that's to describe the functions of these nerves, all of this will build up in a second. So you have three basic sort of or four basic types of nerves that you can describe. You can either have motor, you can have sensory, you can have both and you can have parasympathetic. So let's just take motor and sensory. So this is quite easy. So, olfactory must be sensory, I'll just put s for now just to make it a bit more obvious optic sensory, ocular motor. Well, there's a bit of motor in that. So it must be motor trochlear, motor, by the way, if I'm, if my hand is obscuring the page, I can't actually see what I'm writing, but, oh, just let me know if the page sort of goes off because I'm sort of writing out an angle, by the way. Um No, it's, it was better before. Yeah, like that. Like that. Yeah. OK. All right. All right. I'll try and keep it to the sort of this part of the patient. Uh So where do we go? Um So describing sensory motor. So trigeminal is both A B er facial er sorry obducens, er motor, facial, both vestibular cochlear sensory, gross, both vagus, both accessory motor and hypoglossal motor. And hopefully that also isn't, you know, too much of a reach to remember. But if that was a struggle because you're not on off the top of your head, then there's two ways of remembering that either you need to go back and think of what was the test that you did when you did your rosy. So, olfactory, you know, you got them to smell some coffee or ammonia or something. There's actually distinguishing between, you know, problems with the cribriform plate and olfactory nerve, but that's for another time, optic nerve, of course, you give them a snellen shot or Aihara test. So obviously, those are both sensory oculomotor. So 34 and six, you're asking them to move their um it to check their eye movements by, you know, looking at er, sort of a white or red, er, pins stick and asking them to move around trigeminal. Um, as you probably recall has two functions when you're testing in, in a cranial nerve examination, one is that you assess the face so you touch um the sides of the face in their distribution. So V one V two V three distributions, but of, of course, if you remember correctly, the trigeminal also supplies the muscles of mastication. So you should be feeling for a glaw uh jaw clench as well. And obviously taking a step further, you have, you know, the blink reflex, which is a 57 reflex. So you've got a, a few different things going on with the trigeminal but clearly you can see it's motor and sensory abducens we've already spoken about. It's a motor as part of the motor sequence. Facial. Again, it's er, or your muscles are facial expression, but also you have er a few other things as well. It's got a little sensory branch going to the ear, er it has er specific functions going for sort of tears and taste. Um And so there's a few sensory functions as well which we'll come back to in a moment. Facial is a particularly complicated nerve, er vestibulo cochlear obviously, that's a sensory glossopharyngeal. Er, again, it has a sensory function uh as well as various motor functions going to various muscles of the pharyngeal or the neck vagus, as you might remember if, if you can't remember anything else, this has your branches. So you have the recurrent laryngeal nerve which goes to the vocal cords. So it must be a motor kind of thing and it also has some sensory functions as well. Er, and then accessory and a hypoglossal accessory to trapezius and stenocladum mysid and a hypoglossal to the tongue are both motor. Um So, again, that should be fairly straightforward because you probably remember, er, your ay, um, and how ooh, some people are saying they can't hear or see anything. Uh No, we can. I think it's an issue but just, just one person. Fine, fine, fine, fine. I just uh accidentally clicked the chart and no, don't worry. II would let you know. Thanks. So, er, is that straightforward? I think that's straightforward. So when you're doing your Roski, when you're testing the cranial nerves of a, of a patient, you, you do all those things in, in a quite straightforward way. So I think you'll probably remember if they're mixed, if they're sensory or motor. If you don't, there is a mnemonic as well. So we had the first mnemonic. So I'm not gonna repeat again, but you also have, um, I need to remember this now. I have to Google it. It's, er, uh hold on. I just remember it has boobs and butts. It's been a while since I had to do this uh sensory. It's uh, pneumonic crania. No. Oh, yes, yes. Yeah. Right. Some say ma money and what's the other one? Oh God. Yeah. But my brother says big brains matter most. We remembered it as big butts matter most. So, just to clarify again. So some say marry money. But my brother says big brains matter most. If you can remember this, you'll be able to remember all of the rest of the stuff. I'm going to teach you about cranial nerves, but everything else just kind of comes after is built on sort of this knowledge. Um And so that's why your kind of way to stick with it if you're sort of struggling cos often it is really hard to remember the nuclei and remember which canal they go through and which ganglion they associate with. But if you can remember, for example, that let's say the trigeminal is both ie that has a motor component and a sensory component, then usually you should remember. OK, there probably is going to be a motor nuclear, there's gonna be a sensory nuclear. I um you can remember that there's going to be a mo motor set of targets, a sensory set of targets and that'll start to kind of help feed forward. So we've discussed names, we've discussed functions and to a certain degree we've discussed dysfunctions. I'll pause there any questions so far, right. OK. So I also mentioned that there's another function as well which is parasympathetic and there's four nerves in particular, which have parasympathetic functions. Anyone can guess what they are to unmute. 