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International Journal of Otolaryngology
Volume 2010, Article ID 907960, 4 pages
Case Report

Lhermitte's Sign Developing after IMRT for Head and Neck Cancer

1Department of Radiation Medicine, Oregon Health & Science University, Mailcode KPV4, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA
2Tuality/OHSU Cancer Center, Hillsboro, OR 97123, USA

Received 26 January 2010; Revised 9 March 2010; Accepted 7 May 2010

Academic Editor: Alfio Ferlito

Copyright © 2010 Dong C. Lim et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Lhermitte's sign (LS) is a benign form of myelopathy with neck flexion producing an unpleasant electric-shock sensation radiating down the extremities. Although rare, it can occur after head and neck radiotherapy. Results. We report a case of Lhermitte's developing after curative intensity-modulated radiotherapy (IMRT) for a patient with locoregionally advanced oropharyngeal cancer. IMRT delivers a conformal dose of radiation in head and neck cancer resulting in a gradient of radiation dose throughout the spinal cord. Using IMRT, more dose is delivered to the anterior spinal cord than the posterior cord. Conclusions. Lhermitte's sign can develop after IMRT for head and neck cancer. We propose an anterior spinal cord structure, the spinothalamic tract to be the target of IMRT-caused LS.