What’s Lhermitte’s sign?

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Lhermitte’s sign is a physical exam maneuver believed to have a positive outcome when a patient feels a stabbing, electric-like pain radiating from the back of the neck down the back when the neck is bent forward by a physician or by another healthcare professional. When patients have this symptom sporadically at other times, it is called barber’s chair phenomenon or Lhermitte’s phenomenon. Although the sign is most closely associated with a disease called multiple sclerosis, it can be caused by a variety of diseases that affect the part of the nervous system located in the neck region. There is no specific treatment for the condition, but patients may experience a reduction in the symptom with treatment of its underlying cause.

Many patients who have a positive Lhermitte’s sign on physical examination describe the pain as a throbbing, tingling, shock-like sensation. The pain typically begins in the back of the neck and spreads downward, affecting the back, arms, spine, and even the legs. Often the pain is present only for seconds. Some doctors or health care professionals can also trigger the sensation by tapping on the back of the neck as the patient bends the neck forward.

The disease most commonly associated with Lhermitte’s sign is multiple sclerosis (MS). This condition occurs when the parts of the nervous system that insulate the nerves are attacked and destroyed by the body’s immune system cells. It can cause a variety of neurological deficits that can come and go over time.

A variety of other conditions can also cause a patient to have Lhermitte’s sign. Any disease that affects the nerve roots that exit the spinal cord in the neck region or any disease that affects the spinal cord in this region could cause the symptom to occur. Common conditions such as osteoarthritis, which occurs with advancing age due to chronic wear and tear on the joints, can cause the symptom. Rarer causes may include vitamin B12 deficiency, administration of high-dose chemotherapy, and transverse myelitis.

There is no specific treatment for having a positive Lhermitte’s sign. It can improve, however, by determining the underlying cause of the sign and treating that underlying disease. Patients with this disorder may undergo further medical examination, including radiological imaging of the neck region or tests that measure the speed of conduction of signals through the nerves. If a comprehensive exam fails to recognize the cause of the pain, doctors may choose to continue monitoring the patient for further signs of disease. Some doctors may choose to treat the pain symptom with medications that reduce the patient’s sensitivity to pain that originates in the nerves.

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