Spinal cord arteriosclerosis and progressive vascular myelopathy.

Spinal cord arteriosclerosis is considered to be infrequent compared with atheromatosis in other parts of the body. Whereas Staemmler (1939) could not observe any atheromatous changes in the spinal cords of 700 unselected cadavers, Nunes Vicente (1964) noted mild arteriosclerosis of major spinal vessels in 13 out of 200 consecutive necropsy cases. Mannen (1963) even reported the incidence of 2-6% atheromatous plaques in the anterior spinal artery of 300 unselected cases upon which necropsies were performed in a geriatric hospital. Moderate to severe atheroma of spinal cord vessels has been observed incidentally but only exceptionally has spinal cord infarction been caused by documented occlusion ofosis of the small intramedullary arteries as a local variant of atheromatosis is also extremely rare (Arendt and Wunscher, 1954). The relationship between thickening of the small intramedullary vessels in advanced age, known as 'perisclerosis', 'hyalinosis', or 'fibrosis' and arteriosclerosis, however , has been uniformlydenied (Liithy and Zollinger, 1946; Stochdorph and Meessen, 1957). On the other hand, spinal cord lesions due to arteriosclerosis have been known since the late nineteenth century (Demange, 1884; Campbell, 1894) but have subsequently received only an occasional mention in the literature. Reviewing myelopathy due to vascular diseases, Keschner and Davison (1933) found only two cases referable to arteriosclerosis in 200 instances of cerebral athero-sclerosis. Recent reports, however, suggest that the condition may be far more common than was formerly supposed (Jellinger and Neumayer, 1962; Hughes and Brownell, 1966). Recently we reported on more than 60 cases, all verified at necropsy, in which a complex neurological syndrome, often referable to a combined lesion of the upper and lower motor neurone, was associated with generalized arteriosclerosis and severe aortic atheroma without thrombosis or occlusion of the spinal tributaries (Jellinger and Neumayer, 1966). The pathogenesis of this rarely diagnosed condition is obscure as, till now, there have been neither sufficient observations regarding the incidence of spinal cord atherosclerosis nor relevant data on the changes of spinal vessels in old age, generalized arteriosclerosis, and systemic hypertension. In this communication the incidence of arterio-sclerotic changes and vascular fibrosis in the spinal cords of 1,037 necropsied cases described in the files of the Neurological and Pathological Institutes of Vienna University is reported and correlated with the age and the frequency of atherosclerosis of the aorta, the coronary and cerebral arteries, as well as the incidence of cerebrovascular lesions and systemic hypertension. Inflammatory vascular processes (syphilis, panarteritis nodosa) …