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Kristin K. Adams, MD; Carlayne E. Jackson, MD; Ronald A. Rauch, MD; Steve F. Hart, MD; Romana S. Kleinguenther, MD; Richard J. Barohn, MD

Arch Neurol. 1996;53(11):1155-1158.

Abstract
Background
The diagnosis of cervical myelopathy is not always initially recognized. Only a few reports have described the discrepancy between sensory level and the site of cord compression, but none, to our knowledge, have used magnetic resonance imaging (MRI) for localization.

Objective
To identify a syndrome of compressive cervical myelopathy with false localizing thoracic sensory levels.

Design
Case series.

Setting

A university hospital referral center.

Results
Four men, aged 24 to 60 years, presented with progressive weakness and hyperreflexia involving the lower extremities and distinct thoracic sensory levels ranging from T-4 to T-10. None of these patients had cervical pain, history of trauma, or upper extremity symptoms. Results of MRI scans of the thoracic spinal cord were unremarkable. Initially, 1 patient was suspected of having transverse myelitis and was treated with high-dose steroids. All 4 patients were eventually found to have cervical spinal cord compression, diagnosed by MRI. Three patients underwent surgery for decompression of the cervical lesion. While all 3 improved in lower extremity strength, 2 had persistent discrete thoracic sensory levels postoperatively.

Conclusions
Failure to diagnose cervical myelopathy because of the presence of a thoracic sensory level can delay appropriate treatment or lead to incorrect therapy. Persistence of a thoracic sensory level following surgery can occur.

Author Affiliations
From the Department of Medicine, Division of Neurology (Drs Adams, Jackson, Hart, and Kleinguenther), and the Department of Radiology, Division of Neuroradiology (Dr Rauch), University of Texas Health Science Center, San Antonio; and the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (Dr Barohn).

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