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November 1991, Vol 117, No. 11 >
ARTICLE | November 1991

Protracted Lhermitte's Sign Following Head and Neck Irradiation FREE

Allan F. Thornton, MD; Shawn H. Zimberg; Harry S. Greenberg, MD; Michael J. Sullivan, MD
[+] Author Affiliations

Accepted for publication March 22, 1991.

Reprint requests to the Department of Radiation Oncology, Massachusetts General Hospital, Cox 3, Fruit St, Boston, MA 02117 (Dr Thorton).


Arch Otolaryngol Head Neck Surg. 1991;117(11):1300-1303. doi:10.1001/archotol.1991.01870230116020
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References
Comments

• Lhermitte's sign is a rare complication of head and neck irradiation involving the delivery of dose to the cervical spinal cord. Although uncommon, symptoms of lightning-like electric sensations spreading into both arms, down the dorsal spine, and into both legs on neck flexion following head and neck irradiation, causes great concern in both the patient and the physician. This spontaneously reversible phenomenon is important for the otolaryngologist and radiation oncologist to recognize and discuss. A particularly severe and protracted case of Lhermitte's sign involving a patient recently completing a radical course of radiation for nasopharyngeal carcinoma is described in detail, including a review of the literature surrounding the cause and management of this condition.

(Arch Otolaryngol Head Neck Surg. 1991;117:1300-1303)

REFERENCES

1 +
Jones A.  Transient radiation myelopathy (with reference to Lhermitte's sign of electrical paraesthesia) . Br J Radiol. 1964;;37:727-744.
2 +
Lhermitte J.  Sur l'hypertrophie musculaire consecutive aux lésions grave des nerfs peripheriques: une observation nouvelle . Presse Med. 1918;;26:64.
3 +
Druckmann A.  Schlafsucht als folge der Rontgenbestrahlung beitrag zur Strahlenempfindlichkeit des Gehirns . Strahlentherapie . 1929;;33:382-384.
4 +
Boden G.  Radiation myelitis of the cervical spinal cord . Br J Radiol. 1948;;21:464.
5 +
Dynes JB, Smedal MI.  Radiation myelitis . AJR . 1960;;83:78.
6 +
Ribeton J. These de Paris. Paris, France. 1919. Thesis.
7 +
Alajouanine T, Lhermitte F, Cambier J, Gautier J.  Douleurs à type de décharge electrique . Rev Neurol. 1961;;9:105.
8 +
Kahn EA, Rand RW.  On the anatomy of anterolateralcordotomy . J Neurosurg. 1952;;9:611.
9 +
Stevenson LD, Eckhardt RE.  Myelomalacia of the cervical portion of the spinal cord, probably the result of roentgen therapy . Arch Pathol. 1945;;39:109.
10 +
Asscher AW, Anson SG.  Arterial hypertension and irradiation damage to the nervous system . Lancet . 1962;;2:1343.
11 +
Koenig H. The Biology of Myelin . London, England: Cassell House; 1959;:241.
12 +
Merine D, Wang H, Kumar AJ, Zinreich SJ, Rosenbaum AE.  CT myelography and MR imaging of acute transverse myelitis . J Comput Assist Tomogr. 1987;;11:606-608.
13 +
Barakos J.  MR imaging of acute transverse myelitis and AIDS myelopathy . J Comput Assist Tomogr. 1990;;14:46-50.
14 +
Dalakas M, Elder G, Hallett M, et al.  A longterm follow-up study of patients with post-poliomyelitis neuromuscular symptoms . N Engl J Med. 1986;;314:959-963.
15 +
Kanchandani R, Howe JG.  Lhermitte's sign in multiple sclerosis: a clinical survey and review of the literature . J Neurol Neurosurg Psychiatry . 1982;;45:308-312.
16 +
Butler WM, Taylor HG.  Lhermitte's sign in cobalamin (vitamin B12) deficiency . JAMA . 1981;;245:1059.
17 +
Page NG, Spiteri MA.  Lhermitte's sign in Behçet's disease . BMJ . 1982;;284:704-705.
18 +
Parry GJ, Bredesen DE.  Sensory neuropathy with low-dose pyridoxine . Neurology . 1985;;35:1466-1468.
19 +
Blanco G, Peters HA.  Myeloneuropathy and macrocytosis associated with nitrous oxide abuse . Arch Neurol. 1983;;40:416-418.
20 +
Dewar J, Lunt H, Abernathy DA, Dady P, Haas LF.  Cisplatin neuropathy with Lhermitte's sign . J Neurol Neurosurg Psychiatry . 1986;;49:96-99.
21 +
Blackburn CR, McLeod JG.  CNS lesions in cystinuria . Arch Neurol. 1977;;34:638.

