Chronic ischaemic myelopathy in aortic atherosclerosis

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Abstract

A clinico-pathological study of a man of 59 who slowly developed weakness of the legs progressing to complete paraplegia is described.

Multiple small areas of necrosis were found in the thoracic cord associated with extensive aortic atherosclerosis. The infarcts were either wedge-shaped in the lateral columns or crescentic in the watershed territory between anterior and posterior spinal arteries, and would account for both the motor and sensory symptoms.

The damage to the spinal cord was due to emboli of grumous material containing some cholesterol crystals originating in the severe eroding atheroma of the aorta. The intercostal, lumbar, radicular and spinal arteries were free from atheroma.

The literature on atheromatous embolism is reviewed and the various ways in which aortic disease can affect the spinal cord are discussed.

It is concluded that owing to the frequency of aortic atheroma compared with the infrequent finding of atheroma of spinal arteries, this mechanism may be a prominent factor in the production of chronic ischaemic myelopathy.

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Wolman, L., Bradshaw, P. Chronic ischaemic myelopathy in aortic atherosclerosis. Spinal Cord 6, 32–41 (1968) doi:10.1038/sc.1968.8

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