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Lhermitte's sign
Lhermitte's sign
Other names	Lhermitte phenomenon
Pronunciation	/lɛərˈmiːt/ ;
Differential diagnosis	Compression of the upper spinal cord, multiple sclerosis, transverse myelitis, Behçet's disease, osteogenesis imperfecta

In neurology, Lhermitte phenomenon, also called the barber chair phenomenon, is an uncomfortable "electrical" sensation that runs down the back and into the limbs. The sensation can feel like it goes up or down the spine. It is painful for some, although others might simply feel strange sensations.^[1]

In many people, it is elicited by bending the head forward.^[2] 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 after the French neurologist Jean Lhermitte.^[3]

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.^{[citation needed]}

Although often considered a classic finding in multiple sclerosis, it can be caused by a number of conditions, including transverse myelitis, Behçet disease,^[4] osteogenesis imperfecta,^[5] trauma, radiation myelopathy,^[6] 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.^[7]^[8] Irradiation of the cervical spine may also evoke it as an early delayed radiation injury, which occurs within 4 months of radiation therapy.^{[citation needed]}

Delayed onset Lhermitte's sign has been reported following head and/or neck trauma.^[9]^[10] This occurs ~2 1/2 months following injury, without associated neurological symptoms or pain, and typically resolves within 1 year.^{[citation needed]}

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 Typically, it only occurs after having taken the medication for some duration, and then stopped or withdrawn rapidly or after administering reduced dose.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.^[11]

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.^{[citation needed]}

Terminology

Lhermitte sign is not attributed to its discoverer.^[12] It was first described by Pierre Marie and Chatelin in 1917.^[13] Jean Lhermitte, a French neurologist and neuropsychiatrist, did not publish his first report until 1920.^[14] However, in 1924 he did publish the seminal article on the subject which resulted in it becoming well known.^[15]

References

^ "Lhermitte's sign | MS Trust".
^ "Definition of Lhermitte sign". medterms medical dictionary a-z list. MedicineNet.com. Retrieved 20 April 2011.
^ Teoli, D; Rocha Cabrero, F; Smith, T; Ghassemzadeh, S (January 2024) [July 21, 2023]. "Lhermitte Sign". Treasure Island, Florida: StatPearls. PMID 29630289. Retrieved November 16, 2024.
^ 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.
^ Steiner, R. D.; Basel, D. (December 12, 2019). "COL1A1/2 Osteogenesis Imperfecta" (PDF). GeneReviews: 1–29. Retrieved February 4, 2020.
^ Jones, A (Oct 1964). "Transient Radiation Myelopathy". The British Journal of Radiology. 37 (442): 727–44. doi:10.1259/0007-1285-37-442-727. PMID 14217730.
^ 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.
^ Amaraneni, A; Seth, A; Itawi, EA; Chandana SR (December 2014). "Oxaliplatin-induced Lhermitte sign. A case report and review of literature". Clinics in Colorectal Cancer. Dec (13): 257–259. doi:10.1016/j.clcc.2014.09.006. PMID 25442817. Retrieved November 16, 2024.
^ 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.
^ 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.
^ 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.
^ 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.
^ Marie, P; Chatelin, C (1917). "Sur certains symptômes vraisemblablement d'origine radiculaire chez les blessés du crâne" [On certain symptoms presumably of root origin in skull injuries]. Revue Neurologique (in French). 31: 336.
^ Lhermitte, J. J. (4 March 1920). "Les Formes douloureuses de la Commotion de la Moelle épiniére" [Painful Forms of Spinal Cord Concussion]. Revue neurologique (in French). 36 (3). Société Française de Neurologie: 257–262 – via Internet Archive.
^ 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" [Electric shock-like pain resulting from cephalic flexion in multiple sclerosis. A case of multiple sclerosis]. Revue neurologique (in French). 2: 56–57.