Lhermitte’s Sign | Myelopathy | Neurological Assessment

The L’hermitté sign was originally described as a sign that could be observed in patients suffering from multiple sclerosis. It has later been referenced in conditions such as cervical myelopathy, cervical spondylitis, trauma, and other conditions affecting the dorsal column of the spinal cord. The pathological mechanisms are thought to be hyperexcitability of demyelinated nerves in the spinal cord or other disturbances of the dorsal column such as pressure or stretch.

Evidence on the diagnostic accuracy of the L’hermitté sign is sparse and rates the sign rather poorly, with a positive and negative LR of 1 as reported by Uchihara et al. (1994).

To conduct the test have the patient in standing or sitting position and then ask them to flex the neck. A positive test shows an electrical “type” response or a “pins and needles” sensation down the spine, possibly extending into the extremities near the end range of flexion.

Other common neurological screening tests for upper motor neuron lesions are:

Babinski Sign or Babinski Reflex

Inverted Supinator Sign

Hoffmann’s Sign

Uchihara T, Furukawa T, Tsukagoshi H. Compression of brachial plexus as a diagnostic test of cervical cord lesion. Spine. 1994 Oct 1;19(19):2170-3.