A Review on Radiogenic Lhermitte's Sign

Olga ÉSIK1, Tibor CSERE4, Klára STEFANITS4, Zsolt LENGYEL5, Géza SÁFRÁNY6, Katalin VÖNÖCZKY3, Erzsébet LENGYEL2, Csaba NEMESKÉRI7, Imre REPA8, Lajos TRÓN9

1Department of Oncotherapy, Semmelweis University, Budapest, Hungary
2Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
3Outpatient Department of Neurology, National Institute of Oncology, Budapest, Hungary
4Department of Oncotherapy, University of Pécs, Pécs, Hungary
5PET Center, University of Debrecen, Debrecen, Hungary
6National Research Institute for Radiobiology and Radiation Hygiene, Budapest, Hungary
7Municipal Oncoradiological Center, Uzsoki Hospital, Budapest, Hungary
8Department of Diagnostic Imaging, University of Kaposvár, Kaposvár, Hungary
9PET Study Group of the Hungarian Academy of Sciences, Debrecen, Hungary


Radiation myelopathy is a rare, but extremely serious side-effect of radiotherapy. Recovery from radiation-induced motor sequelae is rare, whereas, the regeneration of sensory losses is relatively frequent. Among the sensory radiogenic injuries of the spinal cord, Lhermitte's sign (LS) is most frequent. This review describes the clinical picture and diagnostic imaging signs of radiogenic LS. There have been only a few studies on large patient groups with radiogenic LS, demonstrating a rate of occurrence of 3.6-13%, relating mainly to mantle irradiation or the radiotherapy of head and neck tumors. These cases typically manifest themselves 3 months following radiotherapy and gradually disappear within 6 months. Only 3 LS cases have been described in the English literature with extraordinarily severe symptoms lasting for more than 1 year. MRI, a sensitive tool in the detection of demyelination, failed to reveal any pathological sign accompanying radiogenic LS. However, positron emission tomography demonstrated increased [18F]fluorodeoxyglucose accumulation and [15O]butanol perfusion, but a negligible [11C]methionine uptake in the irradiated spinal cord segments in patients with long-standing LS. These imaging data are suggestive of a close direct relationship between the regional perfusion and metabolism of the spinal cord, very much like the situation in the brain. We postulate that an altered, energy-demanding conduction along the demyelinated axons of patients with chronic radiogenic LS may explain the increased metabolism and perfusion. Pathology & Oncology Research, Vol 9, Nr 2, 115-120, 2003

Key words: radiation myelopathy; permanent Lhermitte's sign; magnetic resonance imaging; positron emission tomography; [18F]fluorodeoxyglucose; [15O]butanol; [11C]methionine

Received: Mar 8, 2003; accepted: May 5, 2003
Correspondence: Olga ÉSIK, Department of Oncotherapy, Semmelweis University, Ráth György u 7-9 Budapest H-1122, Hungary; Tel: (36)-1-2248689, Fax: (36)-1-2248620; E-mail:

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