Spinal cord ischemia is an important and potentially treatable cause of acute myelopathy. Similar to brain ischemia, the accurate diagnosis of spinal cord ischemia is necessary to begin timely treatment and avoid debilitating and/or permanent morbidity. Diagnosis in the absence of obvious inciting traumatic, procedural or vascular source (e.g., aortic aneurysm), however, may be elusive for many patients. The recently proposed diagnostic criteria specify the presence of a T2 hyperintensity and/or diffusion-restricted intramedullary spinal cord lesion and supporting factors of associated vertebral body infarction and/or arterial narrowing or occlusion.1 Spinal cord ischemia is also framed as a diagnosis of exclusion, to be considered after eliminating alternative etiologies such as extrinsic cord compression and inflammatory etiologies. This exclusion alludes to the fact that many of the clinical and imaging abnormalities of spinal cord ischemia are, in isolation, nonspecific and may be insufficient for confident diagnosis.