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Question Date: 22/10/2023

Question: A 24-year-old man began to experience Lhermitte phenomenon 2 months after receiving radiation therapy for Hodgkin disease. When seen in neurologic consultation 1 week after the onset of his symptoms, he has a normal general examination and neurologic examination. Imaging studies show no evidence of recurrent lymphoma. MRI scans of the brain, cervical spine, and thoracic spine are all normal. Which of the following is the most likely prognosis?

Options:

• Persistent Lhermitte phenomenon, but no additional symptoms
• Rapid progression to irreversible spastic quadriparesis over the course of days
• Slow progression to irreversible spastic quadriparesis over the course of years
• Spontaneous resolution of neurologic manifestations over the course of weeks to months

Correct Answer: Spontaneous resolution of neurologic manifestations over the course of weeks to months

Explaination: The preferred response is D (spontaneous resolution of neurologic manifestations over the course of weeks to months). Transient Lhermitte phenomenon, thought to result from focal posterior column demyelination, can occur between 6 weeks and 6 months after radiation therapy. MRI studies are normal. The manifestations typically resolve over several weeks to months, and they do not portend the development of subsequent progressive myelopathy. In contrast to this common form of radiation myelopathy manifesting as a transient Lhermitte phenomenon, a less common, delayed-onset, irreversible, progressive myelopathy usually does not occur until months to years after radiation, and MRI studies are typically abnormal (although they may be normal early in the course).

Reference: Page 95, Goodman BP. Metabolic and toxic causes of myelopathy. Continuum (Minneap Minn). 2015 Feb21(1 Spinal Cord Disorders)84-99. doi 10.121201.CON.0000461086.79241.3b. PMID 25651219