Education And Debate

Lesson of the Week: False localising signs in the spinal cord

BMJ 1996; 312 doi: (Published 27 January 1996) Cite this as: BMJ 1996;312:243
  1. D R S Jamieson, lecturer in neurologya,
  2. E Teasdale, consultant neuroradiologista,
  3. H J Willison, senior lecturer in neurologya
  1. a Institute of Neurological Sciences, Glasgow G51 4TF
  1. Correspondence to: Dr Jamieson.
  • Accepted 8 September 1995

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.

Normal radiological examination at the clinical site of a cord lesion should prompt investigation at higher levels

Case report

A 68 year old right handed retired joiner was admitted with acute retention of urine. There had been no prostatic symptoms and no constipation. Three weeks earlier he had developed numbness on the anterior aspects of his thighs. In the initial examination he was reported to have Medical Research Council grade 4 power globally in the legs with normal tendon reflexes and plantar responses. There was impairment of pinprick sensation bilaterally below the inguinal ligament with sacral sparing. Rectal examination and chest x ray examination were normal.

Two days later he was unable to stand and he was transferred as a neurosurgical emergency with a provisional diagnosis of an …

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