Nucleus of the solitary tract, medullary reflexes, and clinical implications

The nucleus of the solitary tract (solitary nucleus, nucleus tractus solitarii [NTS]), located in the dorsomedial medulla, is the first relay station for general visceral and taste afferents carried by the cranial nerves and has a critical role in the initiation and integration of a wide variety of reflexes controlling cardiovascular function, respiration, and gastrointestinal motility. Though isolated bilateral involvement of the NTS in neurologic disorders is infrequent, its intimate anatomical relationship with the fourth ventricle and the area postrema may underlie its major role in clinical manifestations such as those described in this representative case.