Lhermittes sign

Lhermitte's Sign: Understanding the Causes, Symptoms, and Treatment

Lhermitte's sign is a neurological symptom characterized by a sudden, brief sensation of electrical shock or a "shock-like" feeling that travels down the spine, often radiating into the arms or legs. This sensation is typically triggered by bending the neck forward. Lhermitte's sign is most commonly associated with conditions affecting the spinal cord, such as multiple sclerosis (MS), but it can also occur in other neurological conditions. In this article, we will explore the causes, associated symptoms, when to seek medical attention, diagnosis, and treatment options for Lhermitte's sign.

What Is Lhermitte's Sign?

Lhermitte's sign, also known as the "barber chair phenomenon," is a sudden and brief feeling of an electric shock that travels down the spine or into the limbs. The sensation is typically elicited when the neck is bent forward (such as when looking down or putting the chin to the chest). This symptom is caused by irritation or dysfunction in the spinal cord, particularly in areas where sensory pathways are involved. While the sensation is often temporary, it can be a sign of an underlying neurological condition.

Causes of Lhermitte's Sign

Lhermitte's sign is most commonly associated with conditions that affect the spinal cord or the central nervous system. Some of the most common causes include:

Multiple Sclerosis (MS): Multiple sclerosis is an autoimmune disease that attacks the protective covering (myelin) of nerve fibers in the central nervous system. Lhermitte's sign is frequently seen in MS, as demyelination in the spinal cord can disrupt normal nerve signaling, causing shock-like sensations.
Cervical Spondylosis: Cervical spondylosis, also known as neck arthritis, involves the wear and tear of the cartilage and bones in the neck. This can lead to nerve compression or irritation, triggering Lhermitte's sign.
Spinal Cord Injury: Traumatic injuries to the spinal cord, such as those from accidents, can lead to Lhermitte's sign. The injury can disrupt the normal functioning of the spinal cord, causing electrical shock sensations.
Vitamin B12 Deficiency: A deficiency in vitamin B12 can cause neurological symptoms, including Lhermitte's sign. Vitamin B12 is essential for nerve function, and its deficiency can lead to nerve damage.
Radiation Myelopathy: Radiation therapy to the spine, often used to treat cancer, can cause damage to the spinal cord tissue. This damage may lead to Lhermitte's sign as a late effect of radiation treatment.
Transverse Myelitis: Transverse myelitis is an inflammatory condition that affects the spinal cord. It can result from infections, autoimmune diseases, or other conditions and may cause Lhermitte's sign.
Other Neurological Conditions: Lhermitte's sign can also occur in other conditions that affect the spinal cord or nervous system, including certain infections, autoimmune diseases, or neurological disorders like Parkinson's disease.

Associated Symptoms of Lhermitte's Sign

Lhermitte's sign itself is a sudden and brief sensation of electrical shock-like pain, but it is often associated with other symptoms depending on the underlying condition. Common associated symptoms may include:

Neck Pain: Individuals with Lhermitte's sign often experience neck pain or stiffness, especially if the symptom is related to cervical spondylosis or spinal cord issues.
Muscle Weakness: Weakness in the arms, legs, or other parts of the body may accompany Lhermitte's sign, particularly in conditions like multiple sclerosis or spinal cord injuries.
Tingling or Numbness: Some people may experience a sensation of tingling or numbness in the arms or legs along with the electric shock sensation.
Balance Problems: Difficulty with coordination and balance can occur, especially if the underlying condition affects the spinal cord or brain.
Vision Problems: In multiple sclerosis, vision issues such as blurred vision or double vision may occur alongside Lhermitte's sign.
Fatigue: Chronic fatigue is a common symptom in conditions like multiple sclerosis, which can coexist with Lhermitte's sign.

When to Seek Medical Attention

While Lhermitte's sign itself is usually brief and may resolve on its own, it can be a sign of an underlying medical condition that requires medical attention. You should seek medical help if:

Persistent or Recurring Symptoms: If Lhermitte's sign persists or recurs frequently, or if it is accompanied by other neurological symptoms, medical evaluation is necessary.
Severe Pain or Weakness: If the electric shock-like sensations are severe or are accompanied by weakness, numbness, or loss of function in any part of the body, immediate medical care is recommended.
Signs of Multiple Sclerosis: If Lhermitte's sign occurs along with other symptoms of multiple sclerosis, such as vision problems, balance issues, or muscle weakness, see a neurologist for evaluation and diagnosis.
Spinal Cord Injury: If you have recently experienced a spinal cord injury or trauma, seek medical attention for any abnormal sensations like Lhermitte's sign.

