Arterial border zone necrosis of the spinal cord

A 74-year-old man developed necrosis of the spinal cord following an episode of severe hypotension associated with dissection of the aorta. The area of necrosis was confined to the arterial border zone between the anterior and posterior spinal arteries, and involved both gray and white matter symmetrically. The periphery of the cord was spared. Only the lower thoracic cord, which represents a border zone between segmental radicular arteries, was involved. Extensive arterial border zone necrosis was also present in the cerebral cortex and cerebellum. The fact that arterial border zone necrosis is much less common in the spinal cord than in the brain suggests that its development requires a local compromise of the spinal cord circulation in addition to systemic arterial hypotension.