6/27/09

“Neurological signs   that determine of

the site or place of any process or lesion”

False localizing
False localizing sign
signs associated
associated with
with spinal cord
intracranial lesion
lesions

Foramen magnum
Sixth nerve palsy and upper cervical
“ Neurological signs that reflect cord lesions

dysfunction distant or remote from

expected anatomical locus of Fifth and seventh
Lower cervical cord

pathology by clinicoanatomical
and upper thoracic
nerve palsy
cord lesions

correlation “
Third nerve palsy and
Kernohan’s notch
phenomenon

Other false localizing

sign reported with
intracranial pathology

• Unilateral or bilateral
• Most common false
localizing sign of intracranial
tumor , IICP
• Pathophysiology
• Stretch nerve or
compress against petrous
ligament or ridge of
petrous temporal bone
• Mechanical effects of
backward brainstem
displacement by
intracranial space
occupying lesion

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 6/27/09

  Trigeminal neuropathy , facial palsy

›  Causes
• Hypoactive or   Posterior fossa tumor
hyperactive with   Diffuse neoplastic disease
negative or positive   Idiopathic intracranial hypertension
Jacksonian symptoms ›  Pathology
• Trigeminal   Traction CN in brainstem distortion from tumor
neuropathy ,facial
  Trigeminal neuralgia , hemifacial spasm
paisy
• Trigeminal ›  Causes
neuralgia ,Hemifacial   Posterior fossa tumor
spasm

  Causes
•  IICP
  Hutchison ‘s pupil
  Uncal herniation
• Contralateral hemiparesis + Ipsilateral
CN III palsy
• Ipsilateral hemiparesis + Ipsilateral CN III
palsy
“ Kernohan’s notch phenomenon”
  Dynamic axial brainstem distortion
{Transtentorial herniation}

  Trochlear nerve palsy : IICP   Glossopharyngeal ,Vagus nerve palsy :

  Unilateral hearing loss : Idiopathic
posterior fossa tumor
intracranial hypertension   Frontal ataxia : cerebellar ataxia involve

  Unilateral papilloedema : Foster

corticopontocerebellar pathway
Kennedy syndrome
›  Unilateral ,ipsilateral optic atrophy
›  Contralateral papilloedema
›  Central scotoma
›  Anosmia

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• Foramen magnum   Compressive cervical myelopathy

• Paresthesia in ›  Midthoracic girdle sensation
hands
  High thoracic cord compression
• Upper limb weak
{LMNL} ›  Lumbar sensory
• Midline cervical disc
protrusion at C3/4 level
• Numb and clumsy
hands
• T ightening
sensation at
midthoracic level

1.Aterial hypothesis
2.Venous hypothesis
3.Mechanical
hypothesis

  INO
  Aphasia
  MG {pseudo-internuclear ophthalmoplegia}
  subcortical lesion

  Nystagmus
  Dysarthria
  MG { myasthenic nystagmus}
  cortical lesion

  Pseudoathetosis and pseudoastereognosis

  Pseudosyringomyelia
  high cervical cord lesion
  amyloid polyneuropathy ,Tangier disease