Table of Contents
Introduction
Lhermitte's sign is known as "Lhermitte's Phenomenon" or the "Barber Chair Phenomenon", described as a transient electric shock-like sensation extending exclusively down the spine and extremities upon flexion of the neck. Often, it is a sequel to a neurological disease.
Upon the flexion of the nape (back of the neck), an electric shock-like trigger or paresthesia radiates down the spine, often into the upper and lower extremities and sometimes to the trunk. The sensation is rapid and brief. Hence, it only lasts for a short time.
Lhermitte described this phenomenon primarily in patients who have multiple sclerosis and other spinal cord diseases. It was then further found that it also resulted from inflammation of the spinal cord, mostly in the posterior and lateral columns.
What Are the Causes of Lhermitte Sign?
Lhermitte’s sign is usually seen in multiple sclerosis (MS), which is caused by damaged nerves in the spine responding to neck movement. The nerves that are damaged are no longer protected by the myelin sheath, which will start depending on the action of your brain, but it will cause confusion. Your brain will start interpreting the message as pain even though there is no physical reason. Lhermitte’s sign is commonly seen in individuals with MS, but there are other causes.
Pain becomes more prominent when:
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Moving your neck when bending your head to your chest.
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You experience fatigue.
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You are stressed.
What Are the Conditions That Cause Lhermitte Sign?
Several conditions cause Lhermitte's sign, such as:
Disease or Condition:
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Multiple Sclerosis: Multiple sclerosis is an autoimmune condition where your body's immune system turns against you. It is a chronic neurological disorder.
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Head Trauma: It is damage to the scalp, skull, or brain caused by an injury. Head injuries are classified as closed or open. Closed injuries do not damage the skull or penetrate the brain tissue, whereas open injuries do.
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Combined Degeneration of the Spinal Cord: It is a disease affecting the lateral and posterior columns of the spinal cord, primarily due to demyelination.
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Spinal Cord Tumors: It is the growth of cells that form in or around the spinal cord.
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Cervical Spondylosis: It affects the spinal discs in your neck, causing pain.
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Vitamin B12 Deficiency: It occurs when a reduced level of vitamin B12 causes the body to produce abnormally large red blood cells that cannot function properly.
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Systemic Lupus Erythematosus: It is the most common form of lupus, an autoimmune condition involving multiple systems.
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Bechet's Disease: It is an auto-inflammatory systemic vasculitis.
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Arachnoiditis: It is a painful disorder caused by inflammation of the arachnoid, a protective membrane surrounding the spinal cord’s nerves.
Radiation:
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Radiation myelopathy.
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Intensity-modulated radiotherapy.
Chemotherapy:
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Nitrous oxide toxicity.
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High dose.
Parasitic:
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Herpes zoster infection.
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Parasitic invasion of the spinal cord.
Lhermitte Sign and Multiple Sclerosis
Lhermitte's sign is a paroxysmal symptom; that is, it occurs suddenly and is often associated with multiple sclerosis (MS). MS is a chronic autoimmune and inflammatory disease that causes the immune system to attack the myelin, the protective covering around the nerves. Individuals with MS are the first to experience Lhermitte’s sign.
How Is Lhermitte Sign Diagnosed?
Medical history is the most important aspect of diagnosis. The patient is evaluated clinically by asking the patient to flex the neck from the chin to the chest. The doctor will check for any weakness present, decreased sensation, and any swelling in your neck to localize the area where the problem is coming from. There is no standard test for Lhermitte’s sign.
Lhermitte’s sign is found by identifying the condition causing it with diagnostic tests such as cervical spine magnetic resonance imaging or lumbar puncture.
How Is Lhermitte Sign Treated?
Lhermitte’s sign can be treated in the following ways:
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Relaxing techniques.
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Adjusting postures and monitoring them.
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Medications like steroids and antiseizure medications help to treat nerve pain. Antiseizure drugs will control the body's electrical impulses. Drugs include Gabapentin, Oxcarbazepine, and Carbamazepine.
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Doctors might also prescribe antidepressants, sodium channel blockers, and muscle relaxers.
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Waves of energy are sent to the affected nerves by the pulsed electromagnetic field therapy.
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Forward neck movements can be limited by wearing a neck brace.
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Muscle relaxation techniques and stretching should be done with occupational or physical therapy.
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A soft neck brace will help limit neck movements and minimize the triggering of Lhermitte’s sign.
When to See a Doctor?
It is essential to consult the doctor if you are experiencing Lhermitte’s signs. If there are symptoms of Lhermitte’s sign and there is no history of neurological conditions, it is essential to seek medical care. It is essential to contact the doctor even if you have a condition and your symptoms worsen or do not improve with treatment.
Conclusion
Lhermitte’s sign will have a sensation that feels painful or like an electric shock. It radiates from the neck and down the spine to other parts of the body. The shock-like feeling is short and intermittent. Certain treatments can prevent triggering episodes of Lhermitte’s signs and can improve the symptoms. This sign can also occur without MS due to other underlying conditions that can cause it, such as trauma to the neck or transverse myelitis. Even if the sign fades, it should be taken seriously and checked by a doctor to address any underlying issue.
Key Note From iCliniq
Lhermitte’s sign is a brief pain that lasts only a few seconds and travels down your spine from your neck. Confused about the diagnosis? Let the doctors in iCliniq help you find the cause of this symptom and provide further treatment.
