Arteries of the Spinal Cord and Brainstem

The brainstem and upper spinal cord are supplied by the vertibrobasilar system.

The vertebral artery is a branch of the subclavian artery. The connections of the
vertibrobasilar system from caudal to rostral are as follows:

Vertebral artery → posterior spinal artery (PSA), posterior inferior cerebellar arteries
(PICA), and the anterior spinal artery (ASA).

Both vertebral arteries fuse → basilar artery.

The basilar artery runs along the center of the anterior/ventral pons. Its branches are:

1) The anterior inferior cerebellar arteries (AICA)

2) Multiple pontine arteries

3) The superior cerebellar artery

Superiorly, the basilar artery ends by branching into both posterior cerebral arteries.

The anterior spinal artery and bilateral posterior spinal arteries supply the spinal cord.

The anterior spinal artery supplies all the spinal cord except for the dorsal columns.

The dorsal columns are supplied by the posterior spinal arteries.

The vertebral artery supplies the inferior olivary complex.

The PSA supplies the cuneate and gracile nuclei in the medulla.

Lateral medullary (Wallenberg) syndrome results from damage to structures supplied

by the PICA.

Within the medulla:

1) Nucleus ambiguous (CN IX, X, XI)

2) Lateral spinothalamic tract (anterolateral pathway)

3) Spinal trigeminal tract and nucleus

4) Vestibular nuclei

5) Solitary nuclei and tract

Also supplies the inferior cerebellar peduncle.

Medial medullary (Dejerine) syndrome results from damage to the following structures
supplied by the ASA.

Structures within the medulla supplied by the ASA:

1) Pyramids

2) Medial lemniscus

3) CN XII (hypoglossal) nerve and nucleus

Branches of the basilar artery supplies the pons. Pontine arteries supply the entire pons,
and some regions receive additional blood supply from either the AICA or superior
cerebellar artery.

The cochlear nucleus (within the medulla) is supplied by the AICA.

Structures within the pons supplied by pontine arteries and the AICA:

1) Facial (CN VII) nerve and nucleus

2) Vestibular nuclei (CNVIII)

3) Trigeminal (CN V) nuclei and nerve

4) Spinal trigeminal tract

5)Inferior and middle cerebellar peduncles

The superior cerebellar artery contributes blood flow to the superior cerebellar
peduncle.

Other structures within the pons supplied only by pontine arteries:

1) Abducent (CN VI) nucleus and nerve

2) Corticospinal fibers

3) Medial leminscus

4) Medial longitudinal fasciculus

Occlusion of the basilar artery results in locked-in syndrome.

The midbrain receives blood supply mostly from branches of the posterior cerebral
artery.

The exception is the superior colliculus, which receives blood via the superior cerebellar
artery.