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Journal of Neurology Neurosurgery and Psychiatry 2003;74:415-418
© 2003 BMJ Publishing Group

PHYSICAL SIGNS

False localising signs

A J Larner

Correspondence to:
Dr A J Larner, Consultant Neurologist, Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazkerley, Liverpool L9 7LJ, UK; a.larner{at}thewaltoncentre.nhs.uk


ABSTRACT
Neurological signs have been described as "false localising" if they reflect dysfunction distant or remote from the expected anatomical locus of pathology, hence challenging the traditional clinicoanatomical correlation paradigm on which neurological examination is based. False localising signs occur in two major contexts: as a consequence of raised intracranial pressure, and with spinal cord lesions. Cranial nerve palsies (especially sixth nerve palsy), hemiparesis, sensory features (such as truncal sensory levels), and muscle atrophy, may all occur as false localising signs. Awareness that signs may be false localising has implications for diagnostic investigation.

Keywords: false localising signs; intracranial hypertension; nerve palsy

Abbreviations: IIH, intracranial hypertension; MRI, magnetic resonance imaging




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