Lhermitte's Sign | Multiple Sclerosis / Myelopathy / Dorsal Column Disturbance

Summary

In this video, Physiotutors introduces the L'hermitté Sign, a clinical sign originally linked to multiple sclerosis but also observed in conditions like cervical myelopathy and cervical spondylitis. The test involves neck flexion to elicit an electric or 'pins-and-needles' sensation along the spine and limbs. While the L'hermitté Sign's diagnostic accuracy is limited, it remains a valuable tool for identifying spinal cord disturbances. The video encourages viewers to explore other cervical myelopathy tests and supports the channel through various means.

Takeaways

• 😀 The L'hermitté Sign was originally associated with multiple sclerosis.
• 😀 It has also been linked to conditions like cervical myelopathy, cervical spondylitis, and trauma.
• 😀 The sign is related to disturbances affecting the dorsal column of the spinal cord, such as demyelination, pressure, or stretch.
• 😀 The pathological mechanism behind the L'hermitté Sign is thought to be hyperexcitability of demyelinated nerves in the spinal cord.
• 😀 Evidence on the diagnostic accuracy of the L'hermitté Sign is limited and generally not highly supportive.
• 😀 The L'hermitté Sign has a positive and negative likelihood ratio of 1, as reported by Uchihara et al. (1994).
• 😀 To conduct the test, position the patient in either standing or sitting and ask them to flex their neck.
• 😀 A positive L'hermitté test elicits an electrical-type sensation or a pins-and-needles feeling down the spine, possibly extending into the extremities.
• 😀 The sensation of the test is more pronounced depending on the range of neck flexion.
• 😀 For more tests on cervical myelopathy, viewers are encouraged to check out the relevant playlist linked in the video description.

Q & A

What is the L'hermitté Sign?

The L'hermitté Sign is a neurological sign originally associated with multiple sclerosis. It is characterized by an electric shock-like sensation that runs down the spine, potentially extending to the extremities, particularly when the neck is flexed.

Which conditions can the L'hermitté Sign be observed in?

Although it was first linked to multiple sclerosis, the L'hermitté Sign has also been referenced in conditions such as cervical myelopathy, cervical spondylitis, trauma, and other issues affecting the dorsal column of the spinal cord.

What is the hypothesized mechanism behind the L'hermitté Sign?

The L'hermitté Sign is thought to result from hyperexcitability of demyelinated nerves in the spinal cord or from disturbances such as pressure or stretch affecting the dorsal column.

What is the diagnostic accuracy of the L'hermitté Sign?

The diagnostic accuracy of the L'hermitté Sign is considered poor. It has a positive and negative likelihood ratio of 1, according to research by Uchihara et al. in 1994.

How should the L'hermitté Sign test be conducted?

To test for the L'hermitté Sign, the patient should be in a standing or sitting position. The test is positive if the patient experiences an electrical-like sensation or pins-and-needles feeling down the spine when they flex their neck.

What does a positive L'hermitté Sign indicate?

A positive L'hermitté Sign indicates an abnormal neurological response, typically an electric shock-like sensation that may extend from the spine into the extremities when the neck is flexed.

What are the other conditions that can present with symptoms similar to the L'hermitté Sign?

Conditions like cervical myelopathy, cervical spondylitis, and trauma can present with symptoms similar to the L'hermitté Sign due to disturbances in the spinal cord, particularly affecting the dorsal column.

How reliable is the L'hermitté Sign in diagnosing multiple sclerosis?

The L'hermitté Sign is not highly reliable as a diagnostic tool for multiple sclerosis due to its poor diagnostic accuracy, as evidenced by a likelihood ratio of 1.

What does the video suggest about tests for cervical myelopathy?

The video suggests checking out a playlist on cervical myelopathy tests for further information and to gain a broader understanding of diagnostic methods for this condition.

How can viewers support Physiotutors according to the video?

Viewers can support Physiotutors by leaving a thumbs-up on the video, checking the video description for more information, or exploring other ways to support the channel.