### Date : 2024-06-16 13:36 ### Topic : Lhermitte's Sign #medicine #orthopedic ---- ### Lhermitte's Sign Overview **Lhermitte's sign** (also known as the barber chair phenomenon) is a neurological phenomenon characterized by a sudden, transient, electric shock-like sensation that radiates down the spine and into the limbs, often triggered by flexing the neck. It is associated with various conditions affecting the cervical spinal cord. <iframe title="Lhermitte's Sign | Multiple Sclerosis / Myelopathy / Dorsal Column Disturbance" src="https://www.youtube.com/embed/mDQ-UdK-PDs?feature=oembed" height="113" width="200" allowfullscreen="" allow="fullscreen" style="aspect-ratio: 1.76991 / 1; width: 100%; height: 100%;"></iframe> ### Pathophysiology Lhermitte's sign occurs due to irritation or compression of the cervical spinal cord or nerve roots. This irritation can be caused by several underlying conditions, including: - **Multiple Sclerosis (MS):** Demyelination of the spinal cord can lead to this phenomenon. - **Cervical Spondylosis:** Degenerative changes in the cervical spine causing compression of the spinal cord or nerve roots. - **Vitamin B12 Deficiency:** Can lead to subacute combined degeneration of the spinal cord. - **Spinal Cord Tumors:** Compression or infiltration of the spinal cord by neoplastic tissue. - **Radiation Myelopathy:** Damage to the spinal cord following radiation therapy. - **Other Causes:** Trauma, infections, or inflammatory conditions affecting the cervical spine. ### Clinical Features - **Electric Shock Sensation:** A sudden, brief, electric shock-like sensation that radiates down the spine and into the arms and legs. - **Triggered by Neck Flexion:** The sensation is typically triggered or exacerbated by bending the neck forward (flexion). - **Transient and Reproducible:** The sensation is usually brief and can be reproduced by neck flexion. ### Diagnosis Diagnosis of Lhermitte's sign is primarily clinical, based on patient history and physical examination. Additional diagnostic tests may be performed to identify the underlying cause. **Steps to Elicit Lhermitte's Sign:** 1. **Patient Position:** Have the patient sit or stand comfortably. 2. **Neck Flexion:** Ask the patient to bend their neck forward, touching their chin to their chest. 3. **Observation:** Instruct the patient to report any sensations of electric shock-like pain radiating down the spine and into the limbs. ### Interpretation - **Positive Lhermitte's Sign:** The patient experiences a sudden, electric shock-like sensation radiating down the spine when flexing the neck. This is indicative of cervical spinal cord or nerve root irritation. - **Negative Lhermitte's Sign:** Absence of the electric shock-like sensation upon neck flexion. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 28 - **Occupation:** Software Engineer **Medical History:** - **Symptoms:** Jee Hoon Ju reports experiencing a sudden, electric shock-like sensation down his back and into his legs whenever he bends his neck forward. He has also been experiencing intermittent numbness and tingling in his hands and feet. **Physical Examination:** - **Neurological Exam:** Mild weakness and sensory changes in the upper and lower extremities. - **Lhermitte's Sign:** - **Procedure:** The patient is asked to flex his neck forward. - **Result:** He experiences the characteristic electric shock-like sensation down his spine and into his legs. **Additional Diagnostic Tests:** - **MRI of the Cervical Spine:** Shows demyelination plaques suggestive of multiple sclerosis. - **Blood Tests:** Normal vitamin B12 levels, ruling out deficiency. **Diagnosis:** Based on the positive Lhermitte's sign and MRI findings, Jee Hoon Ju is diagnosed with multiple sclerosis. ### Management 1. **Treat Underlying Condition:** - **Multiple Sclerosis:** Disease-modifying therapies (e.g., interferons, glatiramer acetate) and symptomatic treatments (e.g., corticosteroids for acute exacerbations). - **Cervical Spondylosis:** Physical therapy, NSAIDs, or surgical intervention for severe cases. - **Vitamin B12 Deficiency:** Vitamin B12 supplementation. - **Spinal Cord Tumors:** Surgical removal or other oncologic treatments. - **Radiation Myelopathy:** Supportive care and medications to manage symptoms. 2. **Symptomatic Management:** - Pain management with medications like gabapentin or pregabalin. - Physical therapy to maintain mobility and strength. 3. **Regular Monitoring:** - Follow-up visits to monitor disease progression and response to treatment. - MRI and other imaging studies as needed to assess the condition of the cervical spine. ### Conclusion Lhermitte's sign is a significant clinical indicator of cervical spinal cord or nerve root irritation. It is important to identify the underlying cause to provide appropriate treatment and management. Regular monitoring and comprehensive care are essential for patients presenting with this phenomenon.