Dr Gross raises a fair question that the spinal cord lesion could have been a demyelinating plaque. There were, however, no signs or symptoms to indicate more than 1 neurologic lesion, and findings on MRI of the brain were normal. The abrupt onset, the normal spinal fluid, and the observation that the lesion involved the central part of the spinal cord rather than the posterior columns suggested a vascular basis, whether due to vertebral or cervical radicular artery dissection, intervertebral disk embolization, or some undiscoverable cause. I agree that the possibility of a demyelinating or inflammatory lesion could not be entirely excluded, but on clinical grounds, infarction seemed the more probable conclusion. The most interesting point about the case would hold true even if Dr Gross is correct—that an acute lesion localized to the lower cervical spinal cord can influence ascending visceral afferent neurons and mimic pain of cardiac origin.
© 2001 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.