Lhermitte's sign
{{short description|Uncomfortable "electric" sensation going down the back and limbs}}
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| synonyms = Lhermitte phenomenon
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| differential = Compression of the upper spinal cord, multiple sclerosis, transverse myelitis, Behçet's disease, osteogenesis imperfecta
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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.{{cite web | url=https://mstrust.org.uk/a-z/lhermittes-sign#:~:text=Lhermitte%27s%20sign%20(pronounced%20Ler%2Dmeets,head%20forward%20towards%20your%20chest | title=Lhermitte's sign | MS Trust }}
In many people, it is elicited by bending the head forward.{{cite web|title=Definition of Lhermitte sign|url=http://www.medterms.com/script/main/art.asp?articlekey=16049|work=medterms medical dictionary a-z list|publisher=MedicineNet.com|accessdate=20 April 2011}} 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.{{cite web| last1=Teoli |first1=D |last2=Rocha Cabrero |first2=F |last3=Smith |first3=T |last4=Ghassemzadeh |first4=S |title=Lhermitte Sign |orig-date=July 21, 2023 |date=January 2024 |publisher=StatPearls |location=Treasure Island, Florida |pmid=29630289 |url=https://pubmed.ncbi.nlm.nih.gov/29630289/ |access-date=November 16, 2024}}
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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.{{cn|date=June 2022}}
Although often considered a classic finding in multiple sclerosis, it can be caused by a number of conditions, including transverse myelitis, Behçet disease,{{cite journal|last=Page|first=NG|author2=Spiteri, MA |title=Lhermitte sign in Behçet disease.|journal=British Medical Journal (Clinical Research Ed.)|date=Mar 6, 1982|volume=284|issue=6317|pages=704–5|doi=10.1136/bmj.284.6317.704|pmid=6802294|pmc=1496643}} osteogenesis imperfecta,{{cite journal |last1=Steiner |first1=R. D. |last2=Basel |first2=D. |title=COL1A1/2 Osteogenesis Imperfecta |journal=GeneReviews |date=December 12, 2019 |pages=1–29 |url=https://www.ncbi.nlm.nih.gov/books/NBK1295/pdf/Bookshelf_NBK1295.pdf |accessdate=February 4, 2020}} trauma, radiation myelopathy,{{cite journal|last=Jones|first=A|title=Transient Radiation Myelopathy|journal=The British Journal of Radiology|date=Oct 1964|volume=37|issue=442|pages=727–44|pmid=14217730|doi=10.1259/0007-1285-37-442-727}} 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.{{cite journal|last=Heinzlef|first=O|author2=Lotz, JP |author3=Roullet, E |title=Severe neuropathy after high dose carboplatin in three patients receiving multidrug chemotherapy.|journal=Journal of Neurology, Neurosurgery, and Psychiatry|date=May 1998|volume=64|issue=5|pages=667–9|pmid=9598687|doi=10.1136/jnnp.64.5.667|pmc=2170092}}{{cite journal |last1=Amaraneni |first1=A |last2=Seth |first2=A |last3=Itawi |first3=EA |last4=Chandana SR |title=Oxaliplatin-induced Lhermitte sign. A case report and review of literature |journal=Clinics in Colorectal Cancer |date=December 2014 |volume=Dec |issue=13 |pages=257–259 |doi=10.1016/j.clcc.2014.09.006 |pmid=25442817 |url=https://pubmed.ncbi.nlm.nih.gov/25442817/ |access-date=November 16, 2024}} Irradiation of the cervical spine may also evoke it as an early delayed radiation injury, which occurs within 4 months of radiation therapy.{{cn|date=August 2021}}
Delayed onset Lhermitte's sign has been reported following head and/or neck trauma.{{cite journal |author1=Frank H. Anderson |author2=James R. Lehrich |year=1973 |title=Lhermitte's sign following head injury |journal=JAMA Neurology |volume=29 |issue=6 |pages=437–8 |pmid=4759419 |doi=10.1001/archneur.1973.00490300099015}}{{cite journal |author1=Chan RC. |author2=Steinbock P. |year=1984 |title=Delayed onset of Lhermitte's sign following head and/or neck injuries. Report of four cases. |journal=J Neurosurg |volume=60 |issue=3 |pages=609–12 |pmid=6699706 |doi=10.3171/jns.1984.60.3.0609}} This occurs ~2 1/2 months following injury, without associated neurological symptoms or pain, and typically resolves within 1 year.{{cn|date=June 2022}}
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.{{cite journal |author1=Roy R. Reeves |author2=Harold B. Pinkofsky |year=1996 |title=Lhermitte sign in paroxetine withdrawal |journal=Journal of Clinical Psychopharmacology |volume=16 |issue=5 |pages=411–412 |pmid=8889917 |doi=10.1097/00004714-199610000-00013}}
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.{{cn|date=June 2022}}
Terminology
Lhermitte sign is not attributed to its discoverer.{{cite journal |author=José A. Gutrecht |year=1989 |title=Lhermitte's sign: from observation to eponym |journal=Archives of Neurology |volume=46 |issue=5 |pages=557–558 |pmid=2653292 |doi=10.1001/archneur.1989.00520410091029}} It was first described by Pierre Marie and Chatelin in 1917.{{cite journal | last1= Marie |first1=P |last2=Chatelin |first2=C | year = 1917 | title = Sur certains symptômes vraisemblablement d'origine radiculaire chez les blessés du crâne |trans-title=On certain symptoms presumably of root origin in skull injuries |language=fr | journal = Revue Neurologique | volume = 31 | page = 336 }} Jean Lhermitte, a French neurologist and neuropsychiatrist, did not publish his first report until 1920.{{r|Lhermittev_1920}} However, in 1924 he did publish the seminal article on the subject which resulted in it becoming well known.{{cite journal | last1 = Lhermitte |first1=JJ |last2=Bollak |first2=NM | year = 1924 | title = Les douleurs à type décharge électrique consécutives à la flexion céphalique dans la sclérose en plaques. Un cas de la sclérose multiple |trans-title=Electric shock-like pain resulting from cephalic flexion in multiple sclerosis. A case of multiple sclerosis |language=fr | journal = Revue neurologique | volume = 2 | pages = 56–57 }}
References
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{{cite journal | last1 = Lhermitte | first1 = J. J. | author-link1 = Jean Lhermitte | title = Les Formes douloureuses de la Commotion de la Moelle épiniére | trans-title = Painful Forms of Spinal Cord Concussion | url = https://archive.org/details/sim_revue-neurologique_1920-03_36_3/page/257/mode/1up | language = fr | journal = Revue neurologique | publisher = Société Française de Neurologie | date = 1920-03-04 | volume = 36 | issue = 3 | pages = 257–262 | via = Internet Archive | df = dmy-all }}
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{{Eponymous medical signs for nervous system}}
{{DEFAULTSORT:Lhermitte's Sign}}