Lhermitte's Sign: Difference between revisions

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== Introduction ==
== Introduction ==
Lhermitte's Sign is also known as "Lhermitte's Phenomenon", or also referred to as "Barber Chair Phenomenon". It is described as a transient sensation of an electric shock extending down the spine and/or extremities upon flexion of the neck, often a sequela of neurologic disease.<ref>Teoli D, Rocha Cabrero F, Ghassemzadeh S. [https://pubmed.ncbi.nlm.nih.gov/29630289/ Lhermitte Sign]. 2021 Jun 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29630289. </ref> In this condition, upon the flexion of the nape, electric shock like trigger or paresthesia<ref>Koehler PJ. Lhermitte, Jean. [https://www.sciencedirect.com/science/article/pii/B9780123851574009453 Encyclopedia of the Neurological Sciences (Second Edition)] 2014, Page 884</ref>, radiates down the spine, often into the upper and lower extremities, and sometimes to the trunk.<ref name=":0">Khare S, Seth D. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445188/ Lhermitte's sign: the current status]. Annals of Indian Academy of Neurology. 2015 Apr;18(2):154.</ref> It only lasts for short period of time. It results from the stimulation of irritated nerves or the [[Spinal cord anatomy|spinal cord]] and causes a similar sensation/irritation to hitting the elbow.<ref>Eske Jamie, Hammond Nancy, MD. [https://www.medicalnewstoday.com/articles/323889 What is Lhermitte's sign?] MedicalNewsToday. March 17 2021</ref> Lhermitte's sign can also be described as a symptom, as it is spontaneously explained by patients, on their own.<ref>Garcia-Moreno JM, Izquierdo G. [https://europepmc.org/article/med/11927103 Lhermitte's sign]. Neurologia (Barcelona, Spain). 2002 Mar 1;17(3):143-50.</ref> It is often one of the symptoms that people mention when they’re first diagnosed with [[MS Multiple Sclerosis|multiple sclerosis]].<ref>Brown Tracy, Melinosky Christopher. [https://www.webmd.com/multiple-sclerosis/lhermittes-sign-what-is-how-treat Lhermitte’s Sign: What Is It? How Do You Treat It?] WebMD. July 23 2020</ref>  
Lhermitte's sign is termed "Lhermitte's Phenomenon" or the "Barber Chair Phenomenon" described as a transient electric shock-like sensation extending exclusively down the spine and/or extremities upon flexion of the neck. Often, it is a sequel to neurological disease.<ref>Teoli D, Rocha Cabrero F, Ghassemzadeh S. [https://pubmed.ncbi.nlm.nih.gov/29630289/ Lhermitte Sign]. 2021 Jun 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29630289. </ref> Upon the flexion of the nape, electric shock-like trigger or paresthesia <ref>Koehler PJ. Lhermitte, Jean. [https://www.sciencedirect.com/science/article/pii/B9780123851574009453 Encyclopedia of the Neurological Sciences (Second Edition)] 2014, Page 884</ref>,radiates down the spine, often into the upper and lower extremities, and sometimes to the trunk.<ref name=":0">Khare S, Seth D. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445188/ Lhermitte's sign: the current status]. Annals of Indian Academy of Neurology. 2015 Apr;18(2):154.</ref> The sensation is rapid and brief. Hence, it only lasts for a short time. <ref>Pearce JM. [https://jnnp.bmj.com/content/jnnp/57/7/846.2.full.pdf Lhermitte's sign]. Journal of neurology, neurosurgery, and psychiatry. 1994 Jul;57(7):846.</ref> It results as a stimulus to irritated/injured nerves or the [[Spinal cord anatomy|spinal cord]]. It causes a similar kind of sensation/irritation as hitting the elbow.<ref>Eske Jamie, Hammond Nancy, MD. [https://www.medicalnewstoday.com/articles/323889 What is Lhermitte's sign?] MedicalNewsToday. March 17 2021</ref> Lhermitte's sign can be categorized as a symptom because it is generally explained by patients. <ref>Garcia-Moreno JM, Izquierdo G. [https://europepmc.org/article/med/11927103 Lhermitte's sign]. Neurologia (Barcelona, Spain). 2002 Mar 1;17(3):143-50.</ref> And is commonly one of the symptoms that patients diagnosed with [[MS Multiple Sclerosis|multiple sclerosis]] mention during the assessment.<ref>Brown Tracy, Melinosky Christopher. [https://www.webmd.com/multiple-sclerosis/lhermittes-sign-what-is-how-treat Lhermitte’s Sign: What Is It? How Do You Treat It?] WebMD. July 23 2020</ref>  
== History ==
== History ==
Lhermitte's sign was first described by Marie and Chatelin in 1917. The first reference to the symptom was described by Beriel and Devic in 1918 in [[MS Multiple Sclerosis|multiple sclerosis (MS)]]. In 1924, Lhermitte ''et al.'' described in detail a patient with MS and electric dysesthesias.<ref name=":0" /> Jacques Jean Lhermitte, a forefather of modern clinical neurology, was a French neurologist conducting the majority of his research between 1908 and 1957. Lhermitte was famously recognized for his eponymously named “Lhermitte’s sign.”<ref>Chu DT, Hautecoeur P, Santoro JD. [https://journals.sagepub.com/doi/10.1177/1352458518820628 Jacques Jean Lhermitte and Lhermitte’s sign.] Multiple Sclerosis Journal. 2020 Apr;26(4):501-4.</ref> Lhermitte's sign has been associated with the intensity-modulated radiotherapy (IMRT) for head and neck cancer patients. It is one of the late term effects following IMRT in these patients.<ref>Pak D, Vineberg K, Feng F, Ten Haken RK, Eisbruch A. [https://pubmed.ncbi.nlm.nih.gov/22284690/ Lhermitte sign after chemo-IMRT of head-and-neck cancer: incidence, doses, and potential mechanisms.] International Journal of Radiation Oncology* Biology* Physics. 2012 Aug 1;83(5):1528-33.</ref>
Lhermitte's sign was first described by Marie and Chatelin in 1917. The first reference to the symptom was described by Beriel and Devic in 1918 in [[MS Multiple Sclerosis|multiple sclerosis (MS)]]. In 1924, Lhermitte ''et al.'' described in detail a patient with MS and electric dysesthesias.<ref name=":0" /> Jacques Jean Lhermitte, a forefather of modern clinical neurology, was a French neurologist conducting the majority of his research between 1908 and 1957. Lhermitte was famously recognized for his eponymously named “Lhermitte’s sign.”<ref>Chu DT, Hautecoeur P, Santoro JD. [https://journals.sagepub.com/doi/10.1177/1352458518820628 Jacques Jean Lhermitte and Lhermitte’s sign.] Multiple Sclerosis Journal. 2020 Apr;26(4):501-4.</ref> Lhermitte's sign has been associated with the intensity-modulated radiotherapy (IMRT) for head and neck cancer patients. It is one of the late term effects following IMRT in these patients.<ref>Pak D, Vineberg K, Feng F, Ten Haken RK, Eisbruch A. [https://pubmed.ncbi.nlm.nih.gov/22284690/ Lhermitte sign after chemo-IMRT of head-and-neck cancer: incidence, doses, and potential mechanisms.] International Journal of Radiation Oncology* Biology* Physics. 2012 Aug 1;83(5):1528-33.</ref>
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#* Herpes Zoster Infection
#* Herpes Zoster Infection


