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l'hermittes
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l'hermittes

Wow. This forum is great. I have been trying to find information on l'hermitte's sign everywhere and have been unable until now to find any substantive information on the topic. However, I have some clarifying questions, if someone would be so kind as to address them!
1. Is l'hermitte's ALWAYS very jarring/noticeable or can it be pretty mild (ie, might not notice it if you aren't testing/looking for it)
2. Is there anything other than l'hermitte's that can cause SOME sensation SOMEWHERE below the neck that is triggered by neck flexion?
3. Why do the doctors on this forum (not you, Quix, but the ones who work for medhelp) tell people it's probably NOT l'hermitte's when someone describes anything other than an electric shock that radiates down the spine?
4. As a presenting symptom of MS, would it be tyical for l'hermitte's to move around a lot (started down both arms, lasted for 1 week. Two weeks later returned in left hand, lasted 2 days. 1 week later showed up in right index finger, lasted 2 hours. A week later it was in my left pinky only, where is settled for two weeks. Then nothing for 2 weeks. Then 1 week of upper right thigh, followed by 3 days of both legs, followed by 1 week of left knee followed by alternating legs (throughout the day). If this is l'hermitte's, what would this indicate? numerous lesions? growing lesions?
5. The only study I could find said the l'hermitte's is "stereotyped in individual patients." What does that mean?

Thanks, in advance. I've been written off as having anxiety only, but like others on this forum, feel that the reproducibility of this symptom should be taken seriously. Struggling with my HMO to get to a neurologist.
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18 Comments Post a Comment
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Avatar_m_tn
Lhermittles is a sign/symptom of all kinds of neurologic conditions.  In and of itself it's not that meaningful.  Your other symptoms combined with it would be more revealing.
The fact that you are experiencing sensory changes over multiple areas of your body at different times ahould be all the reason you need to see a Neurologist.

I am not an expert on Lhermittes.  I do know that it typically presents itself only when the head (chin) is pushed downward hard to the chest.  It can be transient, and is indicative of a lesion on the spinal cord in the cervical area.  The same lesion might be responsible for the various sensory issues you report in your limbs.  An MRI w/and w/o contrast of the head, cervical and thoracic spine are needed.

Hope this helps

Jon
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Avatar_f_tn
Hi, Sara, and welcome. Though we're not doctors (except Quix, who was not a neurologist), we do our best to help each other, and are happy to have newcomers.

I think Jon has given you some good advice. His explanation of l'Hermittes is the classic one, and as far as I know, the only one neuros accept. But there are loads of other abnormal sensations associated with MS. Please go to our Health Pages (upper right), and read the entry on Paresthesias--Things That Go Buzz in the Night. That should clarify a lot of things for you.

In saying this, though, I'm not suggestion you have MS. Many tests would be necessary before that becomes a real possibility. There are a great many mimics of MS that would have to be ruled out, and yes, anxiety is one of them. So I hope you will see a neuro and get started.

I'm not clear, though, on what you mean by reproducibility of symptoms. Do you mean you can by some means induce a symptom to show up? Or do you just mean that symptoms recur? There are a few ways that doctors can induce symptoms in susceptible patients (heat sensitivity, bending the neck of someone with l'Hermittes), but in general, symptoms happen when they happen.

ess

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147426_tn?1317269232
Hi, and Welcome to the Forum!  It seems like you've read quite a bit here.  That's good because I think we have a lot to offer.  Remember, I truly am not a neurologist.  My answers do oftentimes differ from that of real neurologists.  The reason is that 1) Maybe I don't know any better :)) or 2) that from my my reading and experience I disagree with them on certain points.  I wish I always knew the difference, alas.  :((

I'll give you my best shot at your questions.

1)  There is not reason why the sensation of L'Hermitte's must be remarkable or strong.  Since it is felt to be a pressure on or next to a nerve when the neck is flexed forward, whether it is strong or weak would depend some on the amount of that stimulation.  In my case the sensation was fairly mild and I felt it in the front of my left thigh, yet my MS neuro, a clinical researcher agreed that it was classic L'Hermitte's.  Also, I did not feel it every time I flexed my neck. For me it was intermittent.

2) I think your question is the definition of L'Hermitte's.  Remember, Jon is correct.  L'Hermittes is a symptom (misnamed a sign and it stuck) of a sensation somewhere below the level of the irritation of the cervical cord that occurs when the neck is flexed.  Just having it "suggests" MS (because that is the most common disorder that it is seen in) but does not "indicate MS.  It appears in other diseases, too.

