Clinical Reasoning: A 59-Year-Old Man With Delayed Electric Shock-Like Sensations After a Fall.

Abstract

We present a 59-year-old man who developed delayed-onset electric shock-like sensations triggered by neck flexion approximately 3-4 weeks after a workplace fall. Immediately after the fall, he experienced a brief episode of transient global sensory loss that resolved within minutes, followed by headache and posterior neck pain. Approximately 10 minutes later, he developed bilateral upper extremity paresthesias in the C6 dermatomal distribution that gradually resolved over several hours. Several weeks later, he developed reproducible electric shock-like sensations radiating from the neck throughout the body with neck flexion, consistent with Lhermitte sign. Neurologic examination revealed no motor or sensory deficits. MRI of the brain was unremarkable, and serial MRI studies of the cervical and thoracic spine showed no intramedullary abnormalities. This case demonstrates a structured clinical reasoning approach to post-traumatic sensory phenomena.