The case reported showed acute necrotic myelopathy and acute perivenous encephalomyelitis against a background of renal infection, malignant hypertension, and a history of injury. Death from renal disease and pneumonia halted the neurological pathology in the acute stage, thus allowing a more detailed histological examination than is possible in the later stages. The pathogenesis of acute necrotic myelopathy, together with the effects of oedema and vascular compression in the cord, are discussed briefly.