Lhermitte syndrome

Lhermitte's syndrome was first described in 1917 by Marie and Chatelin (Teoli 2023), but was later attributed to the French neurologist Jacques Jean Lhermitte (1877–1958) and named after him (Walter 2021).

The Lhermitte sign refers to an electric-like sensation that occurs along the spine when the neck is flexed, radiating into the extremities (Khare 2015 / Teoli 2023).

Khare (2015) further distinguishes between Lhermitte's sign, which is triggered by flexion of the neck, and the reverse Lhermitte's sign, which is triggered by extension of the neck.

Reverse Lhermitte’s syndrome is caused by external compression of the cervical spinal cord and immobilization with a neck brace (Khare 2015).

• Test Procedure:

The patient’s head is passively tilted forward (Walter 2021).

• Test result:

Passively bending the head forward causes stretching of the meninges in the region of the cervical spine. In the presence of certain conditions, the patient reports abnormal sensations in the form of paresthesias in the extremities or trunk (Walter 2021).

This syndrome is one of the most common causes of neurological impairment in young adults worldwide (Teoli 2023).

In patients with multiple sclerosis, the overall prevalence ranges from 9% to 41%. It has low sensitivity for MS but very high specificity at 97% (Teoli 2023).

• Multiple Sclerosis
• Tumors in the Spinal Cord Region
• Severe spondyloarthrosis
• Inflammatory changes in the spinal cord region (Walter 2021)
• Radiation effects associated with the mantle field technique (Herold 2021)
• Systemic lupus erythematosus
• Vitamin B12 deficiency
• Nitric oxide toxicity (Teoli 2023)
• Behcet’s disease
• Arnold-Chiari malformation
• Tumor progression with spinal cord compression
• Radiculopathy
• Cervical spondylolysis
• Transverse myelitis
• Subacute combined degeneration of the spinal cord
• Parasitic infiltration of the spinal cord
• Radiation myelopathy
• High-dose chemotherapy (e.g., with cisplatin)
• Trauma
• Arachnoiditis
• Herpes zoster toxicity
• Syringomyelia (Khare 2015)

The phenomenon of triggered paresthesias is most likely caused by ephapses (contact points between adjacent nerve fibers), where mechanical irritation leads to the jumping of nerve impulses (Walter 2021).

Gemici (2010) describes Lhermitte’s syndrome as a myelopathy resulting from damage to sensory axons in the posterior columns of the cervical and thoracic spinal cord.

Lhermitte's syndrome can cause numerous other neurological symptoms, such as:

• Mononuclear painful visual disturbances
• Spinal hemiparesis
• Mono- or paraparesis
• Hypoesthesia
• Dysesthesia
• Paresthesias
• Urinary dysfunction
• Sphincter dysfunction
• Diplopia
• Oscillopsia
• Ataxia
• Vertigo
• Dysmetria
• Intensity tremor
• Facial palsy
• Faciobrachial-crural hemiparesis
• Faciobrachial-crural hemihypoesthesia (Teoli 2023)

In a study, patients with multiple sclerosis responded well to treatment with extracranial pulsed electromagnetic fields in the picotesla range (Khare 2015).

1. Gemici C (2010) Lhermitte’s sign: A review with special emphasis on oncology practice. Crit Rev Oncol Hematol. 74 (2) 79–86
2. Herold G et al. (2021) Internal Medicine. Herold Verlag 77
3. Kasper D L, Fauci A S, Hauser S L, Longo D L, Jameson J L, Loscalzo J et al. (2015) Harrison’s Principles of Internal Medicine. McGraw-Hill Education
4. Khare S, Seth D (2015) Lhermitte’s Sign: The Current Status. Ann Indian Acad Neurol. 18 (2) 154–156
5. Teoli D, Cabrero F R, Smith T, Ghassemzadeh S (2023) Lhermitte’s Sign. StatPearls Treasure Island Bookshelf ID: NBK493237
6. Walter F et al. (2021) Lhermitte’s Sign. https://flexikon.doccheck.com/de/Lhermitte-Zeichen