Anatomy

6.2

January 24, 2012

Dr. Zulueta

Blood Supply of the CNS

OUTLINE
I. The Brain
II. Internal Carotid Artery
A.Middle Cerebral Artery
B.Anterior Cerebral Artery
III. Vertebral Artery System
A. Posterior Cerebral Artery
IV. Circle of Willis
A. Middle Meningeal Artery
V. Venous Drainage of the Brain
VI. The Spinal Cord

Objectives:
Describe the origin and course of the arterial blood supply of the brain:
o Internal carotid artery system
o Vertebral artery system
o Circle of Willis
Describe the general distribution of the different branches of arteries that
supply the various regions of the brain
Describe the venous drainage of the brain
Describe the arterial supply and venous drainage of the spinal cord

* Texts in Comic Sans MS are from the lecture.
o Maam gave the lecture with mostly pictures so most texts lifted from
the audio are describing figures.
*Texts in Times New Roman are lifted from the book

I. The Brain
One of the most metabolically active organs of the body
consuming large amounts of oxygen and glucose requires
continuous blood flow
It uses 20% of the body's oxygen consumption and up to 2/3 of
the liver's glucose production. As the brain only stores minimal
amounts of oxygen and glucose, it needs a continuous blood flow
to supply the brain with them. (If you lose blood supply to any
area of the brain, youd lose consciousness for 15 seconds. If you
lose blood supply for 3-5 minutes, youd be in coma.)
Any damage to the brain is irreparable
Diving reflex
o Blood flow is concentrated on areas which needs continuous
blood supply (brain & heart) when in shock
o Usually kidneys are the ones depleted by blood supply
Arterial supply consists of 2 major interconnected systems:
o Internal Carotid System(Anterior)
o Vertebral Artery System(Posterior)
Some books say basilar artery system, the basilar artery is
formed by the union of two vertebral arteries, so its the
same actually

The vertebral artery arising from subclavian artery pass

through vertebral foramen and pass through the biggest
foramen (foramen magnum)
Vertebral veins dont pass through foramen magnum, only
vertebral arteries

Group 5 | Dave, Bamba, Precious, Jaela

Fig. 1 Blood Supply to the CNS

This figure shows the origin of

both systems - the anteriorly

placed INTERNAL CAROTID SYSTEM supplies most of the
TELENCEPHALON and the DIENCEPHALON, while the posteriorly
placed VERTEBRAL ARTERY SYSTEM or the vertebral-basilar
system supplies the SPINAL CORD, the BRAINSTEM, the
CEREBELLUM and the INFERIOR and POSTERIOR parts of the
CEREBRUM. The internal carotid, along with the external carotid,
which supplies the face, the scalp and other extracranial
structures, arises from the COMMON CAROTID in the neck.

II. INTERNAL CAROTID ARTERY

Start in the neck from the bifurcation of common carotid artery
into Internal Carotid Artery + External Carotid Artery
Perforates the skull through Carotid canal of the temporal bone in
the floor of the middle cranial fossa, passes forward through the
cavernous sinus just lateral to the sellaturcica
Turns/bends medial to the anterior clinoid process and perforates
the dura mater
Have many turns called carotid siphon (only in radiographs)
Divides into the anterior and middle cerebral arteries
Major Intracranial Branches of ICA before it terminates:
Hypophyseal arteries
o Supply the pituitary glandand constitute part of the
hypophyseal portal system
Ophthalmic artery
o Will give rise to central retinal artery (the sole supply of the
retina, the nervous part of the eye and essentially you will be
blind if occluded). Terminal branches also supply the frontal
scalp, ethmoid and frontal sinuses, and the dorsum of the nose.
Posterior communicating artery
o Which anastomoses with the posterior cerebral artery forming
part of the circle of Willis

Page 1 of 10

 Anterior choroidal artery

o Supplies the choroid plexus(secretes Cerebrospinal fluid) in the
inferior horn of the lateral ventricle, the optic tract, and parts of
the thalamus, basal ganglia, and the ventral part of the internal
capsule.
o It varies a great deal in size and importance in different
individuals and may instead branch from the middle cerebral
artery.
Anterior cerebral artery (ACA)
o When ICA goes up near interhemispheric fissure. Its cortical
branches supply the entire medial surface of the cerebral
cortex as far back as the parietooccipital cortex. Also supplies
the leg area of the precentralgyrus.
Middle cerebral artery (MCA)
o When the ICA branches to the lateral sylvian fissure.
o Largest branch of the ICA and its cortical branches supply the
entire lateral surface of the hemisphere except for the portion
supplied by the anterior cerebral artery (ACA), the occipital
pole, and the inferolateral surface supplied by the posterior
cerebral artery (PCA).