379 10. Is that Taler? Of course, it's taler. OK, tell you're not allowed to answer any uh other questions from this point because I know that you've been uh revising and swing up tells correct. So 379 and 10. So P P PP. So I think some are obvious oculomotor as you remem, remember, er controls like your sphincter pupilla. It helps in terms of pupil dilation and constriction. So there must be a parasympathetic component there as you probably kind of sort of recalling back to sort of earlier preclinical years of medical school, facial parasympathetic parasympathetics to do with tears. The facial nerve also has something to do with tears. Therefore, there's gonna be a parasympathetic component as well as also uh kind of salivary gland as well. Glossopharyngeal is a little bit more complicated we'll come back to. But vagus obviously has a parasympathetic component because it's going directly to your visceral organs and the heart. Ok. So that's like 101 cranial nerves. If you can remember this, you can do your osk and you can probably get away with um uh some of the more basic questions that you have in your anatomy exam. The next thing I'd like you to do is to draw er cranial nerves. So this is not gonna be as you'll find out my anatomy drawing is not great. But uh so, excuse me, I've got a bit of a cough. OK. So if you can draw something which resembles that, that'd be good. That's brain. So let's just say these are, these are obviously your frontal lobes, temporal lobes. This is your, it's gonna be difficult to see this er, from all the way up there. But let's actually just try and draw another bit in here. So make it a little bit easier for you. OK? That probably makes it a little bit easier. It's not actually sort of super accurate. And so then you've got your midbrain horns and all of this is the medulla, OK, with me so far. So the most common diagram that you see is usually of the dorsal surface of the brainstem, er, sorry, the ventral surface of the brainstem where you're seeing, let's draw the er, sorry, the olfactory bulbs in first. So they're probably looking at something like this. You have your optic chiasm, this is not supposed to be anatomically correct. By the way, it's just to help your memory more than anything else. So the first thing to note is that the termination of your, of your olfactory and optic, obviously going to your eye and to the cribriform plate as you probably are aware. But um where they originate from is actually from the brain substance and therefore, they're not, they're considered the false two cranial nerves. So they don't directly come from a brain stem nuclei per se. They actually come from the brain substance itself. And actually, if you think about it embryologically, they are also originating from that aspect of the mesencephalon rather than er telenal sorry, rather than the pharyngeal arches, which is where the other cranial nerves or the majority of other cranial nerves are coming from. So we can put them to one side to begin with. They're kind of easy to remember. Now, the other ones are start to get a bit more interesting. So we've got the midbrain. So we have two nerves coming out or the ventral aspect of the midbrain. And this is in the mid, uh this is just here. And then we have, and sorry, some would say that it goes between sort of the midbrain and the pons. Then we have something which kind of crawls from the outside. So it's not actually from the Pons itself, but it's coming from the outside. And that's your trochlear nerve, which sort of takes that sort of kind of altered course. And that's also from the dorsal aspect of the midbrain. And that's your midbrain done moving on to the pons. There's only really one nerve which is coming directly from the pons, that's your trigeminal nerve. And that's your like sort of thick bundle that you're gonna get. And sort of the little pore that I've created here is to demonstrate that um, the three divisions and that's it for the pons. So just to summarize again, cranials nerves one and two do not come from the brainstem. They come from the cerebrum, cranial nerve three is coming from the midbrain as is cranial nerve four, either one's in red. Um Just ignore the fact that I've used the letters and read as well. Cranin of three is coming from the ventral aspect. Cranial of four is coming from the dorsal aspect. There is only one major nerve which is coming directly from the pons itself and nowhere else. And that is the trigeminal nerve. There is that thick one here and then everything else is from there below. Then at this point, you have something called the Ponto medullary junction, which is basically what it says, it's between the pons and er the medulla, which is basically this line right here. And then you have three sets of nerves coming from there. You have nerve number six, nerve number seven, which is often shown with sort of two bits to it. And then of course, nerve number eight, 67 and eight from the Ponto Medullary junction wrong with me so far. And then the last bit is easy because now we're outside the Ponto Ponto junction. So er we're almost directly going to be getting to everything else. So nine is a little bit lower down. Oh, sorry, let me change color. We have er 10 even further down. We have 11, which is actually the lowest, which kind of looks like this. And then we have 12 wis here. OK. That may have been the worst diagram in the world. But the point is I'm trying to make is to help you remember their origins Creon nodes one and two come from the cerebrum, cranial nodes three and four, come from the midbrain cranial of five comes from the pons cran nodes 678 are coming from the Ponto medullary junction. Um It has a few other names which we'll come back to and then everything else are called the lowers. That's 9, 1011 and 12. And they'll be coming from the middle. This diagram is often one that they use um sort of intestine things and it should be one that you can remember and look at reasonably well. Um Obviously, if you're trying to learn a diagram, don't get caught out by learning a specific diagram that you found on Google because that is a diagram, it's not real, it's not an Atlas. So if you are going to learn it or you, you, you're in a medical school where they teach it, then make sure you look at an Atlas as well as in a real structure of how er the ventral surface of the brain looks like. So you can identify these cos often it is that and often they may just focus on say one particular area like this or this to try and sort of tease apart whether you can work out which nerve is, which, and there's little kind of clues that I've just mentioned. So if you're able to remember those things that I said that, um, of where they're likely to be and sort of the other tricks, you know, it's a thick bundle. It's likely to be trigeminal. It's coming from the dorsal aspect. It's likely to be trochlear. It's got this sort of weird sort of webby type material, then you're gonna have a few more clues about where they're coming from if you're stuck and you're trying to think about where they are. So let me pause there. If you haven't drawn a diagram like this, just draw a, draw a diagram like this just to try and cement that knowledge. I'll just give you a minute. Maybe if you just give a thumbs up that once you've done. OK. Maybe 30 seconds more. OK. Cool. I think, er, probably a few of you have sort of caught on or you're managing to catch up, er, if you haven't, that's fine. This is like the most easiest diagram you can find on Google, like alongside a lot of the other stuff related to craniot. Come back to it in just a moment. Let's revis that topic. Now, we talked about, um, we talked about uh the different types of motor and sensory but of course, those break down even further. Um Some of you are familiar with this. Some of you won't, we'll just touch upon this in a moment. So your cranial nerves and you split into motor and sensory and this is where a lot of confusion comes in because sort of people get