Background
Hemorrhage affecting the spinal cord is rare. Spinal cord hemorrhage can be divided based on etiology, into two types: (1) traumatic and (2) non-traumatic. It can also be divided based on the compartment into which the hemorrhage occurs, namely: (1) intramedullary (including hematomyelia), (2) subarachnoid (SAH), (3) subdural (SDH), and/or (4) epidural (EDH).
Spinal cord hemorrhage is most commonly caused by trauma, vascular malformations, or bleeding diatheses. Spinal cord hemorrhage usually presents as sudden, painful myelopathy, which may reflect the anatomic level of the hemorrhage.
For perfusion, three longitudinal vessels form an anastomotic network that supplies the spinal cord: two posterior spinal arteries, and the anterior spinal artery. Blood flows from the anterior spinal artery into medullary branches of the intradural vertebral arteries, and subsequently into segmental radiculomedullary arteries. The blood flow to the posterior spinal arteries originates from intradural vertebral arteries, which are from medullary segments of the posterior inferior cerebellar arteries and segmental radiculopial arteries. Blood flow to the lower portion of the spinal cord (T8–L3) is supplied by a large radicular artery with somewhat variable positioning, termed the Artery of Adamkiewicz.
Vascular supply and venous drainage of the spinal cord
The cross-sectional blood supply of the spinal cord can be divided into (1) central and (2) peripheral systems, which supply the grey and white matter, respectively (with some degree of overlap). The central perfusion region receives blood supply from the anterior spinal artery, which forms the central sulcus artery and courses into the ventral median sulcus and supplies the grey matter of spinal cord. The posterior spinal arteries give rise to the “vasocorona,” which eventually branches into peripheral arteries and mainly supplies the white matter of the spinal cord.
Anterior and posterior median spinal veins drain the anterior and posterior regions of the spinal cord, respectively. The pial surface and superficial regions of the spinal cord are drained by radial veins and the coronal venous plexus.