Fig. 2 Branches of Internal Carotid Artery

This figure shows the branches of both
the ICAs seen inferiorly from the

base of the brain - the ophthalmic, the posterior communicatingthe
anterior cerebral, and the middle cerebral arteries.

Fig. 3B Arterial Supply

Side Note: Maam discussed about how to locate the cranial nerves:

CN I
o There are two boobs (mammillary bodies) - two pairs of boobs
in the brainstem which are Superior and Inferior colliculi.
Youll see olfactory tract and bulb (must know the difference)
are beside Interhemispheric fissure. The free nerve endings
are actually in the nose.
CN II
o Optic nerve and optic chiasm- maam differentiated the two
with the optic tract
CN III
o Upper pons (rostral pons) occupied by the CN III
(Oculomotor nerve)
CN IV
o Very small nerve arising from posterior part of brain
Trochlear nerve (CN IV) usually like a strand of dirt (as thin
as the strand of hair
CN V
o Occupying lateral pons - motor and sensory component
CN VI Pons and medulla junction
o pontomedullary junction in between is the Abducens nerve (CN
VI)
CN VII, VIII, IX, X
o Lateral pontomedullary junction VII and VIII are always
together Facial Nerve (CN VII) the biggest while IX and X
are together
CN XI
o Dorsolateral sulcus you will see rootlets of Spinal Accessory
Nerve which innervates trapezius and sternocleidomastoid
CN XII
o Ventrolateral sulcus you will see rootlets of Hypoglossal
nerve which innervates all intrinsic muscles except
palatoglossus

Fig. 3A Arterial Supply

Group 5| Dave, Bamba, Precious, Jaela

Page 2 of 10

A. Middle Cerebral Artery

Direct communication of the ICA
Supplies the dorsolateral surface of the cerebral hemispheres
o The MCA is regarded as the direct communication of the
INTERNAL CAROTID ARTERY, passing laterally to the Sylvian
fissure and is distributed in a fanlike fashion supplying the
dorsolateral surface of the cerebral hemisphere.
Branches from stem or M1 segment (initial part of the MCA

KEY FUNCTIONAL AREAS OF MCA:

Superior branches
o Sensorimotor cortex (except legs) - surrounding the
Rolandic fissure
o Frontal eye fields- important for bilateral eye
coordination
o Brocas area (language expression)

Inferior branches
o Wernickes area (language comprehension)
o Auditory cortex
o Optic radiations

o As it passes laterally, the stem gives off a series of 6-12 long,

small diameter penetrating vessels that travel upward to
supply the basal ganglia and much of the internal capsule
called the LATERAL STRIATE ARTERIES (Together with the
medial striate arteries, which are branches of the ACA also
supplying the basal ganglia and internal capsule, they are
collectively called LENTICULOSTRIATE ARTERIES)

o Once in the Sylvian fissure itself, the MCA stem divides into two
main cortical branches that supply the entire lateral surface of
the brain as well as the insula:
Superior (upper or suprasylvian) MCA branch
Inferior (lower or infrasylvian) MCA branch
MCA supplies:
1. Inferior frontal gyrus
o BA 44 & 45 (Motor speech area/Brocas area)
Function: Language expression
located at the back of the temporal lobe and traverse the
gyrus of Heschel (Wornikkes area BA 22
2. Precentralgyrus
o BA 4 (Primary motor area)
3. Postcentralgyrus
o BA 3, 1, 2 (Primary somatosensory area)
4. Superior temporal gyrus
o BA 22 (Wernickes area)
Function: Language comprehension
5. Frontal Eye fields
o BA 8
This can also be affected if MCA occluded

Fig. 4 Right Lateral view of right

hemisphere
On this lateral view of the cerebral hemisphere, in blue is seen the
superior or suprasylvian branches of the MCA supplying the
inferior and lateral frontal lobe and the anterolateral parietal lobe
and the inferior or infrasylvian branches of the MCA supplying the
lateral temporal, the lateral occipital and the posterior parietal
lobes.