confused with like GSE G VA GV ASV A is like some sounds like all really, really bizarre. It's not, it's just trying to describe the different types of nerve and some of this has um is has an embryological origin and that's why it makes it quite difficult. Let's look at sensory first, sensory can divide into three. Sorry if there's, I'm, I'm just using the paper just to kind of save time. But if it looks weird from your screen, just let me know. So, somatic sensory. So that's your easy one that's like, you know, temperature, fine touch, pressure and so on. Uh things like your kind of typical trigeminal sensory. You have visceral ie from an organ or from say the crossed body like the glossopharyngeal. And so that is kind of unique. So that'll be your sort of G VA rather than GSA. And then you have the last one which is special and the way to think about special is just the special senses. There's not, you know, sight, sound, taste, er hearing equilibrium are er your only special senses. And so that's how they divide motor can also be divided as well in kind of a similar way, motor you have uh somatic. So that's like your uh you know, voluntary striatal muscles. Which you can control things like your eye movements, then you have um, er, visceral motor, which is a bit more complicated. That's basically the same as parasympathetic. You can almost consider that in its own, er category. So we'll just box that up for now. Er, and then finally you have your branchial motor and this is where people start to get confused. Bronchial is the same as sort of pharyngeal. And these are the embryological er origins of the nerve. And bronchial basically just means every sort of motor which is also under voluntary control. But it goes to things like in the neck, things like um digastric mylohyoid, um nerves to like vocal cords, things like that. So that sort of sort of has a branchial origin. Um in my medical school, at least I think you, you get tested on thank God on the pharyngeal arches related to cranial nerves. I hated pharyngeal arches like literally, you just pointless. But there is some truth in the fact that you, if you can, if you're lucky enough to be taught the fryn arches, you should be able to work out backwards what the cranial nerves supply. Um especially if you're trying, if you've been asked to remember very specific muscle groups, er, associated with those nerves and that can get quite tricky, particularly nerves. 579 are always a bit tricker and 10, of course, always tricky to remember the individual nerves and the branches which are going to it. And that's why I probably say it's sort of like the sort of finer sort of top level in terms of trying to really understand. So let's just summarize this bit just in case we, you know, you've just joined cranial nerves. We we explain that there's three groups of uh three types of cranial nerves, motor sensory and separately parasympathetic. And they can also be both and a combination of the others. As you remember, you now know that the pneumonic for remembering which are motor and sensory and as has already been described, you should know which ones are parasympathetic. So just as a reminder, so 379 and 10, are you parasympathetic? And the way to remember whether there are sensory motor or both is you use the mnemonic, which I'm always gonna keep on forgetting because I've ended up learning what I wrote is that some say um money blah, blah, blah, blah, blah. So that big brains that, that mnemonic, if you're sort of struggling to remember that if you can't even remember that, just remember what you're testing when you do the cranial nerve examination. Er So for example, trigeminal nerve, you're te testing the fact that they've got sensation on their face and you're also testing their jaw muscles and so on. So therefore, it may be a nerve which supplies both now that may seem completely, you know, pointless, but there is some use to this which we'll come back to in just a moment. Er, I promise. Um, so just a reminder that your special sensory, if it wasn't obvious already. So, coming back to this sheet, so your special sensory out of the ones that are sent. So, olfactory obviously smell is a special sense. Optic is a special sense, er, your facial because it's IPs for taste, vestibular cochlear because it's obviously hearing and balance glossopharyngeal with its responsible for taste as well as other kind of aspects as well. Er and um and vagus er as well as we'll talk about in a moment. It's got some er sensory supply around the epiglottis, which is a kind of a better bit unique. So has that just been a complete waste of time? Not quite let us move. Sorry. Does anyone have any questions about this? No, just check the chart? No. OK. All fairly straightforward. So let's just drive it up a notch now. Embryology. Uh Yeah. So there's a neural tube, I'll just do one side but just imagine its symmetrical on the other. OK. OK. What on earth am I drawing when the neural tube forms your nuclei form in this sort of particular pattern? Um And that pattern is matched according to those nuclei and those nerve groups I said in terms of motor or sensory or both and this pattern holds and it rotates as we'll just see you in a moment and if you can remember that it gives you an additional understanding of where the nuclear are likely to lie. The reason I say this is because there's a really, I would say ugly hairy diagram that when I was a medical sort, I ended up learning rote and it was just a complete waste of time because you'll forget it instantly once the exam is over. Er, but if you can remember sort of the embryology, then it, it, it helps a little bit and you can navigate um sort of where the nuclei and the brainstem, which is probably one of the hardest things to remember, er, related to the cranial nerves. So it's fairly straightforward, this is what we will call the Sulcus Limitans, which kind of divides up. This is dorsal, this is ventral. OK. And so these are the ventral roots coming in. Sorry, I see the dorsal roots coming in with the ganglions and these are the ventral roots coming out. Yeah. And the way that these are organized is that you have, if you remember where the Sulcus Limitans is just sort of keep that in your mind for a moment, the ones which are further apart are the somatics, the ones which are closer together are the visceral. Sorry, I'm now mixing up the colors, but hopefully you sort of kind of get what I'm trying to do. So this sort of organization like kind of this weird nuclei homunculus is um or originating at sort of two weeks ie when the neural tube starts to form 2 to 3 weeks. And if you can remember that, that simple fact that you've got sensory sensory on the dorsal aspect, motor on the ventral aspect, that kind of brings true with what you kind of know about Neuroscience. Somatic is kind of wide. There is an origin for that in terms of transcription factors and things we're not gonna go into that and you have the visceral which