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A Localizing Symptom in Thoracic Myelopathy
Thoracic flexion, a rapid forward flexion at the waist, can elicit a circumferential electrical sensation in some patients with multiple sclerosis. The clinical and radiographic features of this phenomenon are described here. This symptom is typically a sensory band around the T6-T7 dermatomes and is usually associated with recent thoracic cord lesions. It is clinically independent of cervical pathology and Lhermitte’s sign. Similar to the vertical radiation of symptoms upon neck flexion due to cervical cord lesions, this sign may help localize MS plaques to the thoracic cord, even when thoracic MRI is negative.
A 54-year-old male with ankylosing spondylitis presented with complaints of progressively worsening bilateral leg weakness and difficulty ambulating of 2-week duration. He also felt a sharp, electric, shock-like sensation radiating from his lower back into his legs upon flexing the trunk. There was no history of trauma or other inciting events within the 2 weeks prior to presentation. Thoracic MRI at this visit showed a three-column fracture at T11-T12. He underwent spinal fusion surgery and within 2 days after surgery the radiating electrical sensation with spinal flexion had completely resolved.
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