Lhermitte's sign. Is it a relapse?

[Taurus]

Lately, I am experiencing Lhermitte's sign with tingling sensations in my left leg. I am also experiencing weakness in legs now. Is it a relapse? Earlier I had Lhermitte's sign but my MRI was static. Please comment with solutions. Thanks

[jimmylegs]

sounds like an active lesion. weird that you had no enhancing lesions on mri while also having lhermitte's. could just be a mild fluctuation. curious: what's your current regimen? once i know that i might have some ideas for solutions. in the meantime, one thing i know they've measured in relapse vs remission is uric acid. it's low in relapse, which means zinc is down. which means ammonia is high. which is no fun. the easy action item is ensure high normal zinc status. but that's all just supposition until i have more info

[euphoniaa]

Lately, I am experiencing Lhermitte's sign with tingling sensations in my left leg. I am also experiencing weakness in legs now. Is it a relapse? Earlier I had Lhermitte's sign but my MRI was static. Please comment with solutions. Thanks

Hi Taurus,

I know you just posted another question about Lhermittes sign today, but I've been meaning to reply to this one anyway. The bottom line is that Lhermittes sign is NOT exclusive to MS in the first place, so it is NOT automatically indicative of either a spinal lesion (active or not), and thus it is NOT automatically indicative of an MS relapse. MS lesions are a possible cause, but there are MANY other potential causes of it.

I've posted about Lhermitte's often at ThisIsMs because I had a pretty nasty case of it years ago. At the time I assumed it was from a couple of earlier whiplash incidents (I was probably right), and created an exercise program paying attention to my neck and my posture that improved it considerably. It improved so much that I felt perfectly healthy when I was dx'd with MS years later.

I had no sign of MS lesions on my C-spine MRI at dx 9 years ago and NO lesions on my most recent spinal MRIs, although there are plenty of signs of spondylosis, stenosis, and arthritis in my spine. And I still get a little twinge of Lhermittes when I bend my head way down.

Here's a list of other causes from Wikipedia:

http://en.wikipedia.org/wiki/Lhermitte%27s_sign

Lhermitte's sign, sometimes called the Barber Chair phenomenon, is an electrical sensation that runs down the back and into the limbs. In many patients, it is elicited by bending the head forward[1]. It can also be evoked when a practitioner pounds on the posterior cervical spine while the neck is flexed; this is caused by involvement of the posterior columns.

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 transverse myelitis, Behçet's disease, trauma, radiation myelopathy, 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. Irradiation of the cervical spine may also evoke it as an early delayed radiation injury, which occurs within 4 months of radiation therapy.

This sign is also sometimes seen as part of a "discontinuation syndrome" associated with certain psychotropic medications, such as serotonin reuptake inhibitors, particularly Paroxetine and Venlafaxine. Typically, it only occurs after having taken the medication for some duration, and then stopped or withdrawn rapidly. Fluoxetine, given its very long half-life, can be given as a single small dose, and often avoid Lhermitte's sign and other withdrawal symptoms.

In the dental field, three studies (Layzer 1978, Gutmann 1979, Blanco 1983) have identified Lhermitte's sign among nitrous oxide abusers.

You should try doing a "search" for Lhermittes here and you'll find tons of discussions about it. Good luck!

[Absentee]

I also agree that just having Lhermittes does not automatically mean you have an active lesion, as I have had Lhermittes at the same time as an MRI with nothing active and no change in lesions over a 2 yr period. But also, it is possible for there to be symptoms and progression without an active lesion.
This is the insidious nature of the condition we all face. All of these questions and all of these labels and really so much of it just causes anxiety and more questions (that the neuro cannot answer).

Good luck Taurus and be well.

[Taurus]

I thank you all for your prompt replies

[Taurus]

This is the image of my Cervical spine. Does it show anything like spondolosis or anything else. Please comment

[euphoniaa]

This is the image of my Cervical spine. Does it show anything like spondolosis or anything else. Please comment

Hi Taurus, I can't see the pic you posted, but I don't recognize anything in my own c-spine MRIs anyway. I got all my information from the very detailed radiologist's report, where they specifically pointed out plenty of "diffuse, discogenic degenerative change" throughout the cervical and upper thoracic spine. The report also mentions cervical spondylosis, disc bulging, and endplate spurring and noted exactly where they occurred on my spine.

The reports came along with the copies of my MRIs, so you should be able to get your reports also.

[MarkLavelle]

euphoniaa has a very good point, even if she didn't put it this way: the radiologist's written report is what you should be looking at. The MRI itself is pretty much useless without the report or the training needed to properly interpret the pictures (thus, the specialty of radiology).

Even the written reports can be misleading to us non-medical types, because radiologists generally note anything that's not 'normal' -- whether it's 'significant' or not. That's because your doctor is the one who uses the scan info and their examination and your description of your sx to figure out what's going on. Any one of those three is not enough for confident diagnosis.

My spine MRI reports always note several things that are abnormal or deteriorated, but my physiatrist knows that all of my current sx are from my L4-5 disc...

Backing up to your question about a relapse: If you've already got a MS dx, I would assume your Lhermitte's sign is not a relapse. As I understand MS and relapses, only new sx can indicate relapses. "Old" sx that return are generally pseudoexacerbations.