Atypical presentations of Lhermitte's sign after treatment for human papillomavirus-associated oropharyngeal squamous cell carcinoma.
Alifya Altaf Lokhandwala, Jonathan Paly, Thomas Roberts et al.
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Case in brief
Two patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma developed Lhermitte’s sign after chemoradiotherapy. One experienced symptoms for 20 months after definitive concurrent volumetric modulated arc radiotherapy and weekly cisplatin; the other had symptoms for 12 months after adjuvant de-escalated volumetric modulated arc radiotherapy. Lhermitte’s sign is an electric shock-like sensation triggered by neck flexion and can indicate cervical or upper thoracic dorsal column dysfunction. In both cases, symptoms persisted well beyond treatment completion, although the report characterises the condition’s prognosis as benign.
What made this case unusual
The notable feature was prolonged Lhermitte’s sign after modern conformal radiotherapy, with symptoms lasting 20 months in one patient and 12 months in the other.
Diagnostic / clinical pearl
After head and neck chemoradiotherapy, neck-flexion–triggered electric shock-like sensations radiating down the spine may represent Lhermitte’s sign; symptoms can persist well beyond treatment completion.
Why it matters
Although the prognosis was described as benign, persistent symptoms may affect quality of life.