Clincial Correlation
Occlusion in the MCA may produce:

Severe contralateral hemiparesis (marked in UE and face)

Contralateral sensory loss mainly the face and the arm

Severe aphasia (if dominant hemisphere is involved

Brocas/Wernickes) problem in understanding and speaking
If there is occlusion in UE than L occlusion in MCA
LE than UE more ACA than MCA involvement
Only weaness (paresis) not paralysis, why is that?
If you affected the peripheral nerve itself, for example you have affected the
radial nerve. Radial nerve supplies the upper extremities such that if you
affected it, there is difficulty in extension of the arm and forearm and there is
paralysis. But if you affected only the pathway, (will be discussed by Dr.
Calilao on Motor Pathway) you will only have weakness.

Group 5| Dave, Bamba, Precious, Jaela

Fig 5. Branches of ICA

B. Anterior Cerebral Artery
is a smaller branch of the Internal Carotid Artery that passes
rostromedially, dorsal to the optic nerve and approaches the
corresponding artery of the opposite side along the
interhemispheric fissure
Anterior branch of Internal carotid artery supplying the medial
aspect of the frontal and parietal lobes
Branches:
o Anterior communicating artery - which allows collateral flow
into the opposite hemispheres if the ICA is occluded on either
side.
o Orbital branches and frontopolar artery
o Callosomarginal artery
o Pericallosal artery

Page 3 of 10

o Medial striate artery or recurrent artery of Heubner (part of

III. VERTEBRAL ARTERY SYSTEM

the lenticulostriate arteries)

is an early branch near the base of the artery which sends
off deep penetrating branches to supply the anteromedial
part of the HEAD OF THE CAUDATE NUCLEUS, adjacent
parts of the INTERNAL CAPSULE and PUTAMEN, and
parts of the SEPTAL NUCLEI.

Fig. 6 Medial View of Cerebral Hemisphere

On the medial view of the cerebral hemisphere, the Ant CEREBRAL

Artery sweeps forward into the interhemispheric fissure and then
runs up and over the genu of the corpus callosum, giving off orbital
branches and the frontopolarartery supplying the orbital, the
frontal pole and the medial aspect of the frontal lobe. As it turns
backwards, it forms one branch that stays immediately adjacent to
the corpus callosum (the pericallosal artery) while a second branch
runs in the cingulate sulcus just superior to the cingulategyrus (the
callosomarginal artery)

KEY FUNCTIONAL AREAS OF ACA:

Septal area

Sensorimotor cortex for the lower extremities

Motor planning areas in the medial frontal lobe anterior to

the precentral gyrus

CLINICAL CORRELATON
Occlusion in the ACA may produce:

Contralateral hemiparesis and hemisensory loss greatest

in the lower limb

Inability to identify objects correctly, apathy and

personality changes (frontal and parietal lobes)

Inhibition of primitive reflexes in the frontal lobe such as

rooting reflex












Group 5| Dave, Bamba, Precious, Jaela

Fig.7 Vertebral Arteries

The VERTEBRAL ARTERIES usually arise from the subclavian

arteries. They course through the CERVICAL TRANSVERSE
FORAMINA, run medially and ascend into the FORAMEN
MAGNUM where they pierce the dura and enter the cranial cavity.
They would then join to form a SINGLE BASILAR ARTERY, which
would later bifurcate to form the POSTERIOR CEREBRAL
ARTERIES, whose branch the POSTERIOR COMMUNICATING
ARTERY joins with the ipsilateral INTERNAL CAROTID
ARTERYjoining both systems.

