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Pathogenesis of normal tissue side effects
Published in Michael C. Joiner, Albert J. van der Kogel, Basic Clinical Radiobiology, 2018
Radiation-induced changes in the spinal cord are similar to those in the brain in terms of latent period, histopathology and radiation tolerance. Among the (relatively) early syndromes, the Lhermitte sign is a frequently occurring, usually reversible demyelinating reaction, which develops several months after completion of treatment and lasts for a few months to more than 1 year. It may occur at doses as low as 35 Gy in 2 Gy fractions, well below tolerance for permanent radiation myelopathy, when long segments of cord are irradiated, and does not predict for later development of permanent myelopathy.
Posterior cervical surgery
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Dennis T. Lockney, Angela Wolfe, Daniel J. Hoh
Myelopathy Extremity paresthesias across multiple dermatomes or below a spinal cord levelWeakness and loss of hand dexterity (e.g., difficulty with buttoning shirts, writing, opening jars, dropping objects)Gait instability—broad based, use of ambulatory assistance, feeling unsteady, trouble ascending or descending stairsUrinary or bowel incontinence—less common and generally represents long-standing severe myelopathy Lhermitte sign—electrical shock–like sensation down the back with neck extension or flexion
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
The clinical picture of myelopathy is often preceded by local nociceptive pain due to invasion of vertebral body or epidural space and then neuropathic pain of radicular origin. When the compression extends to the dorsal column of the spinal cord, generating focal demyelination, the presence of Lhermitte sign confirms the onset of clinical myelopathy. Pure central neuropathic pain is infrequent; it prevails a neuropathic pain originated from compression/invasion of spinothalamic pathways. Â 27 The pain is usually unilateral, a few myelomers below the affected level-extended down to the foot or with a patchy distribution, associated with tingling and allodynias, peculiarly due to cold and spontaneous thermal sensations.
An update on the pharmacological management of pain in patients with multiple sclerosis
Published in Expert Opinion on Pharmacotherapy, 2020
Clara G. Chisari, Eleonora Sgarlata, Sebastiano Arena, Emanuele D’Amico, Simona Toscano, Francesco Patti
A 2008 meta-analysis classified pain associated with MS in four categories: continuous central neuropathic pain, intermittent central neuropathic pain (i.e. trigeminal neuralgia, Lhermitte sign, glossopharyngeal neuralgia), musculoskeletal pain (i.e. painful tonic spasms, pain secondary to spasticity, pain related to being wheelchair-bound) and mixed neuropathic and non-neuropathic pain (i.e. headache) [11].