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Lhermitte’s Sign Lhermitte’s phenomenon Barber chair phenomenon
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Lhermitte’s sign (also known as Lhermitte’s phenomenon and the barber chair phenomenon) describes 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. It was first described by Marie and Chatelin in 1917. It was erroneously credited to Babinski and Dubois, and correctly credited to Jean Jaque Lhermitte through the seminal paper Les douleurs à type de décharge électrique consécutives à la flexion céphalique dans la sclérose en plaques: Un cas de forme sensitive de la sclérose multiple (1924) by Lhermitte et al. and Gutre. Lhermitte described it in multiple sclerosis and spinal cord diseases and further hypothesized it was a result of irritation and inflammation of the cord, likely in the posterior and lateral columns. • Lhermitte's sign is classified as one of the paroxysmal pain syndromes of multiple sclerosis. Multiple sclerosis is a chronic, predominantly immune-mediated disease of the central nervous system. It is one of the most common causes of neurological disability in young adults globally. The new Mc Donald's criteria 2017 establishes clinical and radiographical dissemination of time and space of symptoms, presence of at least one lesion in at least two out of four CNS areas: Periventricular, cortical or juxtacortical, infratentorial and spinal cord. Additional radiographical and laboratory criteria include new T2 and/or gadolinium (Gd)-enhancing lesion on follow-up MRI (with reference to a baseline scan), irrespective of the timing of the baseline MRI, the simultaneous presence of asymptomatic Gd-enhancing and nonenhancing lesions at any time, and presence of oligoclonal bands in CSF. Common initial clinical symptoms include mononuclear painful visual loss, spinal cord hemiparesis, mono/paraparesis, hypoesthesia, dysesthesia, paraesthesia, urinary and/or sphincter dysfunction, diplopia, oscillopsy, vertigo, gait ataxia, dysmetria, intentional/postural tremor, facial paresis, faciobrachial–crural hemiparesis, and faciobrachial–crural hemihypoesthesia. It affects multiple organ systems of the patient. • Lhermitte's sign or symptom should not be confused with Uhthoff phenomenon, another finding in multiple sclerosis patients. The phenomenon is defined by heat sensitivity after prolonged heat exposure, saunas, and hot tubs. Although frightening to some patients, these events are not a true advancement of disease (such as in multiple sclerosis). • Reference: • Teoli D, Rocha Cabrero F, Ghassemzadeh S. Lhermitte Sign. [Updated 2019 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NB... • Khare S, Seth D. Lhermitte's Sign: The Current Status. Ann Indian Acad Neurol. 2015;18(2):154-156. doi:10.4103/0972-2327.150622 • Image credit: Kjpargeter, luis-molinero, kjpargeter, brgfx, clalinus, agartist, Racool_studio / Freepik @ http://www.freepik.com • Case courtesy of Dr Heba Abdelmonem, Radiopaedia.org, rID: 61355 • Case courtesy of Dr Paresh K Desai , Radiopaedia.org rID: 10854
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