3)  I really can't speak for the other docs.  I think the electric shock down the back may have been the original description by Dr. L'Hermitte, but in my reading it can be any sensation that is repeatedly elicited by flexion of the next.  Again, in my case, my sensation was a buzzy, jiggly feeling in the anterior L thigh.  When I asked my neuro about it, he assured me that it could take many forms.

4)  I have to say that I cannot imagine it moving around like that so quickly unless you had rapidly forming - and remyelinating - lesions in the cervical spine.  Of course, I can't say that it wouldn't occur, but I have never heard of anything like what you describe.

5)  "Stereotyped in individuals" means that within each individual the L'Hermitte's remains the same.  A person will have the same sensation and in the same location each time that it is felt.  The next person will always feel it in their own way.  In medicine steroetypic means repeatedly reproducible.

Why don't you tell us your story and what else you are going through?

Quix
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147426_tn?1317269232
As I think about it, I suspect that one of the reasons that the doctors have written off your symptoms as due to anxiety is the rapidly changing nature of the sensations that you have, especially as you describe the alternating during the day.

MS lesions tend to be more static than that.  The lesions we are describing are those of demyelination.  These lesions do no occur and heal that quickly.

One of the tip-offs to somatization or anxiety complaints is "rapidly changing and variable complaints of pain, discomfort or paresthesias." So these two things may be what are causing your doctors to dismiss you without proper evaluation.  Personally, since the symptoms of MS and other neurologic diseases are so disturbing anxiety is common.

I have worked in HMOs where the PCP is pressured to be the stone wall to more comlex evaluations and care.  The care socked and I quit when I saw it happen -   Don't get me started.

Quix
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382218_tn?1341185087
Here is a thread from this forum dating back to June that may be useful to you:

http://www.medhelp.org/posts/show/533474

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Avatar_n_tn
Thanks to everyone! I do think, in my Dr.'s defense, that part of the reason this is written off as anxiety is that I have been, over the last ten years, diagnosed with panic disorder, OCD, and most recently GAD. and i must admit that i agree with all of these diagnoses. however, i feel confident i am experiencing lhermitte's, and the only thing that's throwing me is the transitory nature. i should add, though, that when it moves from spot to spot it is definitely confined to a discreet area (left inner knee and right upper thigh in this case).

not having any medical training, i am confused about how the nerves in your cervical spine work (dermatomes?)...as in, is there one nerve that goes to all fingers on both hands, so that having it for two weeks on my left pinky and then for two hours on my right thumb would mean the same potential lesion? as i said, this has moved from upper inside of both arms (2 weeks, off and on) to the base of right pointer finger (1 hour), to nothing for two weeks, to one evening where my left palm would react to neck-bending, to 2 continuous weeks of my left pinky, to nearly three weeks of nothing, at which point i starting "testing" it again (therapist claims this is my OCD), which is when i discovered these pulling sensations in first my right thigh (one day my right foot), then this spot on my left knee.

i am trying to determine if this would make sense in teh context of MS, and it sounds like Quix is saying it wouldn't. I just cant see how anxiety is responsible, though my other symptoms (dizziness and a numb hand once) were chalked up to this as well.

thanks to everyone

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378497_tn?1232147185
I don't know if I have Lhermitte's or not...seems like it...and I'll just add a couple of cents.

I have buzzes that hit my right heel and my left front shin above the ankle. This past summer, I also got one in my right arm every time I sat in a hot tub on vacation. They come and go, but always in these places. One thing I've noticed is if I exercise or get overheated, they fire up. These only hit when I bend my head forward, so I'm going to say they're Lhermittes. I don't have a history of OCD or depression (although just in the last month I had what probably was actual depression, about a year after my neuro symptoms started). I had anxiety almost 20 years ago that was transient and the product of my parents getting a divorce and my getting a divorce, and I just rode it out. Nothing significant since. I certainly don't feel anxious now.

Anyway...yours are moving around a LOT, but have you noticed any link to activity or heat?

Bio
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Avatar_n_tn
nope, and believe me, i've looked for it! showering, etc, seems to have no affect. Bio, does your dr. think this is lhermitte's? are you undiagnosed?
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Avatar_m_tn
Anxiety may be making you overly self-concious of minor sensory changes.  However you are describing a pattern typical of MS and one that I have experienced personaly where sensations do move around, resolve after an hour or a month.  These can be "psuedo" exacerbations that are an indication (if you do have MS) of past damage that is irritated or somewhat active.

I still advise you to get MRIs of the brain, cervical and thoracic spine w and w/o contrast.

