Lhermitte's sign

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Lhermitte's sign
Other namesLhermitte phenomenon
Pronunciation
Differential diagnosis Compression of the upper spinal cord, multiple sclerosis, transverse myelitis, Behçet's disease, osteogenesis imperfecta

In neurology, Lhermitte phenomenon, also called the barber chair phenomenon, is an uncomfortable "electrical" sensation that runs down the back and into the limbs. The sensation can feel like it goes up or down the spine. It is painful for some, although others might simply feel strange sensations. [1]

Contents

In many people, it is elicited by bending the head forward. [2] It can also be evoked when a practitioner pounds on the cervical spine while the neck is flexed; this is caused by involvement of the posterior columns.

Lhermitte phenomenon is named after the French neurologist Jean Lhermitte. [3]

Associated conditions

The sign suggests a lesion or compression of the upper cervical spinal cord or lower brainstem—usually dorsal columns of the cervical cord or caudal medulla.[ citation needed ]

Although often considered a classic finding in multiple sclerosis, it can be caused by a number of conditions, including transverse myelitis, Behçet disease, [4] osteogenesis imperfecta, [5] trauma, radiation myelopathy, [6] vitamin B12 deficiency (subacute combined degeneration), compression of the spinal cord in the neck from any cause such as cervical spondylosis, disc herniation, tumor, and Arnold–Chiari malformation. Lhermitte's sign may also appear during or following high-dose chemotherapy. [7] [8] Irradiation of the cervical spine may also evoke it as an early delayed radiation injury, which occurs within 4 months of radiation therapy.[ citation needed ]

Delayed onset Lhermitte's sign has been reported following head and/or neck trauma. [9] [10] This occurs ~2 1/2 months following injury, without associated neurological symptoms or pain, and typically resolves within 1 year.[ citation needed ]

This sign is also sometimes seen as part of a "discontinuation syndrome" associated with certain psychotropic medications, such as selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors, particularly paroxetine and venlafaxine. Typically, it only occurs after having taken the medication for some duration, and then stopped or withdrawn rapidly or after administering reduced dose. Fluoxetine, given its very long half-life, can be given as a single small dose, and often avoid Lhermitte's sign and other withdrawal symptoms. [11]

In the dental field, three studies (Layzer 1978, Gutmann 1979, Blanco 1983) have identified Lhermitte sign among nitrous oxide abusers. This is likely due to nitrous oxide depletion of vitamin B12 leading to a very severe, rapid deficiency in the absence of supplementation.[ citation needed ]

Terminology

Lhermitte sign is not attributed to its discoverer. [12] It was first described by Pierre Marie and Chatelin in 1917. [13] Jean Lhermitte, a French neurologist and neuropsychiatrist, did not publish his first report until 1920. [14] However, in 1924 he did publish the seminal article on the subject which resulted in it becoming well known. [15]

Related Research Articles

<span class="mw-page-title-main">Transverse myelitis</span> Inflammation of the entire cross-section of the spinal cord

Transverse myelitis (TM) is a rare neurological condition wherein the spinal cord is inflamed. The adjective transverse implies that the spinal inflammation (myelitis) extends horizontally throughout the cross section of the spinal cord; the terms partial transverse myelitis and partial myelitis are sometimes used to specify inflammation that affects only part of the width of the spinal cord. TM is characterized by weakness and numbness of the limbs, deficits in sensation and motor skills, dysfunctional urethral and anal sphincter activities, and dysfunction of the autonomic nervous system that can lead to episodes of high blood pressure. Signs and symptoms vary according to the affected level of the spinal cord. The underlying cause of TM is unknown. The spinal cord inflammation seen in TM has been associated with various infections, immune system disorders, or damage to nerve fibers, by loss of myelin. As opposed to leukomyelitis which affects only the white matter, it affects the entire cross-section of the spinal cord. Decreased electrical conductivity in the nervous system can result.

<span class="mw-page-title-main">Cervical spine disorder</span> Medical condition

Cervical spine disorders are illnesses that affect the cervical spine, which is made up of the upper first seven vertebrae, encasing and shielding the spinal cord. This fragment of the spine starts from the region above the shoulder blades and ends by supporting and connecting the skull.

<span class="mw-page-title-main">Spondylosis</span> Degeneration of the vertebral column

Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, the neural foramina and the facet joints. If severe, it may cause pressure on the spinal cord or nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, imbalance, and muscle weakness in the limbs.

<span class="mw-page-title-main">Spinal cord injury</span> Injury to the main nerve bundle in the back of humans

A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. It is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions.

Myelopathy describes any neurologic deficit related to the spinal cord. The most common form of myelopathy in humans, cervical spondylotic myelopathy (CSM), also called degenerative cervical myelopathy, results from narrowing of the spinal canal ultimately causing compression of the spinal cord. When due to trauma, myelopathy is known as (acute) spinal cord injury. When inflammatory, it is known as myelitis. Disease that is vascular in nature is known as vascular myelopathy.