are kind of close together and they're divided by the Sulcus Limitans. Then that's all you need. Everything else can start to build on top of that. Now, what happens is is that as er development continues this neural tube effectively, it starts to push out the Sulcus Limitans, it starts to push out and then this comes in. So just to draw, this starts to push out and this starts to move in and it starts to form this structure which starts to look like this. No, no, hold on. It starts to, I'm gonna have to redraw it just so you can explain one sec that's a bit better. So basically everything sort of has shrunk down and formed this and this is the next stage of development. Well, you'll see where we're going in a second. This is the Sulcus Limitans, this is the Sulcus Limitans. This was on the dorsal aspect which has now gone sort of outside. And this is now the ventral aspect which is basically this side here. Let me explain that again. So this is dorsal, ventral, dorsal VR and then you have the same combination. Again, you have somatic sensory, which is furthest away from the Sulcus Limitans. You have somatic motor furthest away from the sulcus limit. Times you have uh uh visceral sensory, the closest to the S sulcus limitans. Uh And then you have visceral motor, again, closest towards the Sulcus limitans. Hopefully, I haven't lost anyone there. All that's happened is that this has shrunk and kind of twisted a bit. And again, the same thing applies. So your dorsal roots are coming in here, your ventral roots are coming up here. Does that make sense? Is someone with me that I'm not lost. Reminder, embryology, neural tube. This is the neural tube. This is the Sulcus Limitans, which is the first sort of dividing fold. It divides into dorsal and ventral. The sulcus Limitans also acts as a sort of milestone and checkpoint in terms of where sensory, sorry, where visceral and somatic is supposed to lie with somatic widest further away and visceral, close together that shrinks down as you start to form. You know, in week, week, week, three, week four, as you start to form the telen cephalon and diencephalon, by the way, this is the fourth ventricle and then you have the same thing, but it shrunk. This is your ventral, this is your dorsal, this is the Sulcus Limitans. This is where you have your visceral ones which are close to the Sulcus Limitans and this is where you have your somatic ones which are over there. Ok. Well, no one's shouted anything else. So I'm just gonna assume that, uh, you haven't lost you. So, just try and remember or picture that if you haven't drawn it already. Hopefully, I'm doing it slow enough that you've been drawing at the same time. If you haven't, I would just quickly sketch this in the next like 10 seconds. It's not a work of art. It will take you like five seconds to do. Yeah. OK. So when you have from that or, or sorry, actually, uh what we can probably do is use this. So this is your infantile um pre neonate or fetal brainstem, which is starting to manifest. And this is the line that you see if you remember this bulge here, which sort of forms your med medulla in a way. Uh This is the same as this bulge, which is gonna start forming here. And so if I draw it like this, you can now see where the nuclei is gonna start to originate in the level, the actual levels of the brainstem. And what will happen is that this further subdivides. So you have your er somatic sensory and that further subdivides into special and somatic and then you have a further subdivision within here as well. If you can remember that, then it will help a lot when it comes to the orientation of the next diagram, which I'm gonna come up with any questions so far? No. OK. Right now let's really go off the boat. So let's just try and draw the same thing but kind of uh in a bit more sort of zoomed in. So I'm gonna just draw half. OK. This is the fourth ventricle. This is your sulcus Limitans. This is the rest of the brainstem which is like this. And we've now said, remember that this is the furthest away from the Sarcos Limitans. So this must be somatic. So here I'm going to have, I'll just draw on black just so you can just be straightforward. So it's gonna be sort of sort of some sort of er somatic is gonna go on here. And OK. So we've agreed that everything which is ventral has to be a motor. So we have your somatic efferent right here in this section. Visceral is gonna be closer to your Sulcus Limitans. So this also divides. So you have your visceral efferent and usually the one which is closest is the general one if you have to learn and then you have your visceral efferent special, which is there. Does that make sense? Feel free to stop me if that all all is looking weird or you can't see my right eye. Can you just repeat how we got into this diagram? Yeah. Yeah. Sure. So let's go back on stuff. So you remember from this diagram, it's gone from a neural tube to the telencephalon, diencephalon and mesencephalon. You remember the split? What is now happening? Is that out of four nuclei? These are now gonna form six. So this green one is gonna split and there's gonna be a special one which is budded out of it. So, now you have a special, er, afferent, a somatic afferent and, er, um, er, what's it? Sorry. Um, I was forgetting, forgetting the name, er, a visceral afferent as well. And then you're gonna have a similar thing going on the other side where this also splits as well. So this one splits as well and this will, um, form two ins your, and you've also got the somatic inferent as well. So you've gone from four nuclei to six. Yeah. Yes. No, maybe makes sense. Yeah. Thank you. And so that's what I'm trying to show you here and that's where the origin of these letters come from. If you, if this doesn't make sense, don't worry that we're gonna come back to it again if it's completely like, oh, I have no idea what you're talking about. That's, don't worry, that's completely fine. Remember here, we had the same sort of principle. So we had one set of new guy here. This is now gonna be split into two. So we have the special one here. So this is s sa remember Somatic is furthest away from the Zols limit. So it's a special somatic afferent. You have general somatic afferent, which is here because the somites are far further away and then you have the general viscera front there and look something like that. And this is where the nuclei are gonna be positioned. And you already now know that some of your nuclei or some of the cranial nerves are going to be motor, some are going to be sensory, some are going to be both. So let's take an example, let's say something like um er say vestibular nucleus or vestibulocochlear nerve. So just shout out what kind of nerve is the vestibulo cochlear nerve? I know it sounds really obvious special sensor. Yeah, it's a special sensory because we're discussing hearing is a special sense as you probably all remember and it's also um er er what's it an afferent? So it's going to be