The Cervical Herniated Intervertebral Disc Presenting with False Localizing Thoracic Sensory Levels

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1 The Cervical Herniated Intervertebral Disc Presenting with False Localizing Thoracic Sensory Levels Bo-Ram Lee, M.D., Dong-Sin Cho, M.D., Shin-Koo Yoon, M.D., Sang-Gull Cho, M.D., Moo-Young Ahn, M.D., Ki-Bum Sung, M.D. Department of Neurology, College of Medicine, Soonchunhyang University Symptoms of compressive cervical myelopathy classically include spasticity and weakness, predominantly involving the lower extremities. Sensory abnormalities are reportedly common in the upper extremities, but are often vague or misleading. The sensory findings are usually localized 2-3 spinal segments below the actual spinal cord compression. In our current series, 3 patients presented with progressive symptoms of weakness and hyperreflexia involving the lower extremities without upper extremity symptoms and with a distant thoracic sensory level ranging from T10 to T12. All 3 patients were eventually found to have a cervical herniated intervertebral disc. The direct physical effects of compression and vascular compromise in the central cervical cord compression may be responsible for the reported abnormality at a distinct thoracic sensory level. Failure to diagnose cervical myelopathy because of the presence of a thoracic sensory level can delay appropriate treatment or lead to incorrect therapy. J Kor Neurol Ass 17(5):747~751, 1999 Key Words : Compressive myelopathy, Cervical herniated intervertebral disc, Thoracic sensory level, False localizing signs Ki-Bum Sung, M.D. Copyright 1999 by the Korean Neurological Association 747

2 Figure 1. CT scan of Case 2 after metronizamide myelogra - phy shows ventral indentation of the spinal cord at C5-C J Kor Neurol Ass / Volume 17 / September, 1999

3 Figure 2-A. Showing lines of stress in anterior spinal cord compression. Primary stress is placed on the anterior columns. Secondary stress is directly on lateral corticospinal and spinothalamic tracts. Least stress of all is placed on the posterior columns. B. (Top) Cross-sec - tion of normal spinal cord and (bottom) spinal cord compressed in anteroposterior plane. When cord is flattened, vertically oriented vessels of anterior and posterior columns become short and tortuous. Horizontally oriented vessels of central gray matter and lateral columns are elongated and attenuated. J Kor Neurol Ass / Volume 17 / September,

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