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いろいろなレルミット徴候 回診でレルミット徴候（Lhermitte sign; LS）について議論しました．頸部を前屈させた時，背中から下方に向けて電撃的な痛みが放散する現象です．おもに脊髄後索の病変で生じます．原因として脱髄疾患が有名ですが，ビタミンB12欠乏や圧迫性病変など様々な疾患で見られます．三重大学冨本秀和教授から「逆Lhermitte徴候」について教えていただきました．頸部を後屈させた時に生じるためreverse LSと呼ばれます．私が調べた症例報告では黄色靭帯による圧迫が原因でした．なんとそれ以外にもdelayed LSとinverse LSがありました．前者は頸部外傷後「遅発性」に生ずるものを指し，後者は上下さかさま，つまり頸部を前屈すると背中から「上方」に向けて電撃痛が放散するものです．笑気ガス吸入によるミエロパチーにより生じるそうです．種類により原因をある程度詰められる点が興味深いです． J Clin Neurosci. 2008 Apr;15(4):379-81. | 岐阜大学大学院 医学系研究科 脳神経内科学分野
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