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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
pathology by clinicoanatomical
and upper thoracic
nerve palsy
cord lesions
correlation “
Third nerve palsy and
Kernohan’s notch
phenomenon
• 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
1
6/27/09
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}
2
6/27/09
1.Aterial hypothesis
2.Venous hypothesis
3.Mechanical
hypothesis
INO
Aphasia
MG {pseudo-internuclear ophthalmoplegia}
subcortical lesion
Nystagmus
Dysarthria
MG { myasthenic nystagmus}
cortical lesion