Electric shock-like sensations in 42 cancer patients: clinical characteristics and distinct etiologies

Abstract

We retrospectively evaluated 42 consecutive cancer patients manifesting electric shock-like sensations. Fourty three percent presented with Lhermitte's sign (LS), 24% with the previously described outstretching ir. abduction maneuver (OAM) of the arms, and 33% had both phenomena. Twenty nine patients had underlying polyneuropathy related to cisplatin-based chemotherapy in 27 and to thiamine deficiency in 2. Thirtreen patients had myelopathy which was induced by radiotherapy in 11. Patients with polyneuropathy manifested both LS and OAM, while patients with myelopathy more often presented with LS. Neurologic signs suggestive of spinal cord involvement were present in 3 patients with polyneuropathy and in 7 of 11 irradiated patients. MRI disclosed cervical spinal cord swelling in 3 patients with LS. Prolonged cervical latencies on SSER were noted in 5 of 15 patients. All had LS and 3 also had OAM associated with abnormal latencies in the brachial plexi. We conclude that LS and OAM are positive sensory manifestations of increased mechanosensitivity of the damaged central or peripheral sensory axons in the cervico-brachial area. In cancer patients, these phenomena largely manifest treatment-induced myelopathy or polyneuropathy. Auxillary studies help to confirm diagnosis and to depict the uncommon but treatable causes.

Lhermitte sign and myelopathy after irradiation of the cervical spinal cord in radiotherapy treatment of head and neck cancer

“…First, LS is usually reversible. Only late onset LS may develop into CPRM [6,10,12,20,28,32]. Second, LS developed at maximum doses as low as 38.2 Gy.…”

“…Chronic progressive radiation myelopathy (CPRM) can be preceded by delayed onset of Lhermitte sign (LS; 9-15 months after radiotherapy treatment) [6,10,12,20,28,32]. LS is a transient myelopathy with shock-like sensations from the neck to the extremities, typically after flexion of the neck, and can be evoked by different factors including radiotherapy [2,21,27,30].…”

Oxaliplatin-Induced Lhermitte’s Phenomenon as a Manifestation of Severe Generalized Neurotoxicity

“…Damage to the dorsal root ganglia (DRG) may also produce ectopic impulse bursts ascending into the dorsal columns, potentially leading to Lhermitte’s phenomenon [4,31]. As DRG toxicity is a well-recognized feature of platinum-based chemotherapies [32], modulation of DRG excitability may contribute to the development of Lhermitte’s phenomenon in oxaliplatin-treated patients.…”

“…While Lhermitte’s phenomenon is typically associated with demyelinating lesions in the dorsal columns of the cervical spine [2], it has also been described with spinal compression, subacute combined degeneration of the spinal cord, Behçet’s disease and vitamin B 12 deficiency [3]. In the setting of malignant disease, Lhermitte’s phenomenon has been associated with radiation myelopathy, neoplastic spinal compression and chemotherapy-induced toxicity [4]. Regarding the latter, Lhermitte’s phenomenon has been reported in the context of worsening cisplatin-induced neuropathy [5] and with docetaxel treatment [6].…”

Lhermitte's Phenomenon and Platinum, Beware of Latency

“…A retrospective analysis of 45 patients with known cisplatin-induced peripheral neuropathy demonstrated that 11 of these patients had LS [5]. Lossos et al [6] examined 42 cases of Lhermitte's in a cohort of oncology patients referred to a neuro-oncology clinic, and found 64% to be due to cisplatin. It has been suggested that LS is under-recognised and thus under-reported in oncology practice [1].…”