Acute spinal cord compression is an emergency where irreversible neurological damage can occur within hours. The diagnosis should be considered in any patient with an acute paraparesis, parasthesiae, or urinary retention, but there is commonly a delay because neurological examination is incompletely performed or the urgency of the condition is not appreciated. In the days of myelography the whole spinal axis up to the foramen magnum was routinely examined, but nowadays the use of more sophisticated imaging may miss the lesion because of the tendency to restrict the imaged field to the likely clinical site. If the signs are falsely localising there is a danger of missing a treatable cause. We describe a case where the sensory level localised the lesion 11 cord segments distal to the abnormality, leading to a serious delay in diagnosis.