The Vertebral Artery System is from the 1st part of Subclavian
artery. It:
Perforates the intervertebral foramen of the upper 6 cervical
vertebrae
Enters cranial cavity through the foramen magnum [medulla +
vertebral artery]
Terminates into a big artery at the level of the pons Basilar
artery
The entire blood supply of medullary oblongata, pons,
mesencephalon and cerebellum

Divided into 2 Branches
1. Vertebral artery
ascend on the ventrolateral surface of the brainstem
Branches are:
Spinal arteries- 2 posterior and 1 anterior
A pair of POSTERIOR SPINAL ARTERIES
o branches and descends along the posterolateral surface
of the spinal cord AND two anterior branches join to
form a single midline ANTERIOR SPINAL ARTERYthat
supplies the medial regions of the lower medulla and the
upper
spinal
cord.
These
arteries
form
an
ANASTOMOTIC system with the RADICULOSPINAL
ARTERIES, which supply the spinal cord

Meningeal arteries supply the bone and dura mater in the

posterior cranial fossa

Posterior inferior cerebellar arteries (PICA)
o Supplies inferior and posterior surface of the cerebellum,
lateral 1/3 of medulla and the choroid of the 4th ventricle
Medullary (bulbar) branches
o Small branches that are distributed to the medulla oblangata

Page 4 of 10

2. Basilar artery - Formed by fusion of the two vertebral arteries at

medullary pontine/pontomedullary junction and further divided
into(arranged from caudal to rostral):
Anterior inferior cerebellar arteries (AICA)
o At point of fusion
o supply the lateral region of the caudal pons, upper medulla,
and portions of the inferior surface of the cerebellum;
Internal auditory (labyrinthine) arteries
o Enter internal acoustic meatus with CN 7 and 8
o Sometimes arise from AICA
o Supplies the inner ear
Pontine arteries
o paramedian, circumferential (short and long)
o have paramedian branches supplying the medial pons, short
circumferential branches supplying the ventrolateral surface
of the pons and long circumferential branches which
anastomose with the AICA and the superior cerebellar
arteries to supply most of the pontinetegmentum;
Superior cerebellar arteries
o Before termination
o At upper pons and end at dorsal surface of cerebellum, pons,
and superior cerebellar peduncle
o Supplies rostral pons, superior surface of the cerebellum,
pineal gland, and the superior medullary velum.
Posterior cerebral arteries (PCA)
o terminal branches of the basilar artery.

A. Posterior Cerebral Artery [PCA]
Terminal branch of the basilar artery
Cortical brances supply the inferolateral and medial surfaces of the
temporal lobe (visual cortex). Central branches supply parts of the
thalamus and the midbrain. A choroidal branch supplies the
choroid plexus and third ventricle
From parieto-occipital sulcus and posterior to it (Preoccipital
notch)
Also supplies the Reticular Activating System (RAS) for
maintenance of consciousness
Branches:
o Calcarine artery
An important branch of the Post Cerebral Artery which
supplies the visual cortex at the occipital lobe.
o Posterior choroidal arteries
Arise from the Posterior Cerebral Art to supply portions of
the midbrain, the thalamus, and the choroid plexus of the
3rd ventricle.
*So the main blood supply of the choroid plexus at different levels are:
rd

(lateral ventricles, anterior choroidal a. [ICA (or MCA)]; 3 ventricle, posterior

th
choroidal a. [PCA]; 4 ventricle, PICA

o Deep perforating branches- As each Post Cerebral Artery

passes around the cerebral peduncles, it forms a series of
branches to the midbrain and gives rise to Deep perforating
branches
Supply much of the hypothalamus and the thalamus (of
the diencephalon). The small branches to the midbrain
supply especially the RETICULAR ACTIVATING
SYSTEM (or RAS) whose function is maintenance of
consciousness.

KEY FUNCTIONAL AREAS OF PCA:

Diencephalon: All with the word thalamus

Midbrain

Primary visual cortex

Hippocampal formation (memory)

CLINICAL CORRELATON
Occlusion in the PCA may produce:

Contralateral homonymous hemianopsia = Bigger blindspot

-Due to occlusion of Calcarine artery
-Remember! NOT BLINDNESS
-It is the occlusion of OPTHALMIC ARTERY that causes blindness

Bilateral occlusion: defect of memory

Fig. 8 Vertebral Artery System

IV. CIRCLE OF WILLIS
Also called circulus arteriosus
Formed by the junction of the basilar artery and the 2 ICAs
through the presence of 2 posterior and 1 anterior
communicating arteries
Gives of 2 types of arteries:
1. Central
2. Cortical
**Aside from the cortical branches from the different
arteries, which form part of the circle, there are CENTRAL

Fig. 9 Vertebral Artery System (Gross)

Group 5| Dave, Bamba, Precious, Jaela

ARTERIES which penetrate the substance of the brain and

supply deep structures. The 2 groups of central arteries
within the circle itself are the ANTERIOR MEDIAL and
the POSTERIOR MEDIAL GROUPS.