== Validity ==
== Review ==
In the patients undergoing '''radiotherapy''', Lhermitte's sign is most likely to be seen in younger patients than the older patients. <ref>Mul VE, de Jong JM, Murrer LH, van den Ende PL, Houben RM, Lacko M, Lambin P, Baumert BG. [https://pubmed.ncbi.nlm.nih.gov/22194023/ Lhermitte sign and myelopathy after irradiation of the cervical spinal cord in radiotherapy treatment of head and neck cancer.] Strahlentherapie und Onkologie. 2012 Jan 1;188(1):71-6.</ref> Thus, patient age can be considered as one of the important factor.


== Review ==
The development of Lhermitte's Sign in patients of younger age, with no available history of trauma to the head and neck or history of undergoing radiation, is of great diagnostic importance.<ref>Kanchandani R, Howe JG. [https://jnnp.bmj.com/content/jnnp/45/4/308.full.pdf Lhermitte's sign in multiple sclerosis: a clinical survey and review of the literature]. Journal of Neurology, Neurosurgery & Psychiatry. 1982 Apr 1;45(4):308-12.</ref>


== Conclusion ==
== Conclusion ==

Revision as of 21:12, 25 November 2021

Original Editor - Shristi Maharjan

Top Contributors - Shristi Maharjan and Kim Jackson   

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (25/11/2021)

Introduction[edit | edit source]

Lhermitte's sign is termed "Lhermitte's Phenomenon" or the "Barber Chair Phenomenon" described as a transient electric shock-like sensation extending exclusively down the spine and/or extremities upon flexion of the neck. Often, it is a sequel to neurological disease.[1] Upon the flexion of the nape, electric shock-like trigger or paresthesia [2],radiates down the spine, often into the upper and lower extremities, and sometimes to the trunk.[3] The sensation is rapid and brief. Hence, it only lasts for a short time. [4] It results as a stimulus to irritated/injured nerves or the spinal cord. It causes a similar kind of sensation/irritation as hitting the elbow.[5] Lhermitte's sign can be categorized as a symptom because it is generally explained by patients. [6] And is commonly one of the symptoms that patients diagnosed with multiple sclerosis mention during the assessment.[7]