<span class="mw-page-title-main">Jean Lhermitte</span> French neurologist and neuropsychiatrist (1877–1959)

Jacques Jean Lhermitte was a French neurologist and neuropsychiatrist.

Wobbler disease is a catchall term referring to several possible malformations of the cervical vertebrae that cause an unsteady (wobbly) gait and weakness in dogs and horses. A number of different conditions of the cervical (neck) spinal column cause similar clinical signs. These conditions may include malformation of the vertebrae, intervertebral disc protrusion, and disease of the interspinal ligaments, ligamenta flava, and articular facets of the vertebrae. Wobbler disease is also known as cervical vertebral instability (CVI), cervical spondylomyelopathy (CSM), and cervical vertebral malformation (CVM). In dogs, the disease is most common in large breeds, especially Great Danes and Doberman Pinschers. In horses, it is not linked to a particular breed, though it is most often seen in tall, race-bred horses of Thoroughbred or Standardbred ancestry. It is most likely inherited to at least some extent in dogs and horses.

Beevor's sign is medical sign in which the navel moves towards the head upon flexing the neck, indicating selective weakness of the lower abdominal muscles. Causes include spinal cord injury, amyotrophic lateral sclerosis (ALS), and facioscapulohumeral muscular dystrophy (FSHD).

<span class="mw-page-title-main">Spinal cord compression</span> Medical condition

Spinal cord compression is a form of myelopathy in which the spinal cord is compressed. Causes can be bone fragments from a vertebral fracture, a tumor, abscess, ruptured intervertebral disc or other lesion.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

<span class="mw-page-title-main">Central cord syndrome</span> Human spinal cord disorder

Central cord syndrome (CCS) is the most common form of cervical spinal cord injury (SCI). It is characterized by loss of power and sensation in arms and hands. It usually results from trauma which causes damage to the neck, leading to major injury to the central corticospinal tract of the spinal cord. CCS most frequently occurs among older persons with cervical spondylosis, however, it also may occur in younger individuals.

<span class="mw-page-title-main">Laminoplasty</span>

Laminoplasty is an orthopaedic/neurosurgical surgical procedure for treating spinal stenosis by relieving pressure on the spinal cord. The main purpose of this procedure is to provide relief to patients who may have symptoms of numbness, pain, or weakness in arm movement. The procedure involves cutting the lamina on both sides of the affected vertebrae and then "swinging" the freed flap of bone open thus relieving the pressure on the spinal cord. The spinous process may be removed to allow the lamina bone flap to be swung open. The bone flap is then propped open using small wedges or pieces of bone such that the enlarged spinal canal will remain in place.

Vascular myelopathy refers to an abnormality of the spinal cord in regard to its blood supply. The blood supply is complicated and supplied by two major vessel groups: the posterior spinal arteries and the anterior spinal arteries—of which the Artery of Adamkiewicz is the largest. Both the posterior and anterior spinal arteries run the entire length of the spinal cord and receive anastomotic (conjoined) vessels in many places. The anterior spinal artery has a less efficient supply of blood and is therefore more susceptible to vascular disease. Whilst atherosclerosis of spinal arteries is rare, necrosis in the anterior artery can be caused by disease in vessels originating from the segmental arteries such as atheroma or aortic dissection.

<span class="mw-page-title-main">Spinal stenosis</span> Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

Spinal cord injury without radiographic abnormality (SCIWORA) is symptoms of a spinal cord injury (SCI) with no evidence of injury to the spinal column on X-rays or CT scan. Symptoms may include numbness, weakness, abnormal reflexes, or loss of bladder or bowel control. Neck or back pain is also common. Symptoms may be brief or persistent. Some do not develop symptoms until a few days after the injury.

<span class="mw-page-title-main">Hirayama disease</span> Medical condition

Hirayama disease, also known as monomelic amyotrophy (MMA), is a rare motor neuron disease first described in 1959 in Japan. Its symptoms usually appear about two years after adolescent growth spurt and is significantly more common in males, with an average age of onset between 15 and 25 years. Hirayama disease is reported most frequently in Asia but has a global distribution. It is typically marked by insidious onset of muscle atrophy of an upper limb, which plateaus after two to five years from which it neither improves nor worsens. There is no pain or sensory loss. It is not believed to be hereditary.

<span class="mw-page-title-main">Rheumatoid disease of the spine</span> Medical condition

Rheumatoid disease of the spine is a morbid consequence of untreated longstanding severe cervical spinal rheumatoid arthritis (RA)–an inflammatory autoimmune disease that attacks the ligaments, joints, and bones of the neck. Although the anterior subluxation of the atlantoaxial joint is the most common manifestation of the disorder, subluxation can also occur with posterior or vertical movement, and subaxial joints can also be involved.

