False Localizing Signs in Neurology.

False localizing neurological signs reflect dysfunction distant from the site of the pathology. They pose considerable diffculties to the treating neurologist as they are unreliable when attempting to localize the lesion, which challenges the traditional clinicoanatomical correlation. It is important to be aware of false localizing signs and the situations in which they occur as they may be indicative of a serious, even life-threatening, pathology for appropriate and timely investigations and management.

The Cervical Herniated Intervertebral Disc Presenting with False Localizing Thoracic Sensory Levels

Symptoms of compressive cervical myelopathy classically include spasticity and weakness, predominantly involving the lower extremities. Sensory abnormalities are reportedly common in the upper extremities, but are often vague or misleading. The sensory findings are usually localized 2-3 spinal segments below the actual spinal cord compression. In our current series, 3 patients presented with progressive symptoms of weakness and hyperreflexia involving the lower extremities without upper extremity symptoms and with a distant thoracic sensory level ranging from T10 to T12. All 3 patients were eventually found to have a cervical herniated intervertebral disc. The direct physical effects of compression and vascular compromise in the central cervical cord compression may be responsible for the reported abnormality at a distinct thoracic sensory level. Failure to diagnose cervical myelopathy because of the presence of a thoracic sensory level can delay appropriate treatment or lead to incorrect therapy.