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Magnetic resonance imaging and posttraumatic Lhermitte's sign
V C Traynelis1, P W Hitchon, W T Yuh
1Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242.
Journal of Spinal Disorders
|December 1, 1990
Summary
Lhermitte's sign can occur after cervical spine fractures without other spinal cord issues. Subarachnoid scarring, detectable by advanced MRI, may be the cause.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Lhermitte's sign, characterized by an electric shock-like sensation down the spine upon neck flexion, is a rare neurological symptom.
- Its occurrence following cervical spine fractures, particularly when magnetic resonance imaging (MRI) reveals no other spinal cord dysfunction, presents a diagnostic challenge.
Observation:
- Two patients presented with Lhermitte's sign post-cervical spine fracture, exhibiting no other signs of spinal cord injury.
- Standard cervical spine MRI scans in both patients were unremarkable, showing no evidence of demyelination or structural damage.
Findings:
- The study explores potential etiologies for Lhermitte's sign in this specific clinical context.
- Differential diagnoses considered include cervical spondylosis, combined systems degeneration, multiple sclerosis, neoplasms, and radiation myelopathy.
- A key finding is the speculation that subarachnoid scarring, potentially undetectable by standard MRI, may underlie Lhermitte's sign in these cases.
Implications:
- Clinical evaluation should include detailed neurological assessment, cervical spine flexion/extension films, and complete blood counts.
- Advanced imaging techniques like gadolinium-enhanced MRI may be crucial for detecting subarachnoid scarring, offering a potential explanation for Lhermitte's sign.
- This highlights the need for comprehensive diagnostic approaches in patients with Lhermitte's sign following trauma, even with initially normal imaging.