Abstract
Progressive paraplegia with an ascending level is described in a 60-year-old coloured Jamaican woman who was found to have the sickle cell trait. Death resulted from respiratory failure and subsequent autopsy revealed several small infarcts of varying age confined to the central nervous system. Although some infarcts were found in the cerebral cortex, cerebellum and brain-stem they were most numerous and extensive in the spinal cord. The pattern of the micro-infarcts is described at the various segmental levels of the cord and resembled that seen in cases of spinal cord embolism. Although no fibrin thrombus was seen in vessels associated with the necrotic areas, many were found to be distended with plugs of tightly packed abnormally shaped red cells, which would tend to cause ischaemic infarction by their increased viscosity leading to further sickling of red cells. The difficulties and problems in diagnosis are reviewed.
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