Focal myocardial necrosis associated with multiple sclerosis of the medulla

A debate exists as to the capacity of the central nervous system to induce vasospasm of resistance vessels in the coronary circulation both in healthy persons and in patients with coronary artery disease. A view exists suggesting that direct central neural stimulatory effects on the coronary arteries are minimal¹ and that central nervous system stimulation as occurs in head injury results in a generalized autonomie response with circulating catecholamines arising from the adrenal gland causing toxic damage to the myocardium.² A contrasting view is that the extensive intrathoracic sympathetic nervous system that directly innervates the coronary arteries when stimulated can induce myocardial ischemia, which, if prolonged, induces myocardial infarction.³ In this report, we describe a young woman with a brief history of multiple sclerosis involving the medulla who presented with myocardial infarction, and subsequently died.