Is this Lhermitte's sign

[steveo007]

Hello,
I've posted a few times on the neurology forum, but thought this
forum might be the most apropriate place to ask this question.
Firstly, I'm going through tests at the moment re a number of symptoms
ie numbness, tingling, pins and needles etc. I have no issues with weakness,
balance or vision problems and my neurologist does not suspect a sinister
cause at this time.
However, yesterday I did experience a new sensation which has caused some worry.
Basically, I was driving in my car, having just finished a quite strenuous workout, when I began to feel a buzzing sensation in a small area (about 1 or 2 inches wide) at the front of my hip. I would describe this sensation as similar to when a mobile phone vibrates in your pocket.
Anyway, I was not that concerned and put it down as just another strange sensation to put alongside all the others I've been having.
When I arrived at work a few minutes after this sensation started I went and took a shower, during which I could no longer feel any buzzing. However, when I was getting dry I put my chin on my chest and the buzzing began in the same place on my hip. As soon as I lifted my chin up the buzzing would stop. I tried this a number of times, each time with the buzzing starting and stopping as I lowered and raised my chin to my chest.
I then started to stretch ie bending forward at the waist or twisting from side to side to see if I could replocate the sensation.
Whilst doing this, I would occassionally have the buzzing return, depending on which way I was stretching, but nothing like when I lowered my chin.
I did not get any other sensations whilst lowering my chin ie electric shocks in my arms or legs.
So, could this sensation be Lhermittes sign and if so would it make a dx of ms more liklely.
If this does not sound like Lhermittes sign, any ideas wht it could be.
Many thanks in advance.
Steve.      

[Quixotic1]

Good to see you found us.  We have a wealth of information and caring people here,  However, most people won't see your post here.  Would you go to the bottom of theis page to the blue "Back to Forum" button and click it.  That takes you to the Main Page.  I invite you to post your story, all your symptoms how and when they started, what work up you've had, anything you'd like to tell us.  

You do that by click on the "Post a Question" button at the top of the threads.  Then the whole forum will see you as a newcomer and be able to help.  The weekends are often slow as people spend time with the families.  I am the local physician, not a  neurologist and not in active practice.  I help with some of the medical questions.

Welcome, again, Quix

[Bettylou61]

I put poitive Lhermitte sign in a search engine and this is where it took me. I also have the electric shocks going down both arms but not the legs when putting my chin to my chest. I am reading a report from my dermatolagist that says *positive for Lhermitte sign. Nothing has been said to me about this at all. Is this a sign I may develop MS or have it already? I do have what they are calling "essential head tremor" & they just say...we don't know what it is.
Thanks so much,
Betty

[steveo007]

Hi again,
Got another strange sensation this morning, similar to the others that I
mentioned. This time it was a slight tingling sensation in a small area of
my lower left back. Again, I first noticed  when I lowered my head, but this time
I was able to replicate the sensation when keeping my head up and bending
slightly forward at the waist. This to me sounds less like L'Hermittes, but then
again I'm hardly an expert.
I've also had my brain MRI (w/o contrast) results back, with the report stating
that I have "no cerebral abnormality"
Obviously this is good, but with all the info on the this forum regarding the
unreliability of clear MRI's, I'm still unsure where I'm at.
Anyway, my neuro, has booked me in for a follow up appointment in January, not sure what I'm supposed to do until then :(
Steve    

[steveo007]

Carol,

Many thanks for your thoughts and kind words, they really are
appreciated.

Steve

[steveo007]

Thanks again for taking the time to advise.
Actually, the worst part of all this is that I had just been offered a job
in Australia (I'm in the UK) and we were all looking forward to starting a new
life. But with this hanging over me, I don't think I can take the chance with my families future, talk about bad timing.
With regard to what you said about people not being dx at this stage, is that because they don't get the mri's etc or is it because sign's of the disease
don't show up at this stage. If this is the case is it actually worthwhile having the tests  at this stage.  
I did find out (after reading another of your posts) that my brain MRI was done on a 1.5T scanner (without contrast) I feel that this may have been a waste of time, as even a clear result would seem to mean very little.
I do appreciate your honesty and I do know that these symptoms could
lead to ms, but I would also love to know just how likely this is to be, ie would doctors expect someone with my symptoms to go on and develop ms  50% of the time, a lot less, or a lot more.
My neuro, who I spent about 30 mins with, stated that he didn't think there was anything wrong, but looking on this forum, it would appear that this is the norm. What really annoyed me was that he didn't give me any possible explanations for what it could be.
Oh, I'm 35, so just at the right age for ms :(
Many thanks

Steve      

[grannyhotwheels]

Hang in there Steve,  we are right here with you.  We will get through this thing together.

I'll be praying,
Carol

[Quixotic1]

L'Hermite's is definitely triggered by flexion of the neck - rather by it's definition.  I underspoke when I said it is totally non-specific.  It is very very characteristic of any thing that causes lesions with9in the cervical spinal cord.  Mostly that means MS, but other things CAN cause it.

My sensation was "atypical".  But is felt to be true L'Hermitte's.  When I drop my chin down I get an immediate buzz/vibrational/maybe electrical feeling throughout my anterior left thigh.   I also do not feel it radiate from anywhere.  But my neuro does feel it is definitely L'Hermitte's.  I also have cervical lesions.

Don't feel so hopeless about the results of the tests.  We are definitiely a skewed (or screwy) bunch here with our persisitent symptoms and often times clear MRI's.  The reality is that the odds of it being MS go down when the MRI is persistently negative.  They just don't disppear.

