Lhermitte's sign

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, osteogenesis imperfecta, trauma, radiation myelopathy, 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. 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 Lhermitte's sign has been reported following head and/or neck trauma. 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 Typically, it only occurs after having taken the medication for some duration, and then stopped or withdrawn rapidly or after administering reduced dose.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.

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. It was first described by Pierre Marie and Chatelin in 1917. Jean Lhermitte, a French neurologist and neuropsychiatrist, did not publish his first report until 1920. However, in 1924 he did publish the seminal article on the subject which resulted in it becoming well known.

References

References

1. ["Lhermitte's sign | MS Trust"](https://mstrust.org.uk/a-z/lhermittes-sign#:~:text=Lhermitte%27s%20sign%20(pronounced%20Ler%2Dmeets,head%20forward%20towards%20your%20chest).
2. "Definition of Lhermitte sign". MedicineNet.com.
3. (January 2024). "Lhermitte Sign". StatPearls.
4. Page, NG. (Mar 6, 1982). "Lhermitte sign in Behçet disease.". British Medical Journal (Clinical Research Ed.).
5. (December 12, 2019). "COL1A1/2 Osteogenesis Imperfecta". GeneReviews.
6. Jones, A. (Oct 1964). "Transient Radiation Myelopathy". The British Journal of Radiology.
7. Heinzlef, O. (May 1998). "Severe neuropathy after high dose carboplatin in three patients receiving multidrug chemotherapy.". Journal of Neurology, Neurosurgery, and Psychiatry.
8. (December 2014). "Oxaliplatin-induced Lhermitte sign. A case report and review of literature". Clinics in Colorectal Cancer.
9. (1973). "Lhermitte's sign following head injury". [[JAMA Neurology]].
10. (1984). "Delayed onset of Lhermitte's sign following head and/or neck injuries. Report of four cases.". [[J Neurosurg]].
11. (1996). "Lhermitte sign in paroxetine withdrawal". [[Journal of Clinical Psychopharmacology]].
12. José A. Gutrecht. (1989). "Lhermitte's sign: from observation to eponym". [[Archives of Neurology]].
13. (1917). "Sur certains symptômes vraisemblablement d'origine radiculaire chez les blessés du crâne". Revue Neurologique.
14. (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.
15. (1920-03-04). "Les Formes douloureuses de la Commotion de la Moelle épiniére". Société Française de Neurologie.