False localising levels in spinal cord compression

To describe three cases with false localising levels illustrating the difficulty in clinical diagnosis of spinal cord compression.

Three patients (aged 53, 55 and 57 years) developed acute (in one) and subacute (in two) spinal cord syndrome with paraparesis, bladder symptoms and sensory levels suggesting lower thoracic or higher lumbar involvement. Imaging at suspected levels was normal. Follow-up investigations after a significant delay showed compression at higher levels (up to 11 segments). Diagnoses were surgically verified. In one patient who died, post mortem investigation discloseed a caudally situated artery of Adamkiewicz and absent vicarious vessels at T7-T8 that are usually present in such cases.

The well known but rare phenomenon of false localizing sensory levels in spinal cord syndromes should be kept in mind. Its causes can lie in remote higher levels of compressive lesion or in vascular compromise due to variants of the blood supply.