Craniocervical instability (CCI) is a medical condition characterized by excessive movement of the vertebra at the atlanto-occipital joint and the atlanto-axial joint located between the skull and the top two vertebra, known as C1 and C2. The condition can cause neural injury and compression of nearby structures, including the brain stem, spinal cord, vagus nerve, and vertebral artery, resulting in a constellation of symptoms.

Cervical Spondylotic Myelopathy (CSM) is a disorder characterised by the age-related deterioration of the cervical spinal cord. Referred to be a range of different but related terms, a global consensus process selected Degenerative Cervical Myelopathy as the new overarching disease term. It is a neurological disorder related to the spinal cord and nerve roots. The severity of CSM is most commonly associated with factors including age, location and extent of spinal cord compression.

References

  1. ↑ "Lhermitte's sign | MS Trust".
  2. ↑ "Definition of Lhermitte sign". medterms medical dictionary a-z list. MedicineNet.com. Retrieved 20 April 2011.
  3. ↑ Teoli, D; Rocha Cabrero, F; Smith, T; Ghassemzadeh, S (January 2024) [July 21, 2023]. "Lhermitte Sign". Treasure Island, Florida: StatPearls. PMID   29630289 . Retrieved November 16, 2024.
  4. ↑ Page, NG; Spiteri, MA (Mar 6, 1982). "Lhermitte sign in Behçet disease". British Medical Journal (Clinical Research Ed.). 284 (6317): 704–5. doi:10.1136/bmj.284.6317.704. PMC   1496643 . PMID   6802294.
  5. ↑ Steiner, R. D.; Basel, D. (December 12, 2019). "COL1A1/2 Osteogenesis Imperfecta" (PDF). GeneReviews: 1–29. Retrieved February 4, 2020.
  6. ↑ Jones, A (Oct 1964). "Transient Radiation Myelopathy". The British Journal of Radiology. 37 (442): 727–44. doi:10.1259/0007-1285-37-442-727. PMID   14217730.
  7. ↑ Heinzlef, O; Lotz, JP; Roullet, E (May 1998). "Severe neuropathy after high dose carboplatin in three patients receiving multidrug chemotherapy". Journal of Neurology, Neurosurgery, and Psychiatry. 64 (5): 667–9. doi:10.1136/jnnp.64.5.667. PMC   2170092 . PMID   9598687.
  8. ↑ Amaraneni, A; Seth, A; Itawi, EA; Chandana SR (December 2014). "Oxaliplatin-induced Lhermitte sign. A case report and review of literature". Clinics in Colorectal Cancer. Dec (13): 257–259. doi:10.1016/j.clcc.2014.09.006. PMID   25442817 . Retrieved November 16, 2024.
  9. ↑ Frank H. Anderson; James R. Lehrich (1973). "Lhermitte's sign following head injury". JAMA Neurology . 29 (6): 437–8. doi:10.1001/archneur.1973.00490300099015. PMID   4759419.
  10. ↑ Chan RC.; Steinbock P. (1984). "Delayed onset of Lhermitte's sign following head and/or neck injuries. Report of four cases". J Neurosurg . 60 (3): 609–12. doi:10.3171/jns.1984.60.3.0609. PMID   6699706.
  11. ↑ Roy R. Reeves; Harold B. Pinkofsky (1996). "Lhermitte sign in paroxetine withdrawal". Journal of Clinical Psychopharmacology . 16 (5): 411–412. doi:10.1097/00004714-199610000-00013. PMID   8889917.
  12. ↑ José A. Gutrecht (1989). "Lhermitte's sign: from observation to eponym". Archives of Neurology . 46 (5): 557–558. doi:10.1001/archneur.1989.00520410091029. PMID   2653292.
  13. ↑ Marie, P; Chatelin, C (1917). "Sur certains symptômes vraisemblablement d'origine radiculaire chez les blessés du crâne" [On certain symptoms presumably of root origin in skull injuries]. Revue Neurologique (in French). 31: 336.
  14. ↑ Lhermitte, J. J. (4 March 1920). "Les Formes douloureuses de la Commotion de la Moelle épiniére" [Painful Forms of Spinal Cord Concussion]. Revue neurologique (in French). 36 (3). Société Française de Neurologie: 257–262 – via Internet Archive.
  15. ↑ Lhermitte, JJ; Bollak, NM (1924). "Les douleurs à type décharge électrique consécutives à la flexion céphalique dans la sclérose en plaques. Un cas de la sclérose multiple" [Electric shock-like pain resulting from cephalic flexion in multiple sclerosis. A case of multiple sclerosis]. Revue neurologique (in French). 2: 56–57.
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