Spinal cord vascular disease is rare but can be devastating to patients. Hypotension, especially in association with vascular procedures, and embolism are common causes of cord ischemia. Ischemia generally presents with acute painful myelopathy. The enclosed space of the spinal canal also renders the cord vulnerable to compressive effects of space-occupying vascular lesions, such as the dilated veins associated with vascular malformations. These are more likely to present with progressive myelopathy. MRI is the imaging modality of choice in identifying the cause and extent of vascular myelopathy. Interventional endovascular approaches to spinal vascular malformations are becoming more common.