Your persistent paresthesias certainly could be the onset of MS.  People present with only sensory abnormalities about 40% of the time.  MS is rarely diagnosed at this point, because the sensations usually don't correspond to any known nerve pathway or specific section of the brain.  So the patient will often just be dismissed.  A thinking MD will recgnize the possibility of MS and order the MRI of the brain and spine.

On the brighter side, if it is MS, sensory-only presentation is more associated with a milder course of the disease - statistically.  How old are you?

If this answer contradicts what I said to you over on the other forum, it's because I am learning more and more about MS (and other stuff).  Sorry.

Quix

[steveo007]

Just noticed this same sensation this morning after taking my
daughter to school.
This time though it was on my left side, on a small patch high up on my
inner thigh. I would describe the feeling more of a tingling than a buzzing
(if that makes any sense) but started when I lowered my head and stopped
when I raised my head back up.
Most of what I've read re L'Hermitte's sign state that it is an electrical sensation
that radiates from the neck down the spine normally into the limbs, but
occassionaly to the trunk of the body.
My sensation seems to be very localised ie doesn't seem to radiate from anywhere, but like L'Hermitte's is linked to head movement.

Any ideas

Thanks  

[steveo007]

Hi Janey,

thanks for taking the time to respond
I'm sorry to hear of your dx, but it seems that for a lot of people
on here a dx is a relief and at least you've got your answer earlier
than many.
As you were saying that your situation matched mine in some ways, I
was just wandering if you had any issues with eyesight, balance or
weakness.
I have not and I've been clinging to the hope that this makes a positive dx
for ms less likely.
I just wish I could find some statistics on how reliable these tests are, especially
the MRI. It feels like being in a no win situation at the moment, waiting for
the MRI results, either I get a positive dx, which I don't want or I get a clear result, which doesn't actually guarentee anything.
thanks again and I hope things go well for you.

Steve  

[Janey1]

Hi there,

When I read what you have been through in the last few months it is lie reading my own diary.  Majority of my symptoms started about Jan time,... buzzing sensation, bit of numbness here a d there but mainly that strange tingling and painless 'pulling' sensation, radiating from neck to my limbs when I put my chin down.  This lasted for about 2 months and I just kept streching my legs about 10 times a day,... basically all the time, even when I went to the bathroom.  

This sensation stopped and I started feelinf tremor like sensation all over my body, sometimes in my legs, face,... and after a month or so it started in my arms too.  I could you actually decide if it was a tremor or tingling.  I started feeling this for a couple of minutes at any time,.. this was about 4 months ago and now all the symptoms have more or less subsided but I have been left with this unpleasant tingling.  

I kind of knew what was coming,... 2 weeks ago consultant said yes it is ms,... and I have lesions on my brain and some on upper spine. Poo!!!

Not a nice feeling,...

I just wanted to way I have had a very similar sensations,... including numbmess in soles of my feet when I walk for just a few minutes.  All the tests neurologist performed seemed to be fine.  

Currently experiencing just the tingling and slight heaviness in my right arm,... not stopping me from streching and exercising.  

Quix will be alble to provide medical details.  Good luck with your other tests and let us know what they say.  

Take care for now.

Janey1

[steveo007]

Hi Quix and thanks for the reply
You've already kindly offered advice re my situation on the
neurology forum, but things have progressed a little since then.
Basically, I began to notice my symptoms about 5 months ago, which began
with a brief tremor in my left thumb and transient numbness in small patches
on my fingers, toes and legs (mainly left sided, but sometimes right)
This soon progressed to pins and needles in my feet and hands, usually
brought about by pressure on my arms or legs ie seating position or leaning
against something. I also fee a  very transient light numbness to my face
on both sides, although the area effected never feels numb to the touch.
over the past month or so I have noticed that the numbness seems to have
decreased, but I have increasing pains in both hands and feet. I would
describe the pain, primarily, as a dull transient ache that moves around, but also with some burning sensations running down my forearms or at the tips of
my fingers or toes.
The sensation I described above, has only been felt on that one occassion.  
I had some tests with my neurologist, which tested reflexes, peripheral vision,
sensitivity etc. and from that he was of the opinion that there was no serious
cause for my symptoms (I did not have any pain at this point and had not
experienced the strange sensation mentioned above)
He did however arrange an MRI without contrast, which I had last week and
an EMG which I'm due to have next week.
I have done a little more reading on L'Hermittes and as you say, my sensation
sounds very different ie not radiating from the neck or spine to the limbs, but
brought about by putting my chin down to my chest none the less.
Another question you may be able to advise on is with regards to my brain MRI.
I'm still awaiting the results and I'm also aware that the results are not aways 100% when it comes to completely discounting ms, but do you have any ideas on how acurate an MRI without contrast would be in my situation ie would it be reasonable to asume that ms is not the cause of my problems if the MRI is clear or is it only suggestive that ms is not present.        

[Quixotic1]

Hi,  I hope we can be of help.  L'Hermitte's sign is a completely non-specific sign of irritation of the cervical spinal cord.  It is a frequent occurence in MS, but not at all diagnostic for MS.  Within the ocntext of MS it is felt to be from a demyelinating lesion in the cervical cord, and flexion of the neck causes irritation or activation of inflamed nerves.  Your description of the sensation is not classic for L'Hermittes, but mine isn't either.

If the sensation continues you might seek an MRI of your neck (with and without contrast) both to look for spinal lesions or for spinal column pathology.

In terms of making MS more likely, I think it would be placed in the list along with all other abnormalities and symptoms, but not given any particular weight.  This is what I have learned in asking my own neuro about it and from other people who have learned about it from various sources.

You are clearly concerned.  Would you like to tell us you story, but instead of listing the various symptoms, put them into more of a timeline of what started when and lasted how long.  Have you had any neurological evaluation, or are you worried in silence?

Quix