Thoracic flexion provokes and localizes thoracic lesions in multiple sclerosis: a new clinical sign
Author(s):
A.T. Reder
Affiliations:
Neurology, University of Chicago, Chicago, IL, United States
ECTRIMS Online Library. Reder A. 10/10/18; 228217; P372
Anthony Reder
Anthony Reder
Contributions
Abstract

Abstract: P372

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - MS symptoms

Objective: Determine whether local spine flexion can discriminate thoracic from cervical MS lesions.
Background: Lhermitte's sign/symptom indicates there is a cervical cord lesion due to an MS plaque or other cause. New lesions may not be apparent on cervical MRI, the Clinical/MRI paradox, although there may be prior MRI activity. Some MS patients have thoracic symptoms such as a sensory band, usually at T6-8, the “MS hug.” Is it due to cervical or thoracic lesions?
Design and methods: 25 MS patients with potential thoracic cord lesions performed two maneuvers: 1) Rapid neck flexion, with flexion maintained briefly, and also rapid neck extension, and 2) Rapid thoracic flexion with the neck straight and immobile.
Results: Thoracic flexion was positive in 9 of 15 patients with recent onset thoracic cord symptoms such as a thoracic sensory band. Their pain or dysesthesia was provoked or worsened and radiated around the chest or from the thoracic spine then down to the legs. There was no cervical Lhermitte's sign elicited by this maneuver, even when it could be provoked with neck flexion. The thoracic flexion symptom was seldom positive when cord symptoms had appeared in the remote past, as in 10 additional patients. The maneuver is difficult when patients are corpulent, physically inactive, or have abdominal muscle weakness.
Conclusions: Thoracic flexion, a thoracic “crunch,” can elicit an electrical sensation. This is usually associated with recent thoracic cord lesions and is likely to be independent of cervical pathology. As with cervical cord symptoms on neck flexion, this sign may help localize MS plaques, even when MRI is negative.
Disclosure: AT Reder: nothing to disclose

Abstract: P372

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - MS symptoms

Objective: Determine whether local spine flexion can discriminate thoracic from cervical MS lesions.
Background: Lhermitte's sign/symptom indicates there is a cervical cord lesion due to an MS plaque or other cause. New lesions may not be apparent on cervical MRI, the Clinical/MRI paradox, although there may be prior MRI activity. Some MS patients have thoracic symptoms such as a sensory band, usually at T6-8, the “MS hug.” Is it due to cervical or thoracic lesions?
Design and methods: 25 MS patients with potential thoracic cord lesions performed two maneuvers: 1) Rapid neck flexion, with flexion maintained briefly, and also rapid neck extension, and 2) Rapid thoracic flexion with the neck straight and immobile.
Results: Thoracic flexion was positive in 9 of 15 patients with recent onset thoracic cord symptoms such as a thoracic sensory band. Their pain or dysesthesia was provoked or worsened and radiated around the chest or from the thoracic spine then down to the legs. There was no cervical Lhermitte's sign elicited by this maneuver, even when it could be provoked with neck flexion. The thoracic flexion symptom was seldom positive when cord symptoms had appeared in the remote past, as in 10 additional patients. The maneuver is difficult when patients are corpulent, physically inactive, or have abdominal muscle weakness.
Conclusions: Thoracic flexion, a thoracic “crunch,” can elicit an electrical sensation. This is usually associated with recent thoracic cord lesions and is likely to be independent of cervical pathology. As with cervical cord symptoms on neck flexion, this sign may help localize MS plaques, even when MRI is negative.
Disclosure: AT Reder: nothing to disclose

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