Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc
Journal website http://www.neurores.org

Original Article

Volume 1, Number 1, April 2011, pages 22-29

Bilateral Finger Jerks as a Useful Sign for Diagnosis of Cervical Compressive Myelopathy

Figures

Figure 1.
Figure 1. Sagittal T2-weighted magnetic resonance imaging (TR 500 TE 24). (A) Spinal cord compressions owing to C4-5, C5-6 intervertebral disk hernias were observed in Patient 1. (B) Spinal cord compressions owing to C6-7 (and mild C3-4) intervertebral disk hernias were observed in Patient 2. C3 vertebral level spinal cord showed a mild high intensity area and myelomalacia was suspected. (C) C3 vertebra was sliding posterior. C3-4, C4-5 (and mild C5-6) intervertebral level spinal cord compressions and spinal canal stenosis were observed in Patent 3. (D) Spinal cord compression owing to C5-6 intervertebral disk bulging and spinal canal stenosis were observed in Patient 4. (E) Spinal cord compression owing to C5-6 intervertebral level lesion was observed in Patient 5. (F) Spinal cord compression owing to C4-5 intervertebral disk hernia was observed in Patient 6. (G) Spinal cord compressions owing to C4-5 and C5-6 intervertebral disk bulging with osteophyte formations were observed in Patient 7. (H) Spinal cord compression owing to C3-4 intervertebral kyphosis deformity was observed in Patient 8. (I) Spinal cord compression owing to C4-5 intervertebral level lesion and a T2 high intensity area in C4 vertebral level spinal cord were observed in Patient 9. (J) Spinal cord compressions and deformity owing to C5-6 (and mild C4-5) intervertebral level lesions were observed in Patient 10. (K) Severe spinal cord compressions owing to C6-7 (mild C4-5 and C5-6) intervertebral disk bulging and osteophyte formations were observed in Patient 11. (L) Spinal cord compressions owing to C4-5 (and mild C5-6) intervertebral level lesions were observed in Patient 13. (M) Spinal cord compression owing to C4-5 intervetebral disk hernia was observed in Patient 17. (N) Spinal cord compression and mild deformity owing to C5-6 intervertebral disk hernia and hypertrophy of the posterior longitudinal ligament lesion were observed in Patient 18. (O) Spinal cord compressions owing to C5-6 (mild C4-5 and C6-7) intervertebral disk bulging were observed in Patient 19. (P) Spinal cord compression owing to C4-5 intervertebral disk bulging was observed in Patient 20. (Q) Spinal cord compressions owing to C4-5 and C5-6 intervertebral level osteophyte formations were observed in Patient 21. (R) Right side dominant spinal cord compressions owing to C4-5 and C5-6 intervertebral disk hernias were observed in Patient 22. (S) Spinal cord compression owing to C5-6 intervertebral disk bulging was observed in Patient 23. (T) Spinal cord compression owing to osteophyte formation of C6 vertebra and hypertrophy of posterior longitudinal ligament was observed in Patient 24.
Figure 2.
Figure 2. Axial T2-weighted magnetic resonance imaging (TR 500 TE 24). (A) C4-5 intervertebral level section of Patient 1. Spinal cord compression and boomerang-like change owing to C4-5 intervertebral disk hernia were observed. (B) C5-6 intervertebral level section of Patient 1. Spinal cord compression and boomerang-like change owing to C5-6 intervertebral disk hernia were observed. (C) C6-7 intervertebral level section of Patient 2. Spinal cord compression and mild boomerang-like change owing to C6-7 intervertebral disk hernia were observed. (D) C3-4 intervertebral level section of Patient 3. C3-4 intervertebral level spinal cord compression and spinal canal stenosis owing to C3 vertebral sliding were observed. (E) C4-5 intervertebral level section of Patient 3. C4-5 intervertebral level spinal cord compression and spinal canal stenosis owing to C3 vertebral sliding were observed. (F) C5-6 intervertebral level section of Patient 4. Spinal cord compression owing to C5-6 intervertebral disk bulging was observed. (G) C4-5 intervertebral level section of Patient 6. Spinal cord compression owing to C4-5 intervertebral disk hernia was observed. (H) C4-5 intervertebral level section of Patient 9. Spinal cord compression owing to C4-5 intervertebral level lesion was observed. (I) C4-5 intervertebral level section of Patient 13. Spinal cord compression and boomerang-like change owing to C4-5 intervertebral level lesion were observed. (J) C5-6 intervertebral level section of Patient 18. Spinal cord compression and mild deformity owing to C5-6 intervertebral disk hernia and hypertrophy of the posterior longitudinal ligament lesion were observed.

