L'hermittes sign

Can anyone tell me more about this? I know that it is common in MS. I have had this sensation before but it does not hurt..I feel a slight tingle behind my left knee when I bend my head down. Sometimes it only happens a couple times a day..no particular time. It will occur sometimes after a long walk. It is not constant when I bend my head forward. Could this mean something else? I have no other weird things going on; a tight feeling in my left shoulder sometimes. Can anyone help?

[Quixotic1]

Yes, what you are describing is consistent with L'Hermittes.  It is not always painful.  Many times it is just a stimulation felt in a certain area.  Initially mine was a vibratory feeling in my thigh,over a couple weeks it became more startling/disturbing - not really painful, but makes me suck my breath in.  And it isn't with EVERY flex of my neck.  It's worse when I've been still for a long time and worse when I'm tired.

It's just a sign, not even a serious one.  It is also not  exclusive to MS.  It is seen in other conditions, example B-12 Deficiency, electrolyte imbalances, spinal cord irritation.  When you flex the neck it stretches the cervical spinal cord and may stimulate an irritated nerve.

Do you have MS or only this sign?  You asked for help, specifically what with?

Quix

[Quixotic1]

Ahh.. I see.  

Having something that resembles L'Hermitte's is not a great indication that you have MS.  Being a medical professional is tough, though isn't it?  Ignorance truly is bliss.  The vast majority of people with MS have a fairly benign course.  Often the first sign is followed by years of no other problems.  In fact, everyone I meet in real life (not here) seems to have had it for 10 or 20 years and have minimal problems.  A little weakness, areas of numbness not much.  Yes, it can be very disabling, but that is not the norm.  It is true that 75% of all people with MS never even make it into a wheelchair.

It seems to me that far more RN's are disabled by blowing out their backs transferring patients. (attempt at levity....)

How old are you?  Do you want to discuss this a little?  We can do it here or over on the MS forum.  Do you have a family history of MS or of autoimmune phenomena.

Even if this is your first presentation, at least MS has drugs which can slow the rate of disability.  It certainly isn't a death sentence.

Also, maybe you just have isolated L'Hermittes.  Don't let your imagination run away with you until you have more data.  Okay?

Quix

[christhis]

No I do not have MS well I hope I don't anyway. I plan on seeing my doc soon. I am an RN and I sometimes self diagnose but this could be serious. It makes me very afraid. If it is  MS, wouldn't I have more going on...numbness, tingling, vision problem or balance problems? I don;t know that much about MS but I am a little scared.

[Nancy T]

That's Lhermitte's all right.

The neurologist who all but told me I had MS at my first appointment--and never mentioned it again--said, when I told him about the "tense/pulling" sensation in the back of my leg when I bent my head down, "That's MS." No qualifications, no hedging, just "That's MS."

I had heard about the shock down the back being an MS thing, but I had no idea this was also Lhermitte's when it happens just in some odd spot in your leg, hand, whatever. But it is.

Mine varies--it's an electric buzz under my knee, a vibration on the bottom of my foot, a pulling in the front of the my thigh, a buzz in my palm, you name it. Very migratory. Sometimes very consistent--with every head-bend--sometimes just a couple of times a day. Sometimes it sits in one spot for weeks and weeks, sometimes it's a one-day wonder. Always comes out worse after a walk.

I do have a lot of other weird symptoms (paresthesias all over, electric shocks on both sides of my face, a period years ago of my reaching "aim" being a little off, very abnormal auditory evoked potentials, unexplained dizziness, etc. But it was the Lhermitte's that made him say MS.

Still, although my MRIs were not 100 percent normal and I've never had a spinal tap nor visual evoked potential testing, all the doctors now act like I don't have MS and appear to ascribe my muscular and sensory symptoms to anxiety (though they don't say the word), fibromyalgia "central sensitization" mechanism (when I asked the rheumatologist if that also applied to Lhermitte's, he said he'd never heard of Lhermitte's!), etc. So apparently Lhermitte's really IS no big deal! (If it's not painful.)

