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False Localising Signs
False Localising Signs
Sairam,,,
Neurological signs have been described as ‘false
localizing’ if they reflect dysfunction distant or
remote from the expected anatomical locus of
pathology and hence challenging the traditional
clinicoanatomical correlation paradigm.
Jobin v joseph, False Localising Signs in Neurology, Indian Journal of Clinical Practice, Vol. 23, No.
9 February 2013
William Macewen.
Scottish neurosurgeon.
Headache, vomitting
Lesion?
LOCALISATION
• Supratentorial- 13 %
• Infratentorial- 4%
Tumours of the cerebellum rarely fail to
show the signs of cerebellar involvement.
• Paralyses of cranial nerves. 10 %
• Hemianopia.
• Jacksonian epilepsy.
• Bilateral spastic paresis.
• Cerebellar signs.
False localising signs.
Cranial nerve.
1) 6th nerve.
Most common
Seen in both supra and infra tentorial
lesions.
Reason: compression against the petrous
ligament or the ridge of the petrous
temporal bone.
2) Oculomotor nerve : Unilateral fixed dilated
pupil (Hutchinson’s pupil)
• Pseudoathetosis.
• Myasthenic nystagmus.
• Subcortical aphasia.
Collier’s Prime findings
• Signs appearing late in the course of intracranial
tumour, where general symptoms and signs
preexisted, are often of false portent.
• Absence of focal neurological deficits during the
early course of illness is in itself a most
important localizing indicator, confining the
disease to the supratentorial compartment.
• As the disease process progress, generalized
symptoms of increased intracranial pressure
may conceal once recognizable true localizing
signs.
• Tumours of the cerebellum rarely fail to show
the signs of cerebellar involvement
8 year child
Headache, vomitting
Lesion?
LOCALISATION
20 year old – headache, vomiting
7 months
Visual disturbance
10 months
left 6th CN palsy
2 months
Left ear complete deafness,
Left facial nerve palsy
3 months
Left cerebellar signs
• Glioma in left frontal lobe.
References
• James collier, The false localising signs of Intracranial tumour,
Neurology, 1904.