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MS – Chronic Lhermitte Sign — SCE Neurology MCQ

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EasyMultiple Sclerosis & CNS InflammationMS – Chronic Lhermitte SignSCE Neurology

A 45-year-old man with known MS presents with Lhermitte sign. He is concerned about an electric shock sensation radiating down his spine on neck flexion. He asks if this is a sign of a relapse. His last relapse was 2 years ago and his MRI has not changed. What is the most accurate advice?

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Correct answer: D — Lhermitte sign can persist as a chronic symptom from a previous cervical cord lesion and does not necessarily indicate a new relapse — clinical and MRI correlation is needed

Lhermitte sign can be a persistent symptom from a pre-existing cervical cord demyelinating lesion and does not necessarily indicate a new relapse. It results from mechanical irritation of demyelinated dorsal column axons by neck flexion. If the MRI is stable and there are no new symptoms lasting >24 hours, it is unlikely to represent a new relapse. However, if it is a new symptom or associated with other new neurological features, a relapse should be considered with repeat MRI. A: It does not always indicate active relapse. C: Cervical cord compression should be excluded but this is demyelination. D: B12 deficiency is one cause but not the only one. E: Steroids are not needed for a chronic symptom.

Reference: NICE NG100 MS (2022)