What Is Lhermitte's Sign?

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People who have experienced nerve pain as a result of any injury or condition know the jarring discomfort it causes. Lhermitte's sign is a flare up of neuropathic pain that has unique features, causes and management.

What Is Lhermitte's Sign?

Lhermitte's sign is a sense of electricity that shoots down the spine from the head towards the feet, and often out through the arms, legs and appendages. It is often brought on by flexing the neck so that the chin moves towards the chest.

Also known as barber chair phenomenon, it is thought to indicate dysfunction of the dorsal columns of the cervical spinal cord, which are responsible for transmitting information about light touch, proprioception, and vibration to the brain.

Despite being called "Lhermitte's sign," the first people who described this phenomenon were Pierre Marie and Chatelin in 1917. Jean Lhermitte was a French neurologist who published an article on the subject in 1924, which led to wider knowledge about the symptom.

What Causes Lhermitte's Sign?

Lhermitte's sign has classically been thought of as a sign of multiple sclerosis (MS) and, indeed, any patient presenting with Lhermitte's sign will most likely undergo a thorough workup to exclude that disease. In patients with MS, the immune system attacks the coatings of nerves, called myelin. When the myelin wears away, scar tissue can form, which blocks the nerve signals that travel throughout the brain and spinal cord.


In addition to MS, Lhermitte's sign can be the result of many other problems, including vitamin B12 deficiencytransverse myelitis, cervical cord tumors, cervical spondylosis, and nitrous oxide toxicity (can sometimes be associated with a "reverse Lhermitte's sign", in which the electrical sensation travels the opposite direction, from the feet towards the head).


How to Treat Lhermitte's Sign

While it isn't dangerous in and of itself, Lhermitte's sign can cause debilitating discomfort. Treatment should first be aimed at addressing any underlying conditions that are causing or exacerbating the problem. For patients with MS, ensuring they don't become overtired or overheated can help avoid triggering Lhermitte's sign.

Certain lifestyle and noninvasive approaches can help prevent an attack, including

  • Electrical stimulating devices that send low-voltage electricity to the nerves, either from outside the body or through an implantable device
  • Posture adjustment and alignment
  • Neck braces or collars that prevent head movements that can trigger the pain
  • Acupuncture, massage and other relaxation techniques
  • Breathing exercises
  • Stretching

In addition, for patients with Lhermitte's sign, certain medications can help manage pain, including: 


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.

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