Lhermitte's sign

Lhermitte phenomenon, also called the barber chair phenomenon, is an uncomfortable "electrical" sensation that runs through the back and into the limbs. The sensation can feel like it goes up or down the spine.

Lhermitte's sign
Other namesLhermitte phenomenon
Pronunciation
  • /lɛərˈmiːt/
Differential diagnosisCompression of the upper spinal cord, multiple sclerosis, transverse myelitis, Behçet's disease, osteogenesis imperfecta

In many people, it is elicited by bending the head forward.[1] 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 for French neurologist Jean Lhermitte.

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.

Although often considered a classic finding in multiple sclerosis, it can be caused by a number of conditions, including transverse myelitis, Behçet disease,[2] osteogenesis imperfecta,[3] trauma, radiation myelopathy,[4] 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.[5] Irradiation of the cervical spine may also evoke it as an early delayed radiation injury, which occurs within 4 months of radiation therapy.

Delayed onset Lhermittes sign has been reported following head and/or neck trauma.[6][7] This occurs ~2 1/2 months following injury, without associated neurological symptoms or pain, and typically resolves within 1 year.

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 Typically, it only occurs after having taken the medication for some duration, and then stopped or withdrawn rapidly or after administering reduced dose.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.[8]

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.

Terminology

Lhermitte sign is not attributed to its discoverer.[9] It was first described by Pierre Marie and Chatelin in 1917.[10] Jean Lhermitte, a French neurologist and neuropsychiatrist, did not publish his first report until 1920.[11] However, in 1924 he did publish the seminal article on the subject which resulted in it becoming well known.[12]

Given that Lhermitte's sign is named for Lhermitte, it is incorrect to spell the term as "L'hermitte's sign". This holds true for all other named signs or diseases that the discoverers last name does not end in "s" or had the disease themselves.

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References
  1. "Definition of Lhermitte sign". medterms medical dictionary a-z list. MedicineNet.com. Retrieved 20 April 2011.
  2. 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.
  3. Steiner, R. D., & Basel, D. (December 12, 2019). "COL1A1/2 Osteogenesis Imperfecta" (PDF). GeneReviews: 1–29. Retrieved February 4, 2020.CS1 maint: multiple names: authors list (link)
  4. JONES, A (Oct 1964). "TRANSIENT RADIATION MYELOPATHY (WITH REFERENCE TO LHERMITTE'S SIGN OF ELECTRICAL PARAESTHESIA)". The British Journal of Radiology. 37: 727–44. doi:10.1259/0007-1285-37-442-727. PMID 14217730.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. Marie P, Chatelin C (1917). "Sur certains symptômes vraisemblablement d'origine radiculaire chez les blessés du crâne". Rev Neurol. 31: 336.
  11. Lhermitte JJ (1920). "Les formes douloureuses de la commotion de la moelle épinière". Rev Neurol. 36: 257–262.
  12. 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". Revue neurologique. 2: 56–57.
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