Page 5 of 10

Table 1. Arteries to Specific Brain Areas

Little exchange between brain halves (functionally separate):

equalize flow but functionally inadequate
Compensates if there is occlusion to other arteries
Encircles the optic chiasm, tuber cinereum and interpeduncular
region
Anteromedial group Central arteries arise from anterior
communicating artery and ACA
Posteromedial group Originates from PCA and posterior
communicating arteries

Corpus striatum &

internal capsule

Lenticulostriate(supplied mainly
fromlateral striate from MCA and medial
striate from ACA) and anterior
choroidal arteries (from ICA)

Thalamus

PCA (from basilar-vertebral system),

posterior communicating (from ICA)

Midbrain

PCA, superior cerebellar (both from

basilar-vertebral system)

Pons

Superior cerebellar arteries, Pontine

a. and AICA (from basilar-vertebral
system) and PICA (from vertebral)

Medulla oblongata

AICA
PICA
Basilar
Vertebral
Ant and Post Spinal

Cerebellum

Superior cerebellar, AICA and PICA

Notes:
The circle of Willis is highly over-rated as a source of effective

collateral circulation. Normally, there is little exchange of blood

between brain halves because of the equality of blood pressure.
Blood normally does not flow around the arterial circle. Though
interconnected, the two systems are functionally separate. The
anastomotic channels do serve to equalize flow to various parts
of the brain and prevent neurological damage. However, the
communicating arteries are often functionally inadequate if

occlusion occurs acutely. In fact, various combinations of

hypoplastic and asymmetrical arterial circles commonly occur.

1. Anterior cerebral artery

(callosomarginal and
pericallosal arteries)
2. Middle cerebral artery
3. Posterior cerebral
artery
4. Medial striate arteries
to the internal capsule,
globuspallidus and
amygdala
5. Lateral striate arteries
to the caudate nucleus,
putamen and internal
capsule

Fig. 11 Arteries to Specific Brain Areas

Fig. 10 A and B The Circle Of Willis

Group 5| Dave, Bamba, Precious, Jaela

A. Middle Meningeal Artery

Periosteal branch of the external carotid artery
supplies no CNS tissue
enters the cranial cavity through the foramen spinosum
usually ruptured by fracture of the lateral skull vault
bleeding between the dura and overlying skull(extradural or
epidural hematoma)

V. VENOUS DRAINAGE OF THE BRAIN
Do NOT run along course of cerebral arteries
Devoid of valves
External veins divided into superficial and deep groups, which
drain the cortex and subcortical white matter areas respectively,
and piercing the arachnoid and dura mater, they drain into the
dural venous sinuses and ultimately into the internal jugular veins.
o Deep Cerebral Veins
It just follows venae comitantes; will eventually drain into
that set of veins

Page 6 of 10

o Branches of Superficial Cerebral Veins:

External cerebral veins
Superior cerebral veins empty into superior sagittal sinus
Superficial middle cerebral vein drains lateral surface of
cerebral hemisphere and empties into the cavernous sinus
Deep middle cerebral vein drains the insula
Basal veins
from anterior cerebral, striate and deep middle cerebral
veins and empty into the great cerebral vein; drains into
straight sinus
Internal cerebral veins
From thalamostriate, septal and choroidal vv.
Great cerebral vein of Galen
formed by the 2 internal cerebral veins and empty into the
straight sinus




A











The superior cerebral veins drain the cortex and pass upward to
empty into the superior sagittal sinus. The superficial middle

cerebral veinruns inferiorly in the lateral sulcus following the

course of the middle cerebral artery and drains the lateral surface
of the cerebral hemispheres emptying into the cavernous sinus.
A superior anastomotic vein may connect the superficial middle
cerebral vein with the superior sagittal sinus.

