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Lhermitte's Sign, sometimes called the Barber Chair phenomenon, is an electrical sensation that runs down the back and into the limbs from involvement of the posterior columns, and is produced by bending the neck forward or backward. Associated conditions The sign suggests a lesion of the dorsal columns of the cervical cord or of the caudal medulla. Although often considered a classic finding in multiple sclerosis, it can be caused by a number of conditions, including Behçet's disease,[1] trauma, radiation myelopathy,[2] vitamin B12 deficiency (subacute combined degeneration), and compression of the spinal cord in the neck from any cause such as cervical spondylosis, disc herniation, tumor, and Arnold-Chiari malformation. Lhermitte's Sign may also appear during or following high dose chemotherapy. [3] Irradiation of the cervical spine may also evoke it as an early delayed radiation injury, which occurs within 4 months of radiation therapy. This sign is also sometimes seen as part of a "discontinuation syndrome" associated with certain psychotropic medications, such as serotonin reuptake inhibitors, particularly paroxetine and venlafaxine. Typically, it only occurs after having taken the medication for some duration, and then stopped or withdrawn rapidly. Fluoxetine, given its very long half-life, can be given as a single small dose, and often avoid Lhermitte's sign and other withdrawal symptoms. [J Clin Psychopharmacol. 1996 Oct;16(5):411-2. Lhermitte's sign in paroxetine withdrawal.Reeves RR, Pinkofsky HB. PMID: 8889917 PubMed - indexed for MEDLINE] In the dental field, three studies (Layzer 1978, Gutmann 1979, Blanco 1983) have identified Lhermitte's sign among nitrous oxide abusers. Terminology Strictly speaking, the Barber Chair phenomenon is a symptom rather than a sign as it describes a subjective sensation rather than an objective finding. To add more confusion, it is not attributed to its discoverer.[4] It was first described by Marie and Chatelin in 1917.[5] Jean Lhermitte did not publish his first report until 1920.[6] However, in 1924 he did publish the seminal article on the subject which resulted in it becoming well known.[7] References ^ Page NG, Spiteri MA. Lhermitte's sign in Behçet's disease. Br Med J (Clin Res Ed) 1982 March 6; 284(6317): 704–705. ^ Jones A. Transient radiation myelopathy (with reference to Lhermitte's sign of electrical paraesthesia). Br J Radiol 1964; 37:727-44. ^ Heinzlef et al. Severe neuropathy after high dose carboplatin in three patients receiving multidrug chemotherapy. "J Neurol Neurosurg Psychiatry" 1998; 64: 667-669. ^ Gutrecht JA. Lhermitte's sign: From observation to eponym. Arch Neurol 1989; 46:557-558. ^ Marie P, Chatelin C. Sur certains symptômes vraisemblablement d'origine radiculaire chez les blessés du crâne. Rev Neural 1917; 31:336. ^ Lhermitte JJ. Les formes douloureuses de la commotion de la moelle épinière. Rev Neurol 1920; 36:257-262. ^ Lhermitte JJ, Bollak NM. Les douleurs à type décharge électrique consécutives à la flexion céphalique dans la sclérose en plaques. Un cas de la sclérose multiple. Revue neurologique 1924; 2:56-57. v • d • e Eponymous medical signs · nervous system CNS Head, general Battle's sign · Broca aphasia · Kernig's sign · Macewen's sign · Myerson's sign · Stroop test · Wada test · Dix-Hallpike test · Hirano body Multiple sclerosis Dawson's fingers · Lhermitte's sign · Charcot's neurologic triad · Uhthoff's phenomenon Other Romberg's test · increased intracranial pressure (Cushing's triad) · Miller Fisher test PNS Reflexes of extremities/ corticospinal tract Combination Jendrassik maneuver Lower limb Babinski sign · Chaddock reflex · Oppenheim's sign · Westphal's sign Upper limb Hoffmann's sign Other torso/limbs Upper limb Froment's sign · Phalen maneuver Lower limb Abadie's symptom · Gowers' sign · Hoover's sign · Lasègue's sign · Trendelenburg's sign Torso Beevor's sign General Tinel sign · Todd's paresis · Jolly's test Mental/behavioral Russell's sign M: CNS anat(s,m,p,4,e,b,d,c,a,f,l,g)/phys/devp/cell noco(m,d,e,h,v,s)/cong/tumr,sysi/epon,injr proc,drug(N1A/2AB/C/3/4/7A/B/C/D) M: PNS anat(h,r,t,c,b,l,s)/phys/devp/prot/nttr/nttm/ntrp noco/auto/cong/tumr, sysi/epon, injr proc, drug(N1B) M: PSO/PSI mepr dsrd (o, p, m, p, a, d, s), sysi/epon, spvo proc, drug(N5A/5B/5C/6A/6B/6D)