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1 +
Jones A.  Transient radiation myelopathy (with reference to Lhermitte's sign of electrical paraesthesia) . Br J Radiol. 1964;;37:727-744.
2 +
Lhermitte J.  Sur l'hypertrophie musculaire consecutive aux lésions grave des nerfs peripheriques: une observation nouvelle . Presse Med. 1918;;26:64.
3 +
Druckmann A.  Schlafsucht als folge der Rontgenbestrahlung beitrag zur Strahlenempfindlichkeit des Gehirns . Strahlentherapie . 1929;;33:382-384.
4 +
Boden G.  Radiation myelitis of the cervical spinal cord . Br J Radiol. 1948;;21:464.
5 +
Dynes JB, Smedal MI.  Radiation myelitis . AJR . 1960;;83:78.
6 +
Ribeton J. These de Paris. Paris, France. 1919. Thesis.
7 +
Alajouanine T, Lhermitte F, Cambier J, Gautier J.  Douleurs à type de décharge electrique . Rev Neurol. 1961;;9:105.
8 +
Kahn EA, Rand RW.  On the anatomy of anterolateralcordotomy . J Neurosurg. 1952;;9:611.
9 +
Stevenson LD, Eckhardt RE.  Myelomalacia of the cervical portion of the spinal cord, probably the result of roentgen therapy . Arch Pathol. 1945;;39:109.
10 +
Asscher AW, Anson SG.  Arterial hypertension and irradiation damage to the nervous system . Lancet . 1962;;2:1343.
11 +
Koenig H. The Biology of Myelin . London, England: Cassell House; 1959;:241.
12 +
Merine D, Wang H, Kumar AJ, Zinreich SJ, Rosenbaum AE.  CT myelography and MR imaging of acute transverse myelitis . J Comput Assist Tomogr. 1987;;11:606-608.
13 +
Barakos J.  MR imaging of acute transverse myelitis and AIDS myelopathy . J Comput Assist Tomogr. 1990;;14:46-50.
14 +
Dalakas M, Elder G, Hallett M, et al.  A longterm follow-up study of patients with post-poliomyelitis neuromuscular symptoms . N Engl J Med. 1986;;314:959-963.
15 +
Kanchandani R, Howe JG.  Lhermitte's sign in multiple sclerosis: a clinical survey and review of the literature . J Neurol Neurosurg Psychiatry . 1982;;45:308-312.
16 +
Butler WM, Taylor HG.  Lhermitte's sign in cobalamin (vitamin B12) deficiency . JAMA . 1981;;245:1059.
17 +
Page NG, Spiteri MA.  Lhermitte's sign in Behçet's disease . BMJ . 1982;;284:704-705.
18 +
Parry GJ, Bredesen DE.  Sensory neuropathy with low-dose pyridoxine . Neurology . 1985;;35:1466-1468.
19 +
Blanco G, Peters HA.  Myeloneuropathy and macrocytosis associated with nitrous oxide abuse . Arch Neurol. 1983;;40:416-418.
20 +
Dewar J, Lunt H, Abernathy DA, Dady P, Haas LF.  Cisplatin neuropathy with Lhermitte's sign . J Neurol Neurosurg Psychiatry . 1986;;49:96-99.
21 +
Blackburn CR, McLeod JG.  CNS lesions in cystinuria . Arch Neurol. 1977;;34:638.

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