Lhermitte's and herpes?

    
      Re: Lhermitte's and herpes?
    


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Posted by CCF Neurology MD(B) on March 13, 1998 at 13:45:22:

In Reply to: Lhermitte's and herpes? posted by Clark on February 27, 1998 at 14:21:00:

: I have had Lhermitte's sign for years, and it's progressing.  Not only when I bend my neck, but even just breathing.  I recently had a case of "flu" in which the electrical sensations down my spine got much worse.  This has happened two or three times this year.  Each time the "flu" lasts for about 3 days.  It causes muscle aching and headache as well.  Also profound fatigue.  Once at least it was accompanied by a cold sore.  Fifteen years ago I had a horrendous case of oral herpes simplex.  Fever, excruciating lesions all over the mouth and tongue, etc.  I also have other neurological symptoms: weakness in the mouth and left side of face and tongue, weakness in the left arm, and fasciculations all over.  The latter are a long-term problem; the partial paralysis began 15 months ago.  Four neurologists (including two EMGs and an MRI) have found nothing wrong at all.  My question is: could the herpes be living in my nerves and periodically erupting to cause my "flu" symptoms, while also chronically affecting neurological function and muscle strength?  Nobody has an answer for me; can you help?
  Clark
=Dear Clark, I feel that the fevers you have been experiencing are not related to the herpes infection you had fifteen years aqo.  Fevers usually occour prior to the onset of the rash.  The weakness you have experienced in your left face, tongue and arm could be related to a herpes infection of the nerves that innervate your facial muscles and then had spread back to your brainstem to affect that portion of the corticospinal tract which is involved in the control of arm musculature.  However, the vast majority of patients with involvement of the facial nerve have had vesicles on the face or in/around the ear.  Finally, the Lhermitte's sign may indicate some inflammation or damage to the dorsal(sensory) columns of the cervical(neck) spinal cord.  While you have had a MRI, I assume it is of the brain.  I would recommend a C-Spine MRI with and with-out contrast to evaluate if there has been any changes.  In addition, this may explain your weakness if the changes are at the level of the cervical enlargement, this may also provide an alternative explanation for your weakness.  However, this would not be consistent with the EMG results, unless the EMGs were Nerve Conduction Studies only.  Hope this helps.  "This information is for educational purposes only.  You should always consult your physician for diagnosis, treatment and prognosis concerning your medical condition."