History[edit | edit source]

Lhermitte's sign was first described by Marie and Chatelin in 1917. The first reference to the symptom was described by Beriel and Devic in 1918 in multiple sclerosis (MS). In 1924, Lhermitte et al. described in detail a patient with MS and electric dysesthesias.[3] Jacques Jean Lhermitte, a forefather of modern clinical neurology, was a French neurologist conducting the majority of his research between 1908 and 1957. Lhermitte was famously recognized for his eponymously named “Lhermitte’s sign.”[8] Lhermitte's sign has been associated with the intensity-modulated radiotherapy (IMRT) for head and neck cancer patients. It is one of the late term effects following IMRT in these patients.[9]

Pathophysiology[edit | edit source]


Causes[edit | edit source]

There are several conditions that exhibits the Lhermitte's sign:

  1. Disease/Condition[3]
    • Multiple Sclerosis
    • Head Trauma
    • Cervical Spondylosis
    • Transverse Myelitis
    • Sub-acute combined degeneration of the cord
    • Arnold-Chiari Malformation
    • Arachnoiditis
    • Syringomyelia
    • Spinal Cord Compression/Herniation/Injury
    • Spinal Cord Tumors
    • Vitamin B12 Deficiency
    • Systemic Lupus Erythematosus
    • Bechet's disease
  2. Radiation[3]
    • Radiation Myelopathy
  3. Chemotherapy
    • High dose
    • Nitric Oxide Toxicity
    • Oxaliplatin-Induced[10]
  4. Parasitic[3]
    • Parasitic invasion of Spinal Cord
    • Herpes Zoster Infection

Review[edit | edit source]

In the patients undergoing radiotherapy, Lhermitte's sign is most likely to be seen in younger patients than the older patients. [11] Thus, patient age can be considered as one of the important factor.

The development of Lhermitte's Sign in patients of younger age, with no available history of trauma to the head and neck or history of undergoing radiation, is of great diagnostic importance.[12]

Conclusion[edit | edit source]

References[edit | edit source]

  1. ↑ Teoli D, Rocha Cabrero F, Ghassemzadeh S. Lhermitte Sign. 2021 Jun 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29630289.
  2. ↑ Koehler PJ. Lhermitte, Jean. Encyclopedia of the Neurological Sciences (Second Edition) 2014, Page 884
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Khare S, Seth D. Lhermitte's sign: the current status. Annals of Indian Academy of Neurology. 2015 Apr;18(2):154.
  4. ↑ Pearce JM. Lhermitte's sign. Journal of neurology, neurosurgery, and psychiatry. 1994 Jul;57(7):846.
  5. ↑ Eske Jamie, Hammond Nancy, MD. What is Lhermitte's sign? MedicalNewsToday. March 17 2021
  6. ↑ Garcia-Moreno JM, Izquierdo G. Lhermitte's sign. Neurologia (Barcelona, Spain). 2002 Mar 1;17(3):143-50.
  7. ↑ Brown Tracy, Melinosky Christopher. Lhermitte’s Sign: What Is It? How Do You Treat It? WebMD. July 23 2020
  8. ↑ Chu DT, Hautecoeur P, Santoro JD. Jacques Jean Lhermitte and Lhermitte’s sign. Multiple Sclerosis Journal. 2020 Apr;26(4):501-4.
  9. ↑ Pak D, Vineberg K, Feng F, Ten Haken RK, Eisbruch A. Lhermitte sign after chemo-IMRT of head-and-neck cancer: incidence, doses, and potential mechanisms. International Journal of Radiation Oncology* Biology* Physics. 2012 Aug 1;83(5):1528-33.
  10. ↑ Amaraneni A, Seth A, Itawi EA, Chandana SR. Oxaliplatin-induced Lhermitte sign. A case report and review of literature. Clinical colorectal cancer. 2014 Dec 1;13(4):257-9.
  11. ↑ Mul VE, de Jong JM, Murrer LH, van den Ende PL, Houben RM, Lacko M, Lambin P, Baumert BG. Lhermitte sign and myelopathy after irradiation of the cervical spinal cord in radiotherapy treatment of head and neck cancer. Strahlentherapie und Onkologie. 2012 Jan 1;188(1):71-6.
  12. ↑ Kanchandani R, Howe JG. Lhermitte's sign in multiple sclerosis: a clinical survey and review of the literature. Journal of Neurology, Neurosurgery & Psychiatry. 1982 Apr 1;45(4):308-12.
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