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Cervical myelopathy with false localizing sensory levels

K K Adams1, C E Jackson, R A Rauch

  • 1Department of Medicine, University of Texas Health Science Center, San Antonio, USA.

Archives of Neurology
|November 1, 1996
PubMed
Summary

Cervical myelopathy can present with misleading thoracic sensory levels, delaying diagnosis. Magnetic resonance imaging (MRI) is crucial for accurate localization of cervical spinal cord compression.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Cervical myelopathy diagnosis is often delayed due to atypical presentations.
  • Discrepancies between sensory level and spinal cord compression site are rarely reported.
  • Magnetic resonance imaging (MRI) has not been utilized for localizing these discrepancies.

Observation:

  • A case series identified four male patients with cervical myelopathy presenting with false localizing thoracic sensory levels (T-4 to T-10).
  • Patients exhibited lower extremity weakness and hyperreflexia, with no cervical pain, trauma history, or upper extremity symptoms.
  • Thoracic MRI scans were normal, leading to initial misdiagnosis in one case (transverse myelitis).

Findings:

  • All four patients were diagnosed with cervical spinal cord compression via cervical MRI.

Related Experiment Videos

  • Surgical decompression improved lower extremity strength in three patients.
  • Two patients experienced persistent thoracic sensory levels post-surgery.

    • Implications:

    • Failure to recognize cervical myelopathy with thoracic sensory levels can result in delayed or incorrect treatment.
    • Thoracic sensory levels may persist after surgical decompression for cervical myelopathy.
    • Accurate diagnosis requires considering cervical spinal cord compression despite atypical sensory findings.