A man 44 years of age recovered from a myocardial infarction but subsequently developed cardiac pain and failure. Eight years later he suddenly developed ischemia of the lower extremities accompanied by paraplegia, complete anesthesia from the 7th lumbar segment downwards, other neurological signs and urinary and fecal incontinence. On the 28th day he died showing signs of heart failure. Post-mortem examination showed a large scarred aneurysmal area of the left ventricular wall; the area was thrombotic material. In the atherosclerotic lumbar aorta, a thrombus 11.5 cm long was found. Thrombosis extended into the left and right common iliac, external and internal branches, and the lumbar arteries. In the lumbar region of the spinal cord incomplete ischemic necrosis of the ganglion cells was observed and destruction of nervous fibers particularly pronounced in the lateral and posterior bundles of the white matter. General atherosclerosis and cardiac failure were important factors in the development of the spinal changes in this case.