Tables

Table 1. Patients, Vertebral Levels of Lesions, Deep Tendon Reflexes, Sensory Levels, and Sensory Symptoms
 
PatientAge, GenderVertebral levelDTRsSensory levelsSensory and other symptoms
DTR: deep tendon reflex; hyper: hyperreflexia; normo: normoreflexia; hypo: hyporeflexia; a: areflexia; dis.: disturbance; hyperhidro.: hyperhidrosis; hypohidro.: hypohidrosis.
172, FC4-5, C5-6, C6-7hyperC7tingling sensation of left hand
264, MC6-7, (C3-4)variable-tingling of both hands, chest pain
371, MC3-4, C4-5, (C5-6)hyper-gait dis.
462, FC5-6variable-head hyperhidro., body hypohidro.
565, FC5-6hyper-tingling sensations of both feet
662, FC4-5variable-tingling of all extremities
763, MC4-5, C5-6a-tingling sensation of right hand
882, FC3-4hyper-tingling, weakness of both hands
976, FC4-5aC7-8tingling of both hands, gait dis.
1046, MC5-6 (C4-5)a-gait dis., anuresis
1174, MC6-7 (C4-5, C5-6)variableC4-5tingling sensations of both hands
1253, FC5-6hypo-tingling, numbness of both hands
1364, FC4-5 (C5-6)hypoC6weakness of left hand
1471, FC5-6hypoC5-6tingling of lower extremities
1576, FC4-5hyper-tingling of all extremities
1674, MC4-5hyper-gait dis.
1765, FC4-5hyper-tingling sensation of right hand
1862, MC5-6normo-tingling of left hand, gait dis.
1981, FC5-6, (C4-5 (C6-7))hyper-chest discomfort
2069, MC4-5hypo-unsteadiness
2138, MC4-5, C5-6hyper-stiffness of left forearm
2258, MC4-5, C5-6a-tingling sensation of right hand
2353, FC5-6variable-tingling sensations of both hands
2458, FC6a-tingling, clumsiness of both hands

 

Table 2. Vertebral Levels of Lesions, Deep Tendon Reflexes of Upper Extremities, and Long Tract Signs
 
PatientVertebral levelBicepsBrachioradialTricepsFinger jerksLong tract sign
+++: increased; ++: normal; +: decreased; dis.: disturbance; L/E: lower extremities; PTR: patellar tendon reflex.
1C4-5, 5-6++++++++++gait dis., sensory level
2C6-7 (3-4)+++++--chest pain, gait dis.
3C3-4, 4-5 (5-6)++++++++++gait dis.
4C5-6++++++++++hypohidrosis of body
5C5-6+++++++++-tingling sensations of L/E
6C4-5++/+++++/+++++/++++weakness, sensory disturbance of L/E
7C4-5, 5-6---/++-hyperreflexia of L/E
8C3-4++++++++-hyperreflexia of L/E
9C4-5--++-gait dis.
10C4-5--+++gait dis., anuresis, impotence
11C6-7 (4-5, 5-6)+-++-hyperreflexia of L/E
12C5-6+-/+++pain of both toes, increased right PTR
13C4-5 (5-6)++-+++hyperreflexia of L/E
14C5-6+/+++++++tingling sensation of right L/E
15C4-5++++++++-tingling and hyperreflexia of L/E
16C4-5+++++++++-spasticity, hyperreflexia of L/E, gait dis.
17C4-5+++++++++(finger jerks)
18C5-6++++++-gait dis.
19C5-6 (4-5 (6-7))++++++++++(finger jerks)
20C4-5+++-(unsteadiness)
21C4-5, 5-6++++++++++hyperrefleixa of L/E
22C4-5, 5-6--+-
23C5-6++/+++++/+++++/+++-(Wartenberg reflexes)
24C6--++/+-