in the special sensory er special sensory section. So it has to be up here. Now, I'm just going to reorientate this diagram again just to make it easier for you to look at this was just to show you anatomically how everything's pictured. Let me just do it one more time. Hopefully this will finally start to all click together and you'll be like, oh yeah, no, I get it just because I think the previous one was looking kind of messy. OK. And let's just so we said that. So if you just wanna kind of read out for me. So this is what is this, this point here? So Sulcus Limitans. Ok. This is dorsal. This is ventral. What did we say are our furthest away from the Sulcus Limitans. Somatic nuclear. Yeah. So your somatic is going to be here and your somatic is going to be here. What did we say? Which is closest? Visceral? Yeah. Visceral. Exactly. So visceral is gonna be here. Visceral is going to be there. We had two, we had one nuclei, which was the somatic afferent that splits into two into the special somatic afferent, the general somatic afferent. And then you're close to the visceral. So you've got the general vissel afferent. Again, there's a split which is close to here. You have the general vissel efferent, the special vissel efferent and the special somatic efferent. And so these are your groups and types of nuclei. It's a very mean medical school if they're testing you on which nuclei is SSE, which one is se which one is TV. But they do. I went to one. There we go. So any questions so far? Hopefully I've not lost people. Yes. No. Ish. I can't see anyone's face. OK. So now, now we've got this kind of picture. Now it's kind of easy to work out where the nuclear are going to be. So let's just draw, let's kind of convert this. So you can see it and into sort of a table where you have midbrain, you have pawns you have Ponto Medullary ju sorry, can you see this at the bottom onto medullary junction? And you have me and you potentially have six columns? I appreciate that. This is all looking really weird. This is where the easy bit is. So you've got the locations and you've got the rough types of nuclei which are there and then you have this grid. This is gonna make sense in just a second. So let's take one example, the example that I used before was the vestibular occur. We all agree that that's a special um er a special sensory afferent. So it must be furthest apart, it must be widest apart. Remember this is lateral, this is me. Now, you also remember where did I say that the eighth nerve originates from? So remember midbrain was cranial nerves, three and four pons was cranial nerve, ponto 9 1011 and 12. So where does that leave cranial nerves? Um er 678 onto military junction or correct. Exactly. So this is where your eighth nerve will be easy. You know, it's special, you know, it's from the ponto junction. This is where it's going to sit furthest lateral and kind of further down here. Let's take a different example. Let's say oculomotor nerve almost purely a motor nerve, although it has a single paras sympathetic component. So this is a motor nerve so that we know that certainly that this is gonna come from this kind of the side because it's more medial. We also know that it is a somatic efferent because it's controlling the striated muscles of the eyeball. Remember there are two types of motor, one is to the pharyngeal muscles, all the weird muscles of the neck, which it isn't, it's controlling muscles of the eyeball. So it must be a somatic efferent or sse we also know where does the oculomotor nerve come from in terms of the brainstem? Um me walk? Yeah, also known as in brain, correct. This is where your third nerve is. Fourth nerve, fourth nerve is what we go. It's a motor nerve which goes to the eye, eye muscles, eye muscles are a non neck muscle. Therefore, it is not uh a pharyngeal muscle and therefore it is a somatic efferent, not a visceral efferent. And the fourth nerve comes from which part of the brainstem uh mid correct so forth is here just as a show of hands. Let me just, just do a pole who is lost. It has it's anonymous. OK. Fine. So the majority are just about no, why have I just spent so long sort of creating this grid. The reason is, is because there's one disgusting diagram that you're expected to know um which I'm just gonna show you now, which looks like this. Uh And uh hopefully this will make you understand how this all comes together. Uh Hold on, I need to find out how to get it. Yeah. I don't know if this is gonna work but we can try. Uh can you see this diagram? Yes. Yeah. What I'm trying to do is hopefully explain to you how to learn this diagram in a much more logical way than you learning it rote er and all I'm doing in this the previous er sheet over here. Sorry, I think uh I may have switched screens so this is on my other screen now. Can you see my mouse? No, no. Can you see this weird diagram with all the weird colored dots? OK. Can you see my mouse now? No, we could sleep. Yeah. Yeah. Yeah. OK. We can see something. Uh Where is it called? OK. How about now? Mo No. Oh God. And now we can see it. Yeah. Right. OK. No. Yeah. Now we can see it the aim of this slide. Uh Sorry, can you just just have a shout out, sorry, I can't see a poll. Now how many of you have come across this diagram before in medical school? Just say yes. No. Shout out. Yeah. Yeah. Yeah. Anyone has not ever come across this diagram. No one wants to admit it. I as I assure you learning this rote is the most disgusting thing you'll ever do because I can, you'll never be able to remember it. Hopefully, what I've explained is a method by which you can remember it. This is your brainstem midbrain pons, pontomedullary junction, medulla and the cervical spinal cord you can ignore for now these 6123456. I don't know where. I think I'm not sure where my mouse is pointing. Uh It might be pointing inside or outside, but hopefully, you can recognize that these six are all those different types of nuclei, special sensory afferent, somatic afferent, visceral afferent, remember visceral er is closest this this line which is splitting the six up into three and three. That is your sulcus limit hands. As you remember, the somatics are further away, the visceral are closer together. Hopefully, as I said, hopefully, my mouse is pointing at the right thing. I've got three mice on the screen right now which are making things a bit bizarre and this is how they divide it up. So remember special originated from the somatic, it's furthest away most lateral, that's where your special sensory afferents are. And that's why you have the everything which is special sensory all in this column over here. Let's take another example. Let's take something like one of your vagus nerves. So vagus has many different combinations from very many different nuclei and because it has so many different um origins, you just have to remember the functions. So let's go back. So if you remember the vagus nerve, it supplies um your heart. So there is