Limits...
Lhermitte Sign as a Presenting Symptom of Thoracic Spinal Pathology: A Case Study.

Hills A, Al-Hakim M - Case Rep Neurol Med (2015)

Bottom Line: He also felt a sharp, electric, shock-like sensation radiating from his lower back into his legs upon flexing the trunk.There was no history of trauma or other inciting events within the 2 weeks prior to presentation.Thoracic MRI at this visit showed a three-column fracture at T11-T12.

View Article: PubMed Central - PubMed

Affiliation: Class of 2015, OUWB School of Medicine, Rochester, MI 48309, USA.

ABSTRACT
A 54-year-old male with ankylosing spondylitis presented with complaints of progressively worsening bilateral leg weakness and difficulty ambulating of 2-week duration. He also felt a sharp, electric, shock-like sensation radiating from his lower back into his legs upon flexing the trunk. There was no history of trauma or other inciting events within the 2 weeks prior to presentation. Thoracic MRI at this visit showed a three-column fracture at T11-T12. He underwent spinal fusion surgery and within 2 days after surgery the radiating electrical sensation with spinal flexion had completely resolved.

No MeSH data available.


Related in: MedlinePlus

T2 thoracic MRI showing focal signal abnormality at the T11-T12 level (white arrow) with associated edema and loss of disc height, in addition to moderate spinal canal stenosis.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4538963&req=5

fig1: T2 thoracic MRI showing focal signal abnormality at the T11-T12 level (white arrow) with associated edema and loss of disc height, in addition to moderate spinal canal stenosis.

Mentions: Given the patient's clinical examination and symptoms we were most concerned with an underlying progressive pathology of the spinal cord, whether it be of neurologic, orthopedic, or multifactorial origin. We had also not ruled out metabolic, inflammatory, or infectious etiologies at that point without more extensive laboratory testing. Our differential diagnosis at the time included cervical or thoracic spondylotic myelopathy, vertebral disc herniation, thoracic vertebral fracture, spinal stenosis, transverse myelitis, chronic inflammatory demyelinating polyneuropathy, multiple sclerosis, thoracic or lumbosacral radiculopathy, pernicious anemia, malignancy, or an infectious condition such as tabes dorsalis. Our primary concern was to first investigate a potential acute spinal cord injury, so we ordered STAT cervical and thoracic MRIs to evaluate any underlying physical abnormalities that may help explain the patient's overall presentation. The T2 thoracic MRI revealed a three-column vertebral fracture at the T11-T12 level that was associated with significant edema surrounding the spinal cord and loss of vertebral body height, which had resulted in moderate spinal canal stenosis at that level (Figure 1). Later that day the patient underwent an uncomplicated T10-L1 laminectomy and fusion with instrumentation to stabilize the vertebral column. Within 2 days post-op the radiating electrical sensation with spinal flexion had disappeared, and the patient was able to stand and walk without loss of coordination or balance. He was discharged several days later able to stand and walk without assistance and felt that he had regained much of his previous lower-body strength by that point. He continued to be compliant with his physical therapy regimen and reported his symptoms completely resolved by the time of his 1-month follow-up visit with the surgeon.


Lhermitte Sign as a Presenting Symptom of Thoracic Spinal Pathology: A Case Study.

Hills A, Al-Hakim M - Case Rep Neurol Med (2015)

T2 thoracic MRI showing focal signal abnormality at the T11-T12 level (white arrow) with associated edema and loss of disc height, in addition to moderate spinal canal stenosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4538963&req=5

fig1: T2 thoracic MRI showing focal signal abnormality at the T11-T12 level (white arrow) with associated edema and loss of disc height, in addition to moderate spinal canal stenosis.
Mentions: Given the patient's clinical examination and symptoms we were most concerned with an underlying progressive pathology of the spinal cord, whether it be of neurologic, orthopedic, or multifactorial origin. We had also not ruled out metabolic, inflammatory, or infectious etiologies at that point without more extensive laboratory testing. Our differential diagnosis at the time included cervical or thoracic spondylotic myelopathy, vertebral disc herniation, thoracic vertebral fracture, spinal stenosis, transverse myelitis, chronic inflammatory demyelinating polyneuropathy, multiple sclerosis, thoracic or lumbosacral radiculopathy, pernicious anemia, malignancy, or an infectious condition such as tabes dorsalis. Our primary concern was to first investigate a potential acute spinal cord injury, so we ordered STAT cervical and thoracic MRIs to evaluate any underlying physical abnormalities that may help explain the patient's overall presentation. The T2 thoracic MRI revealed a three-column vertebral fracture at the T11-T12 level that was associated with significant edema surrounding the spinal cord and loss of vertebral body height, which had resulted in moderate spinal canal stenosis at that level (Figure 1). Later that day the patient underwent an uncomplicated T10-L1 laminectomy and fusion with instrumentation to stabilize the vertebral column. Within 2 days post-op the radiating electrical sensation with spinal flexion had disappeared, and the patient was able to stand and walk without loss of coordination or balance. He was discharged several days later able to stand and walk without assistance and felt that he had regained much of his previous lower-body strength by that point. He continued to be compliant with his physical therapy regimen and reported his symptoms completely resolved by the time of his 1-month follow-up visit with the surgeon.

Bottom Line: He also felt a sharp, electric, shock-like sensation radiating from his lower back into his legs upon flexing the trunk.There was no history of trauma or other inciting events within the 2 weeks prior to presentation.Thoracic MRI at this visit showed a three-column fracture at T11-T12.

View Article: PubMed Central - PubMed

Affiliation: Class of 2015, OUWB School of Medicine, Rochester, MI 48309, USA.

ABSTRACT
A 54-year-old male with ankylosing spondylitis presented with complaints of progressively worsening bilateral leg weakness and difficulty ambulating of 2-week duration. He also felt a sharp, electric, shock-like sensation radiating from his lower back into his legs upon flexing the trunk. There was no history of trauma or other inciting events within the 2 weeks prior to presentation. Thoracic MRI at this visit showed a three-column fracture at T11-T12. He underwent spinal fusion surgery and within 2 days after surgery the radiating electrical sensation with spinal flexion had completely resolved.

No MeSH data available.


Related in: MedlinePlus