Purpose of Lhermitte’s Sign: To determine if there is a dural or meningeal irritation in the spine or to check if the dorsal column of the spinal cord is hyperexcitable due to demyelination.

Patient position: Long sitting.

Examiner position: Standing beside the examining table while the patient is in a long sitting position.

Procedure: The examiner performs a gentle, passive flexion of the patient’s neck and one leg simultaneously (at the hip joint with knee straight and ankle in a relaxed position), while the patient is in a long sitting position.

Reverse Lhermitte’s sign: The examiner performs a gentle, passive extension of the patient’s neck while the patient is in a long sitting position.

Outcome: The test is positive if electric shock-like sensation and/or paresthesia are felt in the vertebral column and radiate into the upper/lower extremities uni/bilaterally. The test is negative if there are no such symptoms. A positive lhermitte’s sign indicates a compression or a lesion of the upper cervical spinal cord and/or lower brainstem.

Reference:
1. Lhermitte J, Bollak NM, Nicolas M. Les douleurs a type de decharge electrique consecutives a la flexion cephalique dans la sclerose en plaques. Rev Neurol. 1924;2:56-62.

2. Khare S, Seth D. Lhermitte’s Sign: The current status. Annals of Indian Academy of Neurology. 2015 Apr;18(2):154.

3. Chen JJ, Kung KL, Chen CJ, Yeh YS, Chen DL, Tang YM. Reverse Lhermitte’s phenomenon provoked by cervical cord compression. Acta Neurol Taiwan. 2012;21:35–8.