a parasympathetic component to it or a visceral component to it, um which is an efferent. So you have this visceral efferent. And that's why you have a vagus nerve sitting in this direction. Here, you also have a vagus nerve, which supplies a muscle in the neck, which is your recurrent laryngeal nerve, which supplies your vocal cords. That's why you have a vagus in the bronchial section as well. So there's another x there, it also supplies sensation coming from the viscera and that's why you like the gut and that's why you have another nucleus there. And because as I mentioned to you that um the all the lowers originate from the medulla downwards, they don't originate from the ponto mera junction. That is why you have three blobs at this location. Let's take another nerve. Hopefully, by the repetition, it will start, I think to kind of come together. Let's take the trigeminal nerve, trigeminal nerve. You remember from the mnemonic. It is both, it has both sensory and the motor component to it. The sensory one is obvious because that supplies the face. Let's go back to er where sensory is. There's three types of sensory, is it a visceral sensory? No, this is not an organ. Is it a special sensory? It's from the face, it's not a special sense. Therefore, it must be a somatic sense. We also know that the trigeminal, if you remember the location has to come from the pons. Therefore, there is a blob right there. You also remember that the um uh trigeminal supplies muscles of mastication like the jaw and also a number of muscles like the digastric part of the digastric belly, which help you chew food. It is not part of the viscera. It is not a somatic, it's a neck, eye, a branchial um er nuclei and therefore there is a trigeminal blob there always in the pons. Does this make some sense? Is it starting to kind of a like a light is slowly dawning on why the nuclei are located where they are just a bit? Ok. Yeah. OK. That's one excellent. Thank you. My mate. Does anyone really not get this at all? It's completely fine. Like no, you know, no judgment. Um, you, you can just write a message or put a thumbs up or something or would anyone like me to explain this just one last time? If you can take anything away from this cranial note talk and look, you can all watch youtube lectures, you can all watch osmosis, you can go through your lecture slides that you've got from UNI, but no one, I promise you no one will explain it, er, to understand it in this way and you'll end up learning this part wrote. Um, you can always learn where the pathways are, what the nerves are, what they're doing, but this part really kind of sticks together and if you can learn this, then everything else will kind of come together. Um, just er, ok, just so there's any messages anyone maybe to explain it again or can I move on? We've only got like 5, 10 minutes left anyway. OK. I'll just do it one more time. Uh We'll go back to the paper if that's OK. Uh So just click on your screen wherever you can see my hand in the paper and I've lost it now. I sure it is. Can you see the paper? Mm. Yeah. It's visible. Yeah. Great embryology. This is the neural tube. This is the Sulcus Limitans which splits the neural tube into dorsal and ventral. Your nuclei is split along this neural tube. Obviously, it's symmetrical on both sides. I've just drawn one just to make it easier. Somatic are furthest apart, visceral otosis together and you have four nuclei. These are the dorsal nerve roots coming in and the dorsal nuclear and these are the ventral roots coming in further along in development. You get this situation where the er neural tube has started to kind of contract and twist a little bit. So you've got the sulcus limitans here, dorsal ventral, you now have instead of two nuclei, they have split special buds off and the branchial buds off basically is one way to put it. That's all that happens at this stage. This is the fourth French co we said this is the final view where you've got the 66 different types of er nuclei and they all link up with where they are in terms of the brainstem in terms of midbrain pons, ponto junction and medulla. So you can work out in multiple different ways. You can remember the function ie is it motor sensory, er is it branchial non branchial branchial remember is just neck ie, neck muscles, only neck muscles. Um or is there a parasympathetic component and where it is? And hopefully that gives you a number of different ways and angles to identify where a nuclei is in the brainstem. So they, for example, will be like, you know, er you know, an M CQ or an SBA um is er the 7th 8th or seventh or eighth nth, they originate in the medulla. You'll be able to easily remember that. Well, you like, well, actually um potentially yes. But if they say, oh well, if it originates in the mid brain, of course, that's known because it's the ponto medullary junction. But let's say they said it originates on the medial aspect of the medulla, just for instance, that would be sort of, you know, more kind of going towards MRC S type knowledge or FR CS type knowledge. And you know, it's not because the vestibular is an afferent nerve afferent, you know, is more lateral cos all the special sensories and all the afferents are coming more laterally. And that's why, why we have this grid. So when you come back to that really dirty diagram that I showed you earlier, that is how to understand it. It is to understand from the embryological perspective. And hopefully that gives you a bit more of an insight otherwise you're learning it root. Ok. So we've got a bit more to cover. So let's just proceed on a bit more. Now, we haven't really talked about um, the other aspects of, er, some of the nuclei which are sort of the parasympathetic nuclei. Now, there's one kind of sort of hack that you can kind of remember with some of this stuff. Um as you know, all of the um if you're struggling to remember what the names of the nuclei are, which is fine, obviously, there are some dodgy names. So let me just try and draw a brain stem again for yeah, midbrain pons and medulla. Ok. Obviously, that looks completely horrifically ugly. So as you remember, more lateral is going to be afferent because that's where the dorsal aspects originate from and more medial is going to be your efference. Now, there's a few tricks that you can use if it is a purely motor or a somatic motor nerve. Remember, there's two types of motor, there is a somatic motor which goes to striated muscle, which is voluntary. And then you have motor nerves which go to the neck, which are branchial um motor components. As you remember, motor is more medial, it's more towards the midline. So let's take one of those nerves, let's say something like uh abducens. So, abducens nerve is nerve number six, it is a purely motor nerve nerve. Number six. Where does it typically come out? Where does the nerve originate from? Well, we know that it originates from the pontomedullary junction. The nuclei actually