Q: 32 years old female with a known history of Multiple Sclerosis (MS) presented with complaints of an electric shock radiating down as she flexes her neck. Your diagnosis?
Answer: Lhermitte sign
The Lhermitte sign is a known symptom of MS. It is a transient sensory symptom characterized by an electric shock that radiates down the spine or into the limbs, mostly after flexion of the neck. It occurs in about 15-20% of MS patients.
If it occurs in a non-MS patient, other diagnoses should be considered, such as tumors, cervical disc herniation, post-radiation myelopathy, and trauma.
The exact etiology is unknown, but demyelination and hyperexcitability appear to be the cause.
#neurology
References:
1. Kanchandani R, Howe JG. Lhermitte's sign in multiple sclerosis: a clinical survey and review of the literature. J Neurol Neurosurg Psychiatry 1982; 45:308.
2. García-Moreno JM, Izquierdo G. Signo de Lhermitte [Lhermitte's sign]. Neurologia. 2002 Mar;17(3):143-50. Spanish. PMID: 11927103.
3. Khare S, Seth D. Lhermitte's Sign: The Current Status. Ann Indian Acad Neurol. 2015 Apr-Jun;18(2):154-6. doi: 10.4103/0972-2327.150622. PMID: 26019410; PMCID: PMC4445188.
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