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Neurology (Expert Forum)
Lhermitte's and dysesthesia
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Lhermitte's and dysesthesia
by Robert__0, Apr 28, 1998 12:00AM
I appear to be an unusual case, diagnosed with membranous glomerulonephritis with acute transverse myelitis. The glomerular pathology (with nephrotic syndrome) is more or less in remission, but the spinal cord problem is persistent and very troubling. Having done my own literature search in medline, I found one case report of concurrent GNP and myelopathy. Most of the neurological signs have improved (brisk reflexes, sharp/dull discrimination, etc., but I am left with a literally disabling Lhermitte's sign and painful paresthesia that can become very severe. The lesion is at C3, appears neuroradiolocially (2 MRs) to be more consistent with an inflammatory lesion than a tumor. It is on the right side, accounting for the sensory disturbance on the left and the brisk reflexes on the right. No drug has been able to help me with the symptoms, what I call "burning and buzzing." Gabapentin, vicodin, desipramine, and prednisone have all been useless. I have, interestingly enough, found that stretching the lesioned area just the right way, with traction and flexion, will abolish the Lhermitte's sign, but not the allodynia, at least temporarily, anywhere from a 2 to 10 minutes. Does anyone have a suggestion as to a treatment? Am I left with permanent disability? Will the Lhermitte's and/or dysesthesia (which makes my left hand feel like it is frying in oil) damp down? I have tried high dosage prednisone (60 mg daily, two weeks) to no avail, and the palliative drugs have not palliated anything. Does the coexistence of kidney and cord inflammation suggest anything of diagnostic or therapeutic value?
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Hello Robert.
Lhermitte's phenomenon is due to damage of nerve tracts known as the posterior columns, or more technically as the fasciculuc gracilis and cuneatus, and results from excessive, abnormally intense discharges from nerve fibers in these tracts. Transverse myelitis, due to either an infection, an immunologic reaction, or due to multiple sclerosis much more frequently, is the most common cause of the phenomenon. Carbamazepine (Tegretol) is a drug that will often alleviate sudden, jolting or shocking pains of neurological origin. Mexilitine, an oral novacaine-like drug, is sometimes used for such pains as a last resort type of drug. The combination of glomerulonephritis and transverse myelitis strongly suggests an inflammatory/immunological disorder.
We cannot provide specific answers regarding diagnosis and prognosis, as the forum is intended for general informational purposes only, and because to do so responsibly would require a formal evaluation. If you would be interested in a formal second opinion evaluation, of course we would be happy to see you at the Cleveland Clinic (the appointment number is 1-800-223-2273/extension 45559). The actual diagnosis and treatment of your specific medical condition should be strictly in conjunction with your treating physician(s).
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Hello Robert.
Lhermitte's phenomenon is due to damage of nerve tracts known as the posterior columns, or more technically as the fasciculuc gracilis and cuneatus, and results from excessive, abnormally intense discharges from nerve fibers in these tracts. Transverse myelitis, due to either an infection, an immunologic reaction, or due to multiple sclerosis much more frequently, is the most common cause of the phenomenon. Carbamazepine (Tegretol) is a drug that will often alleviate sudden, jolting or shocking pains of neurological origin. Mexilitine, an oral novacaine-like drug, is sometimes used for such pains as a last resort type of drug. The combination of glomerulonephritis and transverse myelitis strongly suggests an inflammatory/immunological disorder.
We cannot provide specific answers regarding diagnosis and prognosis, as the forum is intended for general informational purposes only, and because to do so responsibly would require a formal evaluation. If you would be interested in a formal second opinion evaluation, of course we would be happy to see you at the Cleveland Clinic (the appointment number is 1-800-223-2273/extension 45559). The actual diagnosis and treatment of your specific medical condition should be strictly in conjunction with your treating physician(s).