The internal cerebral vein drains the interior of each hemisphere

while the basal veindrains the cerebrum anteriorly. These two
empty into the great cerebral vein of Galen, which in turn drains
into the straight sinus. Take note that the superficial and deep
cerebral veins are interconnected by numerous anastomotic
channels.

Veins to specific brain areas

o Midbrain drained by veins that open into the basal or great
cerebral veins
o Pons- drained by veins that open into the basal vein, cerebellar
veins, or neighboring sinuses
o Medulla oblongata drained by veins opening into the spinal
veins and neighboring sinuses
o Cerebellum drained by veins emptying into the great cerebral
vein or adjacent sinuses
Dural Venous Sinuses
o Superior sagittal sinus
Runs along the superior margin of the falx cerebri from the
foramen caecum to the confluence.
o Inferior sagittal sinus
Runs along the inferior border of the falx cerebri and caudally
joins the RECTUS or STRAIGHT SINUS, which is located at the
junction of the falx cerebri and the tentorium cerebelli and
then empties into the confluence.
o Rectus (straight) sinus
At the junction of falxcerebri and tentorium cerebelli
Empties into the confluence
o Confluence of the sinuses
located near the internal occipital protuberance where the
superior sagittal, the straight, the occipital and the
transverse sinuses meet (SST)
o Transverse sinuses
arise laterally from the confluence and curve downward and
backward as the SIGMOID SINUSES, which eventually open
into the INTERNAL JUGULAR VEIN.

o Sigmoid sinuses
Turned backwards
Pass into jugular foramen (not the internal jugular vein)
Eventually drain into Internal jugular vein
o Cavernous sinus
an irregular network of communicating venous channels on
either side of the sphenoid sinus, the sellaturcica, and
the

pituitary

CAROTID

gland.

ARTERY

It
and

encloses
CRANIAL

the

INTERNAL

NERVES

3,

4,

ophthalmic 5, and 6. The cavernous sinus of each side is

connected with the other by the basilar venous plexus
and venous channels running anterior and posterior to the
hypophysis.

Group 5| Dave, Bamba, Precious, Jaela

Page 7 of 10

Fig. 15 Dural Venous Sinuses of the Brain

*note: The SUPERIOR PETROSAL SINUS connects the cavernous sinus with
the transverse sinus, while the INFERIOR PETROSAL SINUS connects the
cavernous sinus with the bulb of the internal jugular vein.
The cavernous sinus also receives anastomotic branches from the
veins draining the face and maxilla. Also note that the brainstem
and the cerebellum are drained by numerous veins that parallel the
arteries and form the BASILAR VENOUS PLEXUS, which also
empties into the great cerebral vein via the basal veinsor the
internal cerebral veins.
The basilar venous plexus and the occipital sinus also make
connections with the internal vertebral or epidural venous plexus.
The significance of this I will point out when we discuss the venous
drainage of the spinal cord.

VI. THE SPINAL CORD

Blood supply: perforating vessels from network of pial arteries
o 1 anterior and 2 posterior spinal arteries (insufficient to supply
the cord beyond the cervical levels.)
1 anterior spinal artery = supply anterior horn, lateral horn,
central gray and basal part of the posterior horn
2 posterior spinal arteries = supply Posterior horn and
posterior funiculi
o Radicular arteries
supply the NERVE ROOTS
Branch off from the vertebral/cervical arteries in the neck,
intercostals arteries in the thorax, lumbar arteries in lumbar
region and the abdominal aorta
o Radiculospinal or segmental medullary arteries supply the
RADICULOSPINAL or SEGMENTAL MEDULLARY ARTERIES
arise from branches of the aorta and anastomose with the
anterior and posterior spinal arteries at different levels
each supply about 6 spinal cord segments with the exception
of the GREAT ANTERIOR SEGMENTAL MEDULLARY ARTERY
OF ADAMKIEWICZ, which usually enters the left second
lumbar ventral root, ranging between T10-L4, and supplies
most of the caudal 1/3 of the cord
Group 5| Dave, Bamba, Precious, Jaela

