Lhermitte's sign

Lhermitte's Sign, sometimes called the Barber Chair phenomenon, is an electrical sensation that runs down the back and into the limbs, and is produced by bending the neck forward.

Associated conditions

The sign suggests a lesion of the dorsal columns of the cervical cord or of the caudal medulla. Although often considered a classic finding in multiple sclerosis, it can be caused by a number of conditions, including Behçet's disease, [Page NG, Spiteri MA. Lhermitte's sign in Behçet's disease. "Br Med J (Clin Res Ed)" 1982 March 6; 284(6317): 704–705.] trauma, radiation myelopathy, [Jones A. Transient radiation myelopathy (with reference to Lhermitte's sign of electrical paraesthesia). "Br J Radiol" 1964; 37:727-44.] 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. [ Heinzlef et al. Severe neuropathy after high dose carboplatin in three patients receiving multidrug chemotherapy. "J Neurol Neurosurg Psychiatry" 1998; 64: 667-669.]

Terminology

Strictly speaking, the Barber Chair phenomenon is a symptom 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. [Gutrecht JA. Lhermitte's sign: From observation to eponym. "Arch Neurol" 1989; 46:557-558.] It was first described by Marie and Chatelin in 1917. [Marie P, Chatelin C. Sur certains symptômes vraisemblablement d'origine radiculaire chez les blessés du crâne. "Rev Neural" 1917; 31:336.] Jean Lhermitte did not publish his first report until 1920. [Lhermitte JJ. Les formes douloureuses de la commotion de la moelle épinière. "Rev Neurol" 1920; 36:257-262.] However, in 1924 he did publish the seminal article on the subject which resulted in it becoming well known. [Lhermitte JJ, Bollak NM. Les douleurs à type décharge électrique consécutives à la flexion céphalique dans la sclérose en plaques. Un cas de la sclérose multiple. "Revue neurologique" 1924; 2:56-57.]

Most modern editors prefer the non-possessive form for medical eponyms: Lhermitte sign.

References


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