Quixotic--what's this about electrolyte imbalance as a cause of Lhermitte's? Says who? (Respectfully. :) What kind of imbalance, and could it go on for 7 years?? I have looked and looked for causes of Lhermitte's and MS is the only one that fits (two cervical MRIs have shown NO cause--no lesions, no disk problems, no arthritis).

Nancy T.

[Quixotic1]

Well, Though I've seen mention of L'hermitte's sign occurring as an acute sign of electrolyte imbalance (presumably in association with severe dehydration) I can't find substantiation for it or a description of how this would cause it.  Therefore, Nancy, you're right, it is suspect.  In answer to your question, no, it would NOT be consistent with a longstanding, severe electrolyte imbalance.

I suspect that the neuro that said, "That's MS," was also taking other data from your history, work up and exam.  In the right context it would indeed be further evidence/proof of MS.

Other causes are spinal tumors and cysts, spinal damage from injury or radiation, spinal damage from infection, or post infection phenomena such as transverse myelitis, B -12 deficiency, some cancer chemo therapies can cause neuropathy (such a cisplatin) and cause a L'hemittes.

My MS neuro said that it was certainly part of my MS, but even though it was new and happening several dozen times a day, it wasn't serious enough to qualify as a relapse.

Nancy, in what way were your MRIs abnormal?  How can they rule out MS without doing the supporting work up, as you mentioned VEP, SSEP, LP?  Sounds like everyone settled on a diagnosis and agreed to cease looking.  Do you think this happened?  You said that your l'hemitte's moved around.  Do you mean that within a given short period (a couple days) you will feel it in different areas or that it evolves from one spot to another over time?  The first situation would not be very consistent with MS, though the second would.  To a large extent Fibro is still a diagnosis of exclusion.

Also, again my first three sets of MRI (w/ & w/o constrast) were all negative except for a solitary "insignificant" lesion in my frontal lobe.  This covered a period of 27 months.  Then, with the new, higher resolution 3Tesla MRI have a doazen OLD lesions appeared in my spine.

Christhis - You need to see a neurologist.  I meant to say this in the first post.  I was trying to be reassuring, but MS is the most frequent cause of this symptom.

Quix

[Nancy T]

I searched on "Lhermitte's" and "electrolyte" and there WAS one very old post on the Medhelp site (I think) where someone mentioned both of these things in one post--so I wonder if that's how the idea arose on someone's (nonprofessional) MS site, where I've indeed seen it, and the idea was copied elsewhere. I've never seen it on a true medical site, though.

"I suspect that the neuro that said, "That's MS," was also taking other data from your history, work up and exam."

History was about the only thing. My exam was normal except for hearing loss in the left ear, which was probably a vascular, not neurological, thing (it happened when I sneezed hard). The neurologist even knew, when he first saw me, that I'd had a normal MRI a year earlier--to rule out acoustic neuroma, because of the hearing loss. He still said MS (before later dismissing the idea).

"Nancy, in what way were your MRIs abnormal?  How can they rule out MS without doing the supporting work up, as you mentioned VEP, SSEP, LP?  Sounds like everyone settled on a diagnosis and agreed to cease looking.  Do you think this happened?"

"Scattered small lesions in the deep white matter," according to the radiologist. Without any count or measurement of them. "Consistent with MS" according to the radiologist, but by no means specific for it. The radiologist also said (in two successive reports) that there was "clearing" of old lesions and appearance of new ones, but apparently these were all so small and insignificant location-wise that the neurologist (by then a second opinion) was not at all impressed by them and said the "new" lesions could have been there all along, just in different slices, because they were so small. I have a history of migraines (mild) and my blood pressure and cholesterol are not exactly ideal, so the lesions could be from that stuff, or just perivascular (?) spaces, she said. My brain MRIs ran from age 42 to age 46, none since then (I'm now 50 and haven't seen a neurologist in 4 years).

