Spinal cord infarctions occur rarely and are due to various aetiologies. In an emergency setting with acute spinal cord symptoms, magnetic resonance imaging (MRI) is used to exclude space-occupying lesions which require neurosurgical intervention. We report on two patients presenting with an anterior spinal artery syndrome caused by infarction of the thoracolumbar spinal cord including the conus medullaris. While T2-weighted images 4 h and 28 h after onset of clinical symptoms showed only slight unspecific signal changes, diffusion-weighted imaging revealed clear infarction and detected spinal cord ischaemia in an early stage, showing signal intensity conversion comparable to that in acute cerebral stroke.