originates close in the, in the pons, but the name of the nucleus of any motor nerve is just the nucleus of that nerve. So this is nucleus of obducens, oculomotor nucleus of olear, moor trochlear nucleus of trochlear. Uh What else is that Moor hypoglossal hypoglossal is from the medulla nucleus of hypoglossal. Er what else is there spinal accessory nucleus or spinal accessory? That's one cheat. One kind of simple way to remember it. Another er question which often comes up ex exam is uh your, what is the components of your nucleus ambiguous? Um that you just have to remember but it's simply just 9, 1011, 9, 1011 is ambiguous. I think there is a joke related to that which I'll try and remember in a second, I'll try and Google in a second. So you can try and remember. So that's just 11 trick. So if you're trying to remember the names of these nuclei, all the ones which are pure somatic motor, it is just that nucleus. So it's just the oculomotor nucleus, oc nucleus, abducent nucleus, hyper nucleus and so on. OK, let's take a slightly different angle. This is another way to sort of understand all of this again instead of going in sort of these weird shapes. Let's now start to look at cross sections. So sometimes for in some medical schools, you'll kind of just get a diagram like this. Uh OK. And then it'll be like which section of the brainstem is this any ones? I know it's a horrific diagram, but hopefully you can work out. Uh It's sponsor Middle brain, mid brain, it's not pons, this definitely doesn't look like pons. Um It's midbrain with as mickey mouse is, oh there's also some the red nucleus which makes mickey mouse eyes and nose. OK. So which nuclei are from which nerves are going to be originating in this diagram? Do you think uh trochlea and oculomotor correct? That's it. That is literally it, those are gonna be the only nuclei. So trochlear, you know, sorry oculomotor kind of comes around here and trochlear also a nerve to Tole is going to come just a little bit further down um just kind of beneath this, but it'll sort of kind of be around there and that'll be the nuclear which is kind of originating there. But a common question may come up. It may not, it may show you a slide of a brainstem and the first question number one will be like, what section of the midbrain is this er midbrain? What section of the brain stem is this? And it'll say what nuclear kind of within this place and there's a few other structures which you should know about if you're doing a new enough. Obviously, there's an exist in isolation. What are these bumps here? Ok. Any acid follicular. Exactly. So these are your colliculi? Yeah, exactly. And what are these here? Cerebral peduncles? Perfect. Exactly. So you remember again, so this is your midbrain, midbrain has to have generally two nuclei or two nerves which are originating from it, which are your oculomotor and your trochlear nerve. Now, as you remember from before I said that the oculomotor has two components. The motor component comes from the motor nucleus, which what's the name of the motor nucleus? Given the hack that I just mentioned to you motor focal motor nerve? Perfect or the oculomotor nerve nucleus, nucleus of the oculomotor nerve or the oculomotor nerve nucleus. So that is the oculomotor nerve nucleus there and then there must be another nucleus. Although as you remember, oculomotor has another component to it which controls your pupillary dilatation, which is your um parasympathetic. So there is another nucleus, let's just call it a trochlear sort of inferior to this. Does anyone know what this nucleus is called? Adding the Perfect Exactly. So this one is nucleus to ocular motor and that's the Edinger west. Those are all the new that you need to remember in relation to the third nerve and in relation to the midbrain bonus point, you have something in the midbrain which is here just behind the cerebral peduncles. So sunshine, black color and black. Perfect. Excellent. Well, done. And that's your tricks. The midbrain I think is probably one of the easiest sections, but you look at it bang mickey mouse ears and potentially eyes. If you see the red nucleus, you see this sort of black sort of, you know, um kind of mark across there like a stain. That's your substantia, nigra, cerebral peduncles, colliculi typically the siculi, if it's at the level of the third nucleus, that's kind of more fine print. And then as you remember, the oot nerve must come from this part of, must come from this part of the brain stem because it's the midbrain. And as you remember, the oculomotor has a motor component. As I mentioned, all somatic motor nerves are the ones which don't go to the neck are named after themselves. So there must be a nuclei to the oculomotor nerve and there is another component which is parasympathetic and that's the ending of we far nucleus. Do you hopefully you see how this is coming together and you're sort of trying to layer this sort of one bit on top of each other? OK. Let's just do one last one because I think probably I'm going to start kind of losing people er both in terms of to boredom, er as well as in just, just losing in general. So let's take another section. Er uh OK, let's take this section. Oh I think I've messed up the diarrhea. There we go. OK. Uh Let me give you a few more clues. Uh, so there, yeah, I think that's probably about right, actually. Uh, so that's, uh, actually sort of related to ventricular system. And you also have, this is probably your biggest giveaway if this shape wasn't obvious any guesses. Pons. Mm. No, just to clarify. Pons. Looks like this, right? It looks like, you know, like, oh, sorry. Are those meant to be the olives? What happen? The olives then? Therefore, we are in perfect. Does that make sense? That's sort of your giveaway for the medulla. There's two things. Firstly, you have the pyramids and then you have these are the inferior olives and that gives away you in the medulla. Ok. Fine. So we are in the medulla. What nerves are coming out of the medulla? Anyone shout out, hopefully he's now starting to 911, correct? So there must be 9, 1011, 12. Now of those nerves, which one of those has a somatic motor component. So which one of those is going to something um like a muscle which does not come from the neck. It's not a trick question. 