Fig. 16 Anterior Blood Supply of the Spinal Cord

*The anterior spinal artery forms a circumferential plexus with

the posterior spinal arteries called the VASOCORONA.
* The anterior spinal artery supplies the anterior 2/3 of the cord
including the base of the posterior horn, while each posterior
spinal artery supplies the ipsilateral posterior horn and dorsal
columns.
*Below

the

cervical

level,

the

RADICULOSPINAL

or

the

SEGMENTAL MEDULLARY ARTERIES supply both the roots and

the cord as they join with the spinal artery, augmenting its path.
*Each of these radiculospinal arteries supply about 6 spinal cord
segments

with

the

exception

of

the

GREAT

ANTERIOR

SEGMENTAL MEDULLARY ARTERY OF ADAMKIEWICZ, which

usually enters the left

second lumbar ventralroot, ranging

between T10-L4, and supplies most of the caudal 1/3 of the cord.

Page 8 of 10

Question: The dorsal horn of the spinal cord is supplied by what

artery?
Radicular arteries accompany the spinal nerves and bifurcate to
form a VENTRAL or ANTERIOR RADICULAR ARTERY and a DORSAL
or POSTERIOR RADICULAR ARTERY to supply the ventral and
dorsal never roots respectively.
Radiculospinal arteries connect with the anterior spinal artery to
also supply the cord -SULCAL ARTERIES arise from the anterior
spinal artery and courses in the ANTERIOR MEDIAN FISSURE to
supply approximately 2/3 of the anterior cross-sectional area of
the cord (Sulcal means central)

Venous Supply
o Parallels with arterial supply (venae comitantes)
o Internal vertebral venous plexus (epidural venous plexus)
Between the dura mater and the vertebral periosteum
Have connections thoracic, abdominal and intercostals veins
and external venous plexus
Internal vertebral venous plexus = External vertebral venous
plexus = Systemic venous system
o Because of these connections, infection or carcinoma from
pelvic or abdominal organs may spread to the brain

Fig. 17 Anterior and Posterior Blood Supply of the
Spinal Cord

*Along its course, the spinal cord is supplied anteriorly and

posteriorly from arteries which enter the spinal canal through the
intervertebral foramina in company with the spinal nerves.

CLINICAL CORRELATION
Any infection from angular vein or facial vein can enter cavernous
sinus = Cavernous sinus thrombosis
Each side is connected by basilar venous plexus
Where ophthalmic vein and sphenoparietal sinus drain
Drain into the superior and inferior petrosal sinuses
Superior petrosal drains into sigmoid IJV LInferiorpetrosal
drains directly to IJV
Emissary Veins
-No valves
-For emergency drainage in case IJV is occluded
-Can be a pathway for extracranial infection, leading to infected
thrombosis

Group 5| Dave, Bamba, Precious, Jaela

Fig. 18 Venous Drainage of the Spinal Cord

Notes:
There are usually 3 anterior and 3 posterior spinal veins.
They are arranged longitudinally, communicate with each other, and
are drained by up to 12 anterior and posterior medullary and
radicular veins. These veins join the INTERNAL VERTEBRAL (or
EPIDURAL) VENOUS PLEXUS [point bottom], lying in the
extradural or epidural space.

Page 9 of 10

As mentioned earlier, this INTERNAL VERTEBRAL

VENOUS PLEXUS passes superiorly through the foramen magnum
to communicate with the dural sinuses and basilar venous plexus in
the skull.
The INTERNAL VERTEBRAL VENOUS PLEXUS also
communicates with the EXTERNAL VERTEBRAL VENOUS PLEXUS
on the external surface of the vertebrae and thus connect directly
to the systemic venous system. These connections may act as a
route for spread of infection or carcinoma from the pelvic or
abdominal organs to the brain.

stress stress stress stress stress stress stress stress stress stress
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I AM UNDER A LOT OF STRESS

The anterior spinal artery forms a circumferential plexus with the
posterior spinal arteries called the VASOCORONA . The anterior
spinal artery supplies the anterior 2/3 of the cord including the

base of the posterior horn [point], while each posterior spinal

artery supplies the ipsilateral posterior horn and dorsal columns

Group 5| Dave, Bamba, Precious, Jaela

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