Level

Causes

Pain

Cranial
nerve

Weakness

Foramen
magnum

Tumors:
Meningioma
Neurofibroma
Glioma
Teratoma
Metastasis

Sub
occipital

IX to XII

Around the clock pattern of UMN weakness

Reflexes

Lhermitte
sign

Sensation

Bladder
and
bowel

Others

Occipital paresthesias

Neck stiffness

Numbness and tingling of finger

tips

Papilledema
Downbeat nystagmus
Cerebellar ataxia

Cervical
Spondylosis
Atlantooccipital
subluxation
Basilar
invagination in
paget
Syrinx
Chiari
malformation
MS
Cervicomedullary
junction

C1-C4

Onion
skin
pattern
of facial
sensory
loss
Other
cranial
nerves
XI

Cruciate hemiplegia

Respiratory
insufficiency

Contralateral UL and ipsilateral LL

In distribution of affected levels

Diaphragmatic
paralysis
False localizing signsyndrome of numb and
clumsy hands

Level

Causes

Pain

C5,C6

Cranial
nerves

Weakness

Reflexes

Sensation

LMN signs:
Spinati
Deltoid
Biceps
Brachialis
Brachioradialis
Pectorals
Lattismus dorsi
Triceps
Extensor carpi radialis

Absent :
Biceps
Brachioradialis

C5:
Sensory loss over entire body
below neck and anterior
shoulder

Spastic paraparesis in lower extremities

Paresis of wrist,finger flexors and extensors

C7

Inversion of
brachioradialis
Exaggerated:
Triceps
Finger flexion
reflex
Preserved :
Biceps
Brachioradialis

Bladder
and
bowel

others

Diaphragm
affected(C5)

C6:
Same as C5 except lateral arm
is spared

Sensory loss:
At and below 3rd and 4th digits

Normal diaphragmatic
function

Medial arm and forearm

Exaggerated :
FFR

C8,T1

Weakness involving small muscles of hand

Spastic paraparesis

Paradoxical
triceps reflex
C8:
Absent triceps
and FFR

Sensory loss:
5th digit

u/l or b/l horner

syndrome

Medial arm and forearm

Thoracic segment

Root pain
or
paresthesia
that
simulate
intercostal
neuralgia

Segmental LMN involvement difficult to detect clinically

Paraplegia

T1:
Absent
FFR,preserved
FFR
Above T6:
All superficial
abdominal
reflexes lost
At or below
T10:
Upper and
middle
abdominal
reflexes
present
Below T12:
All reflexes +

Sensory level

Above T5:
Orthostatic
hypotension
Episodic
autonomic
hyperreflexia
T10: beevor sign

Level

Causes

Pain

Cranial
nerves

Weakness

Reflexes

Sensation

L1

All muscles of lower extremity are weak

L2

Spastic paraparesis

Exaggerated:
Patellar and
ankle reflex
Absent:
cremastric

Sensory loss:
Lower extremities upto groin
and above buttock in back
Normal sensation in upper
anterior aspect of thigh

Depressed:
Patellar

L3

L4

Some preservation of hip flexion and leg adduction

Better hip flexion and adduction

Better knee flexion and extension

L5

S1

S2

Able to stand by fixing knee

Normal hip flexion,adduction and knee extension

Weakness over:
Triceps surae
Flexor digitorum longus
Flexor hallucis longus
Small foot muscles

Stronger gastrocnemius and soleus

Weakness of :
Flexor digitorum
Flexor hallucis longus
Small muscles of foot

Hyperactive:
Ankle
Depressed or
absent patellar
Hyperactive
ankle jerk
Absent patellar
Hyperactive
ankle jerk
Preserved
patellar and
hyperactive
ankle jerk
Absent ankle
Preserved knee
jerk

Absent ankle
jerk

Normal sensation in upper

anterior aspect of thigh

Normal sensation in anterior

aspect of thigh and
superomedial aspect of knee

Normal sensation in anterior

aspect of thigh,medial aspect
of leg,ankle and sole
Complete sensory loss over:
Sole
Heel
Outer aspect of foot
and ankle
Anesthesia over:
Medial aspect of calf
Posterior thigh
Outer aspect of saddle
area
Sensory loss over:
Upper part of dorsal
aspect of calf
Dorsolateral thigh
Saddle area

Bladder
and
bowel

others

Level

Causes

Conus medullaris

Pain

Uncommon

Cranial
nerves

Weakness

Reflexes

Paralysis of pelvic floor muscles

Sensation

Symmetric saddle anesthesia

May occur
late in course
involving
saddle area

Cauda equina

Tumors :
Ependymoma
Schwannoma
Meningioma

Early
radicular
pain in
lumbosacral
distribution
Unilateral
Asymmetric
Aggravated
by valsalva
Pain in
tumors more
at night and
recumbency

Flaccid hypotonic areflexic paralysis:

Glutei
Posterior thigh muscles
Anterolateral muscles of leg and foot

Absent ankle
jerk
Knee jerk
variable

Asymmetric sensory loss in

saddle region

Bladder
and
bowel
Autono
mous
neuroge
nic
bladder
constipa
tion
Late

others

Impaired erection and

ejaculation