1112. Correct. Exactly. So 11 is the weird one. Remember 11 doesn't quite come from the upper part of the medulla. It sort of stretches, blow down into the spinal cord. So you won't often see er 11 completely, but you will definitely have a nucleus to the hypoglossal nerve for certain. And that's usually quite close by now, you're starting to remember, let's say you were in an exam and they have, I don't know, they have one nuclei here. They have um I don't know another nuclei here. Um And I'm just trying to think of something else that we can put in. Uh Yeah, and they had two options. This is hopefully test you. One of these is the hypoglossal nucleus. One of these is um say the vestibular cochlear nucleus, which is which and why he's a tunic guy. I'll give you a clue, medial, lateral hypoglossal motor. So the m the one that's most medial would be the hypoglossal. Correct. Exactly. And then therefore, this must be your one which is likely to be sensory and the one that's so furthest apart on this side is likely to be a special sensory and at this level, which special sensor, there's only one special sensory can exist, which is er yeah, it's actually you still was it up upper medulla here? So you still have, you're at the ponto miri junction kind of there's a bit of a trick um because you can see the infra olives, you're actually more closer to the, that gives the way that it's upper medulla and therefore, at the Ponto Midura junction. OK. I think we'll pause there. Um uh Let me just stop sharing. Um Anyone have any questions, I just click on the messages. Uh So, so are exceptions to the system anatomically? No. Uh I, I'm guessing it's reference to that if it's a question about the names also. No, if it's a pure somatic nerve, then it has to have a nucleus named after that nerve. It's a very good system. I've never heard of it before, but it's very, very easy to remember. I was just embryology really. I always forget it. Like, yeah, I never did embryology to be honest. No one did, including me. I've had to learn this the hard way as I'm sure many of you are also in the same boat. Um OK, so hopefully that's a few tricks and no one else is asking any questions for. Maybe I'll just give it 30 seconds more just in case anyone's sort of shy or facilitators, the guys who are organizing this thing, any questions on your end? No. OK. So we'll just briefly recap. Now, thankfully, you've got got loads of random pictures here. So if you go back to the screen, so it just will take two minutes just to recap. So if you remember nothing else, you'll remember the at least the names of your cranial nerves. So these are your 12, you'll have a non mnemonic to relate to those. You should also remember using two different methods. Either you can use a mnemonic to remember the functions of each nerve or you can remember. But if you're done your clinical, if you're sort of in your clinical years, you can remember what functions are when you're testing. So that's really obvious. So, somehow I don't see when I ask sort of questions to students that I have and I'm like, well, what are the functions of, um, I don't know, glossopharyngeal. And then they're like, I have no idea, something related to pharynx. And they're like, well, what do you do when you test cranial nerve nine? They're like, oh, yes. You know, of course, you know, I a you know, ask them to, you know, open their mouth and you know, look in the uvea and you know, do this and do that. It's the same thing. So you can remember your functions in two ways. Either you can use the mnemonic or you can just try and remember what you did in your neuros. Um parasympathetic are it's worthwhile remembering which ones those are once you kind of remember their function, it's not too difficult. So oculomotor, it's got a sympathic mo er function to your pupils, facial nerve. I remember the facial functions as face ear taste. So facial muscles nerve tested um as well as a little sensory area taste. So there's a special sensory function and tear is the parasympathetic function as well as the salivary glands. Er So the facial nerve must have some sort of component. Uh glossopharyngeal is also your other aspect of taste as well. And vagus have obviously has lots of parasympathetic um sorry, glossopharyngeal is related to your carotid bodies in terms of sensation. And so there's a parasympathetic component there. And vagus obviously has a lot of parasympathetic. It's called the entire vagus nerve itself is parasympathetic. So that's the way you remember, parasympathetic. Uh what do we do next? We did locations of nerves, one and two come from the cerebrum, three comes three and four come from the midbrain. Five comes from the pons. This is the origin of the nerve itself in terms of where it exits. It's not strictly speaking where the nuclei is. That's a little bit more complicated as we have spoken about ponto medullary junction. This is where you have 67 and eight, they originate from and then everything else comes from the m medulla at different stages. The 11th nerve also comes from the cervical spinal cord as well. And so that's the purpose of this diagram. Er your motor and sensory can be broken down an easy way to remember is that the motor breaks down into two parts. You've got your somatic, which is your striated muscles, which are not the neck and you have your bronchial muscles which are the neck and that's an easy way to split them apart. You have your parasympathetic, which is separate sensory can be divided into sensory functions like fine touch, somatic visceral from the organs and special is your special senses. And then we had probably the final and worst diagram of all is the embryology. This is how the nuclear or originates, then they kind of rotate and sort of shrink and then they finally form your sixth nuclei. And from this, you can try and work out the origin of where, where they're coming from. Uh And then what was the last thing that we did? We just looked at different sections of the brainstem. We just did 21 is your midbrain mickey mouse ears. You can also see the cerebral peduncle, substantia Niagra red nucleus, it's the midbrain. So it has to have 3rd and 4th nuclei. The other thing I mentioned was that any somatic nerve or somatic a component to a nerve must have a name of itself. So there must be nuclei to oculomotor nerve like there is nuclei or trochlear nuclei, for example, it's got a parasympathetic one as well. So that's something else the in the West. And then I think just for completion, this was upper medulla upon time maduro junction, right? Uh I think we've gone way, way, way, way over. Thank you for coming uh feel free to stick around if you wanna ask any questions, otherwise, I'll hand it back to the admin team. Uh Thank you, Mister Pander uh for that a really, really intensive talk on cranial nerves. It was really helpful. Uh I myself have all the diagrams er like with many other viewers. Um I think uh well, the floor is always the floor is open for any questions uh for anyone that wants to ask it, I just want to remind all our viewers that uh and if you would like to provide feedback, the links in the chat also, that's how we know you attended. So you can get your certificates. And with, with all that said, um I want to again, on behalf of the neuro collaborative team. Thank Mr Pandit again for another year uh coming and giving this talk for us. And uh a reminder for of view is that our next talk on visual pathways will be happening similar to this next week. And yeah, thanks. Thanks again, everybody for coming. Thanks, Mister Pandit. Thanks everyone, see you next time. Um Thank you and have a good day.