Both neurologists did talk about a spinal tap and one even attempted it, but couldn't get any fluid out. They both ended up saying I didn't need one--I think once they've seen you a second time, a year later, and you're still walking and talking without any big new symptoms, nothing disabling or problematical, they wave goodbye! At least if your MRI is unimpressive. And the first neuro, at the year's follow-up, laid "medical student's disease" on me, and though he later said it was just "part of the differential diagnosis," of course THAT'S the label that stuck, as all the doctors downstream of him seemed to take it for granted, telling me that the neurologists had ruled out MS, "MS! You don't want to have that!" etc. etc. (Even though neither neurologist said specifcally that I DON'T have MS.) So no, I don't consider that I've had a really complete workup, but I am also willing to trust their judgment on ordering tests; I figured that even if the undone tests were positive, they still wouldn't diagnose me due to normal exam and lack of really suspicious MRI findings, so why bother.

"  You said that your l'hemitte's moved around.  Do you mean that within a given short period (a couple days) you will feel it in different areas or that it evolves from one spot to another over time?"

BOTH. Sometimes it will occur somewhere for just a day or part of a day. But just as often, or more often, it settles in one place for days, weeks, months at a time, and occasionally will recur months and months later in the same old familiar place.

"  The first situation would not be very consistent with MS, though the second would."

This is what I thought, too.

"Christhis -... MS is the most frequent cause of this symptom. "

From what I've read, I have to agree.

Best wishes to all,
Nancy T.

[Nancy T]

To clarify, when the radiologist said "consistent with MS," I think he was referring to the PATTERN of lesions "clearing" and new ones appearing--not to the characteristics of the lesions themselves, which I understand can be significant.

Nancy

[christhis]

I am going to doc July 2..earlier if I can. I am 30 years old. I am trying to convince myself that it is something else. It is the only symptom I have but I know the odds are against me. I am scared to death though to be honest. I am hpoing it has something to do with my neck. If it is MS well then at least I will have something to deal with.
I do a lot of lifting at work..maybe my l'hermittes is related to some sort of strain. What is isolated l'hermittes anyways? Is l'hermittes an early sign of MS? I have some neck pain here and there, usually ending in a headache. I am just scared because I know that getting a dx of MS can be lengthy.

[Nancy T]

Chris--if you have neck pain or problems, maybe it's some kind of injury or arthritis causing the Lhermitte's--that's certainly a good possibility. Keep that in the forefront of your thinking until you can see the neurologist. July 2 is not very long to wait for a first neurology appointment; usually it takes months!

Lhermitte's CAN be an early sign of MS but I think more often people have something else as a first sign, such as optic neuritis, numbness, or trigeminal neuralgia.

LOTS of people with MS are very mildly affected and never have significant disability through their life. Lots of people are walking around with it and don't even know it and never will (as shown by autopsy studies). Most people remain able to walk all their life.

For most people, getting a diagnosis is not all that lengthy. If the MRI and/or physical exam show the right characteristics, it doesn't have to be a long process. Even if the MRI is not typical, any kind of second symptom or "attack," a few months later, can provide the diagnosis depending on other factors. It's true that many of us languish in "limboland" for many years (8 and counting in my case), but I have become quite comfortable with the fact that a diagnosis may never happen--in fact, I stopped seeing neurologists four years ago--and that I am very lucky to be functioning very well (with the help of a few pills and regular naps!). It's all a matter of perspective.

In any case, let's hope your Lhermitte's is just due to a structural neck problem that can be diagnosed on an MRI or x-ray and eased with proper treatment. If you don't have any other problems, that's a very hopeful thing.

Best of luck,
Nancy T.

[byoungusa]

I am very interested in everyones posts as I have been experiencing this for years. I has never been a painful sensation for me and has actually seemed pleasant at times (strange I know) I have even toyed with it as I can make it happen sometimes. I never knew what it was just a slightly tingling whoosh flying down my neck all the way to my toes or leg somtimes. lasting maybe a second but now somtimes it happens hundreds of times a day. sometimes I get raised goosebumps in just waves and waves across my body.
I am in the middle of ruling out ms, my neuro has so far dx'd fibromyalgia, myofascialpain,trigeminal neuralgia, periferal neuropathy, 4th cranial nerve palsey, vertigo. possible chronic fatigue syndrome.
Neuro has referred me to a Rheumy in January, I have had 3 mri all clear, blood tests for everything including lyme, just had LP do not have results yet.