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Prevalence of Anxiety and Depressive Symptoms in Patients With a Positive Hoffmann Sign and No Cervical Cord
Ebrahim Hejazian1, Forouzan Sedaghat2, Sussan Moudi3
1Department of Neurosurgery Babol University of Medical Sciences Babol Iran.
Background And Aims:
Hoffmann sign is commonly used during screening for cervical myelopathy, but its diagnostic performance varies across studies. Psychological factors such as anxiety have been proposed as possible contributors to false-positive or variable reflex findings, yet data are limited. This study aimed to describe the prevalence of anxiety and depressive symptoms among patients with a positive Hoffmann sign but no cervical cord compression on magnetic resonance imaging (MRI).
Methods:
This descriptive cross-sectional study included 99 consecutive adults evaluated in a neurosurgery clinic who had a positive Hoffmann sign and underwent cervical MRI as part of clinical workup. Patients with significant cervical cord compression or T2 cord signal change were excluded. Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). Results are reported as counts, percentages, means with standard deviations (SDs), and 95% confidence intervals (CIs) where appropriate. Associations with age group, sex, and history of psychiatric consultation were exploratory.
Results:
The cohort included 99 participants; 89 were female (89.9%; 95% CI, 82.4%-94.4%). Clinically significant anxiety symptoms (HADS-A > = 11) were present in 51 of 99 participants (51.5%; 95% CI, 41.8%-61.1%), and clinically significant depressive symptoms (HADS-D > = 11) were present in 40 of 99 participants (40.4%; 95% CI, 31.3%-50.3%). Borderline or clinically significant symptoms (HADS > = 8) were observed in 89 of 99 participants (89.9%) for anxiety and 80 of 99 participants (80.8%) for depression. The history of psychiatric consultation was associated with higher anxiety and depression categories in exploratory analyses.
Conclusions:
In this selected clinical cohort, anxiety and depressive symptoms were common among patients with a positive Hoffmann sign and no MRI evidence of cervical myelopathy. These findings support cautious interpretation of an isolated positive Hoffmann sign and justify further controlled studies. The results should not be interpreted as proving causality or as a basis for limiting neurological workup when objective upper motor neuron signs are present.