Jon
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198419_tn?1360245956
Hi there,

Wanted to say hello, and welcome!

I have l'hermittes and the intensity does vary from strong to mild. For months at a pop sometimes, and it changes too.  I think the definition does not fit the sensation textbook for all of us.  

So much so that I looked up the word after my Dr. said I had it. Read the definition, and said to myself "hmpf - I TOTALLY don't have this. This Dr. doesn't know what he is talking about." I was wrong though.  Mine does not run down my spine then "hit" somewhere.  I bend my neck down and my tailbone buzzes and vibrates. It was called l'hermittes by my Dr. and he was right.

I also get the other varieties of parathesias.  For example directly down my spine, and mostly smack in the middle of my back, I have pressure, which feels like fluid.  It has at times felt like water swishing around in there.  I'm glad you have read our HPs as we have a great write up on there that describes the parathesias of which l'hermittes is one form of it.

See you around,
Shell
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Avatar_n_tn
thanks again to everyone. your perspectives are all so helpful, though i am still confused, because Quix (and obviously my own GP!) don't seem to think that the pattern of the lhermitte's is very typical for MS lesions, but then those of you on here say you've experienced this. i am sick of having everything pinned down as anxiety, but i'm starting to doubt myself...
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382218_tn?1341185087
When I first started experiencing Lhermitte's, before I was dx'ed with MS, I would often do what you said you do, "testing" it by bending my neck forward at various times, to see if it would happen.  

In fact I still do this occasionally, to figure out what brings it on (typically for me, a rise in body temp caused by exercise).

For your therapist to automatically assume this behaviour is due to your OCD seems kind of presumptuous to me.  I suppose it could be, but not necessarily.  As I say, I also did that frequently, as I was trying to figure out what was going on with my body, and understand what was triggering the buzzing and vibrating.  And I do not have OCD or any other psychological condition.  
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Avatar_m_tn
I think Quix thinks you're experiencing these varied sensations on-demand or daily.  I read it differently where I thought you said that they would manifest themselves for an hour to several weeks and then resolve.  Which is it?

Jon
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Avatar_n_tn
they are on-demand in that it only happens when i bend my neck. i don't have odd sensations other times. only with neck bending (which i test constantly)...but they vary, sometimes one will last a week or so and sometimes one will pop up in a new spot for 10 minutes and never return to that spot again. all in all, over the past 2 months, i've had sensations in about 8 different places, and once it leaves that spot it does not tend to return to the same one...and they are super mild "twinges" that if i weren't looking for (i'd heard about l'hermitte's from my friend whose dad has MS) i'd probaly not notice them as abnormal. this is my my therapist/MD thinks it's all anxiety-related.
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Avatar_m_tn
hmm...

You're behaviour indicates Anxiety or OCD (the constant checking).  Its a chicken/egg issue in that when you have symptoms that will naturally cause anxiety,  However the symptoms aren't present unless you're trying to make them happen.  In the abscense of other symptoms I suggeat cooling it on your neck.  MS does not need a prompt to let you know.

It is very possible to put pressure on nerves in your neck through exaggerated movements and be healthy, no disease.  You may simply have an impingment of a nerve or a narrwoing of the canal the cord is in and when pressing hard in a certain way causes the nerves to pinch.

If you start experiencing sensory symptoms w/o any action on your part then thats something to look into.  Hope you can relax and let this go!

Jon
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Avatar_n_tn
i meant to say before that i REALLY appreciate how kind everyone is in responding, and so quickly. i can't talk to my roommates or parents about this anymore, and it's been so great to have this to turn to.
thanks
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Avatar_m_tn
Funny, that's how I experience L'hermitte's sign.  I feel a buzzing in my lower back when I bend my head forward.  Of course, I only experience it if I take too hot a shower.  And it will eventually fade.  But the intensity and length of time do increase with water temperature and the length of time I'm under it.

I told my primary neuro about this, and he said no, it isn't L'hermitte's.  He then recited the textbook definition, an electric shock running down the back.  The neuro at the MS clinic I went to for a 2nd opinion said it was L'hermitte's.  I guess it's all in their interpretation.  Either way, it ain't normal.
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Avatar_f_tn
Hi I wanted to share my electrifying zing but I get it in back of my head it rarley happens but it happens enough for me to wonder why an what it is it it always makes me jump and it happens fast and I can go without having that happen for months then i get zinged out of no where I still remember  when it first happened i was a freshmen in highschool sitting in class now im 22 an it still likes to pay me visits from time to time some one help me please
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