Lhermitte's sign
Encyclopedia
Lhermitte's sign, sometimes called the Barber Chair phenomenon, is an electrical sensation that runs down the back and into the limbs. In many patients, it is elicited by bending the head forward. It can also be evoked when a practitioner pounds on the posterior cervical spine while the neck is flexed; this is caused by involvement of the posterior columns.
Lhermitte's sign is named for Jacques Jean Lhermitte, a French neurologist and neuropsychiatrist. Thus it is incorrect to spell the term as "L'hermitte's sign".
. Although often considered a classic finding in multiple sclerosis
, it can be caused by a number of conditions, including transverse myelitis
, Behçet's disease
, trauma, radiation myelopathy
, vitamin B12
deficiency (subacute combined degeneration
), and 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
.
This sign is also sometimes seen as part of a "discontinuation syndrome
" associated with certain psychotropic medications, such as serotonin reuptake inhibitors, particularly Paroxetine
and Venlafaxine
. Typically, it only occurs after having taken the medication for some duration, and then stopped or withdrawn rapidly. 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's sign among nitrous oxide
abusers.
rather than a sign
as it describes a subjective sensation rather than an objective finding. To add more confusion, it is not attributed to its discoverer. It was first described by Pierre Marie and Chatelin in 1917. Jean Lhermitte
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.
Lhermitte's sign is named for Jacques Jean Lhermitte, a French neurologist and neuropsychiatrist. Thus it is incorrect to spell the term as "L'hermitte's sign".
Associated conditions
The sign suggests a lesion of the dorsal columns of the cervical cord or of the caudal medullaMedulla oblongata
The medulla oblongata is the lower half of the brainstem. In discussions of neurology and similar contexts where no ambiguity will result, it is often referred to as simply the medulla...
. Although often considered a classic finding in multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
, it can be caused by a number of conditions, including transverse myelitis
Transverse myelitis
Transverse myelitis is a neurological disorder caused by an inflammatory process of the spinal cord, and can cause axonal demyelination. The name is derived from Greek referring to the "spinal cord", and the suffix -itis, which denotes inflammation...
, Behçet's disease
Behçet's disease
Behçet's disease is a rare immune-mediated systemic vasculitis that often presents with mucous membrane ulceration and ocular involvements...
, trauma, radiation myelopathy
Myelopathy
Myelopathy refers to pathology of the spinal cord. When due to trauma, it is known as spinal cord injury. When inflammatory, it is known as myelitis. Disease that is vascular in nature is known as vascular myelopathy....
, vitamin B12
Vitamin B12
Vitamin B12, vitamin B12 or vitamin B-12, also called cobalamin, is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins...
deficiency (subacute combined degeneration
Subacute combined degeneration of spinal cord
Subacute combined degeneration of spinal cord, also known as Lichtheim's disease, refers to degeneration of the posterior and lateral columns of the spinal cord as a result of vitamin B12 deficiency , vitamin E deficiency or Friedrich's ataxia...
), and compression of the spinal cord
Spinal cord compression
Spinal cord compression develops when the spinal cord is compressed by bone fragments from a vertebral fracture, a tumor, abscess, ruptured intervertebral disc or other lesion...
in the neck from any cause such as cervical spondylosis
Spondylosis
Spondylosis is a term referring to degenerative osteoarthritis of the joints between the centra of the spinal vertebrae and/or neural foraminae. If this condition occurs in the zygapophysial joints, it can be considered facet syndrome...
, disc herniation
Spinal disc herniation
A spinal disc herniation , informally and misleadingly called a "slipped disc", is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion A spinal disc herniation...
, tumor, and Arnold-Chiari malformation
Arnold-Chiari malformation
Arnold–Chiari malformation, or often simply Chiari malformation, is a malformation of the brain. It consists of a downward displacement of the cerebellar tonsils through the foramen magnum , sometimes causing non-communicating hydrocephalus as a result of obstruction of cerebrospinal fluid outflow...
. Lhermitte's Sign may also appear during or following high dose chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
. Irradiation of the cervical spine may also evoke it as an early delayed radiation injury, which occurs within 4 months of radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
.
This sign is also sometimes seen as part of a "discontinuation syndrome
SSRI discontinuation syndrome
SSRI discontinuation syndrome, also known as SSRI withdrawal syndrome or SSRI cessation syndrome, is a syndrome that can occur following the interruption, dose reduction, or discontinuation of SSRI or SNRI antidepressant medications...
" associated with certain psychotropic medications, such as serotonin reuptake inhibitors, particularly Paroxetine
Paroxetine
Paroxetine is an SSRI antidepressant. Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham, now GlaxoSmithKline...
and Venlafaxine
Venlafaxine
Venlafaxine is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. First introduced by Wyeth in 1993, now marketed by Pfizer, it is licensed for the treatment of major depressive disorder , as a treatment for generalized anxiety disorder, and comorbid indications in...
. Typically, it only occurs after having taken the medication for some duration, and then stopped or withdrawn rapidly. Fluoxetine
Fluoxetine
Fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...
, 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's sign among nitrous oxide
Nitrous oxide
Nitrous oxide, commonly known as laughing gas or sweet air, is a chemical compound with the formula . It is an oxide of nitrogen. At room temperature, it is a colorless non-flammable gas, with a slightly sweet odor and taste. It is used in surgery and dentistry for its anesthetic and analgesic...
abusers.
Terminology
The Barber Chair phenomenon is a symptomSymptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
rather than a sign
Medical sign
A medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient....
as it describes a subjective sensation rather than an objective finding. To add more confusion, it is not attributed to its discoverer. It was first described by Pierre Marie and Chatelin in 1917. Jean Lhermitte
Jean Lhermitte
Jacques Jean Lhermitte was a French neurologist and neuropsychiatrist.He was born in Mont-Saint-Père, Aisne, son of Léon Augustin Lhermitte, a French realist painter. Following his early education at Saint-Etienne, he studied in Paris and graduated in medicine in 1907...
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.