Diagnosis of Lhermitte's Sign

Diagnosing the underlying cause of Lhermitte's sign requires a thorough neurological evaluation. The diagnostic process may include:

Medical History: A detailed medical history will help the healthcare provider identify potential causes of Lhermitte's sign, such as previous injuries, chronic conditions, or symptoms suggestive of multiple sclerosis.
Physical and Neurological Examination: The healthcare provider will conduct a physical and neurological exam to assess muscle strength, coordination, reflexes, and sensory function.
Imaging Studies: MRI (magnetic resonance imaging) is the most commonly used imaging technique to evaluate the spinal cord and brain. MRI can help identify conditions like multiple sclerosis, spinal cord lesions, or tumors that may be causing Lhermitte's sign.
Blood Tests: Blood tests may be used to check for vitamin B12 deficiency, infections, or other conditions that could be contributing to the symptoms.
Evoked Potentials: Evoked potential tests may be used to measure electrical activity in the brain and spinal cord, helping to diagnose conditions like multiple sclerosis.

Treatment Options for Lhermitte's Sign

The treatment for Lhermitte's sign depends on the underlying condition causing it. Common treatment options include:

Medication for Multiple Sclerosis: If multiple sclerosis is the cause of Lhermitte's sign, disease-modifying therapies (DMTs) may be prescribed to reduce inflammation and prevent further nerve damage. Steroid medications may also be used to reduce acute inflammation.
Physical Therapy: Physical therapy can help improve muscle strength, balance, and coordination, especially if the underlying condition affects mobility or coordination.
Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen may be used to manage mild discomfort. For more severe pain, medications like gabapentin or pregabalin may be prescribed.
Vitamin B12 Supplements: If Lhermitte's sign is caused by a vitamin B12 deficiency, supplementation may be recommended to restore proper levels and prevent further neurological damage.
Neck Bracing: In cases of cervical spondylosis, a neck brace may help reduce movement and alleviate strain on the spine, which may reduce Lhermitte's sign.
Surgical Intervention: If Lhermitte's sign is caused by a herniated disc or spinal cord compression, surgery may be necessary to relieve pressure on the spinal cord or nerves.

Myths and Facts About Lhermitte's Sign

There are several misconceptions about Lhermitte's sign that should be clarified:

Myth: Lhermitte's sign is only caused by multiple sclerosis.
Fact: While Lhermitte's sign is commonly associated with multiple sclerosis, it can also be caused by other conditions, such as cervical spondylosis, vitamin B12 deficiency, and spinal cord injuries.
Myth: Lhermitte's sign is always permanent.
Fact: Lhermitte's sign is often temporary and may resolve with appropriate treatment of the underlying condition. In some cases, it may persist as a chronic symptom.

Complications of Lhermitte's Sign

If Lhermitte's sign is left untreated or not properly managed, it can lead to several complications, including:

Progression of Underlying Condition: If the underlying cause of Lhermitte's sign, such as multiple sclerosis or cervical spondylosis, is not properly treated, the condition may worsen over time, leading to increased disability and other complications.
Chronic Pain: In some cases, the electrical shock-like sensations can become chronic, causing long-term discomfort and affecting daily activities.
Mobility Issues: If Lhermitte's sign is caused by a spinal cord condition, untreated symptoms may lead to difficulties with walking, balance, or coordination.

FAQs About Lhermitte's Sign

1. What is Lhermitte's sign?

Lhermitte's sign is a neurological symptom characterized by a sudden, shock-like sensation that travels down the spine and may radiate into the arms or legs, usually triggered by bending the neck forward.

2. What causes Lhermitte's sign?

Lhermitte's sign is most commonly caused by conditions that affect the spinal cord or central nervous system, including multiple sclerosis, cervical spondylosis, and spinal cord injuries.

3. How is Lhermitte's sign treated?

Treatment for Lhermitte's sign depends on the underlying cause. Options may include medications for multiple sclerosis, physical therapy, pain management, and in some cases, surgery.

4. Can Lhermitte's sign go away on its own?

In some cases, Lhermitte's sign may resolve with appropriate treatment of the underlying condition. However, if it is caused by a chronic condition, it may persist or recur.

5. When should I see a doctor for Lhermitte's sign?

If Lhermitte's sign is persistent, severe, or associated with other neurological symptoms like weakness or loss of sensation, it's important to see a healthcare provider for diagnosis and treatment.

Conclusion

Lhermitte's sign is a concerning symptom that may indicate an underlying neurological condition. Early diagnosis and treatment are essential to managing the underlying cause and preventing further complications. If you experience Lhermitte's sign, it is important to seek medical attention to determine the cause and receive appropriate care.