TO ERR in the diagnosis of a relievable disorder is a tragedy. A readily missed and usually eminently relievable lesion of the nervous system is one about the junction of the medulla and cervical spinal cord (a junction lesion). Here, the arrangement of nervous structures and their blood supply1 is such as to result in a multiplicity and variance of symptoms and signs from patient to patient, signs that may come and go.
A recent leading article in The Lancet'2 called attention to missed foramen magnum tumors. Aneurysms and subarachnoid cysts in this locale, characterized by remission and exacerbation, test diagnostic acumen. The most common mistake in diagnosis has been to call these troubles "multiple sclerosis," and perhaps next most common, "cervical spondylosis."
A sign of multiple sclerosis, the tingling shock that occurs on first flexing the neck (Lhermitte sign) has been found in junction lesions. Also, horizontal
Aring CD. Lesions About the Junction of Medulla and Spinal Cord. JAMA. 1974;229(14):1879. doi:10.1001/jama.1974.03230520021023
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