FALSE LOCALIZING SIGNS IN UPPER CERVICAL SPINAL-CORD COMPRESSION

PROPRIOCEPTIVE LOSS, PARESTHESIAS, and atrophy of the hands can occur with disorders afflicting the upper cervical spinal cord. The diagnosi s might be erroneous, because compression in this region might produce signs and symptoms that seem to originate in the lower cervical cord. This article reviews the clinical presentation and radiographic data of a consecutive series of 11 patients who presented between 1992 and 1994 with an extradural lesion above the C4 level. Each patient had a characteristic syndrome of finger and hand dysesthesias, hand atrophy, and occipital or cervical pain. These complaints usually preceded the development of spasticity and gait disturbance. Initial diagnoses inc luded brachial plexopathy, shoulder dysfunction, viral syndrome, and c ervical spondylosis at a lower segment. Cervical spondylosis or a hern iated disc was the most common pathogenesis. The most commonly involve d level was C3-C4. Nine patients underwent a surgical procedure; eight showed significant postoperative improvement (mean time of follow-up examination, 9.7 mo; follow-up range, 1-24 mo). One patient was lost t o follow-up. Although the pathophysiology of these findings is unknown , theories include anterior spinal artery ischemia, venous obstruction , and differential decussation of the forelimb and hindlimb fibers of the corticospinal tract. Recognition of this syndrome might prevent in appropriate operative intervention in patients with coexisting patholo gical conditions of the lower cervical spinal cord.