Poppen Olivia, Troutner Alyssa, Farrell Christopher, Rae Lindsay
VA Finger Lakes Healthcare System, Rochester Clinton Crossings VA Clinic, Rochester NY.
Southern California University of Health Sciences, Whittier, CA.
J Can Chiropr Assoc. 2024 Apr;68(1):58-67.
Lhermitte's sign is a nonspecific historical and exam finding that carries with it a differential diagnosis of cervical myelopathy, multiple sclerosis, intradural tumors, or other central nervous system pathology. Regardless of the suspected diagnosis, further diagnostic investigation is indicated to determine etiology of symptoms.
In this case, a 67-year-old male Veteran presents to a Veterans Affairs (VA) outpatient chiropractic clinic with an insidious 6-month onset of neck pain with historical description of a positive Lhermitte's sign, a single episode of bladder incontinence, and mild changes in upper extremity manual dexterity. These subtle historical findings prompted referral for a brain and cervical spine MRI, revealing an ependymoma in the cervical spine. Urgent neurosurgical referral was made, and the patient underwent C3-C7 laminectomy, C3-T2 fusion, and tumor resection.
This case represents an example of clinical reasoning in a VA chiropractic clinic when presented with subtle neurologic findings, and discusses the differential diagnoses and decision-making process to pursue imaging that resulted in appropriate neurosurgical management.
莱尔米特征是一种非特异性的病史和检查发现，其鉴别诊断包括颈椎脊髓病、多发性硬化症、硬脊膜内肿瘤或其他中枢神经系统病变。无论怀疑的诊断如何，都需要进一步的诊断性检查以确定症状的病因。
在本病例中，一名67岁的男性退伍军人前往退伍军人事务部（VA）门诊整脊诊所就诊，颈部疼痛隐匿发作6个月，有莱尔米特征阳性的病史描述、单次膀胱失禁发作以及上肢手部灵活性轻度改变。这些细微的病史发现促使其转诊进行脑部和颈椎MRI检查，结果显示颈椎有室管膜瘤。遂紧急转诊至神经外科，患者接受了C3 - C7椎板切除术、C3 - T2融合术和肿瘤切除术。
本病例展示了VA整脊诊所面对细微神经系统发现时的临床推理实例，并讨论了鉴别诊断以及进行影像学检查的决策过程，最终实现了恰当的神经外科治疗。
