Severe chest pain resembling angina pectoris in a 42-year-old man preceded the development of neurologic signs, distracting from recognition of the acute infarction of the cervical spinal cord responsible for his pain. Consistent with a spinal origin of chest pain were the absence of any evidence of cardiac disease and the demonstration of infarction at C6-7. This segmental level coincides with the convergence of ascending afferent traffic entering the central nervous system from the cardiac plexus. Spinal stroke affecting the lower cervical level can thus mimic the pain of myocardial ischemia.