Multiple Sclerosis
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ž L'Hermitte's sign
 - Synonyms: Barber Chair phenomenon
 - Associated persons: Jacques Jean L'Hermitte

Description:
Flexing of the neck produces electric shock-like sensations that extend down
the spine and shoot into the limbs during. Caused by trauma to the cervical
portion of the spinal cord, multiple sclerosis, cervical cord tumour, cervical
spondylosis, or even vitamin B12 deficiency.

Bibliography:
    * J. J. Lhermitte, Pollak, M. Nikolas:
      Les douleurs … type discharge ‚l‚ctrique cons‚cutives … la flexion
cephalique dans la scl‚rose en plaques. Un cas de la scl‚rose multiple.
      Revue neurologique, Paris, 1924, 2: 56-57.
    * J. J. Lhermitte:
      Multiple sclerosis.
      Archives of Neurology and Psychiatry, Chicago, 1929, 22: 5-8.

ž Treatment of MS exacerbations
 - according to Mercy's Dr. Corsello, 3/99, ACTH is "out" as having
   no advantage over steroids; treatment is usually
   Solumedrol 1 g over 1 hour IV.

ž MS Epidemiology:
 - A white female between the ages of 20-50 years old would be a classic MS
   patient.  MS is more common in patients who have first degree relatives
   with the disease.

ž Diagnosis of MS:
 - "Clinically Definite":
   MS is characterized by lesions that are "scattered in space and time".  As
   such, clinically definite MS is defined as "a predominantly white matter
   disease involving 2 or more episodes, each at least 24 hours, at least 1
   month apart or in a progressive course over at least 6 months beginning
   between the ages of 10 and 50."  This definition makes early MS nearly
   impossible to diagnose with certaintly clinically in the emergency
   department.
   --Rosen 3rd ed. p 1869
 - L'hermitte's sign is an electric-shock sensation in the torso or
   extremities caused by flexing the neck.  It is due to
   hyperexcitable demyelinated axons.
 - Common early signs:
   internuclear ophthalmoplegia and diplopia
   optic neuritis
   transverse myelitis
   bladder dysfunction,
 - dementia, aphasia, or seizures are quite rare
 - Unilateral internuclear ophthalmoplegia is a "typical" multiple
   sclerosis (MS) sign (though other entities can cause it). Internuclear
   ophthalmoplegia is an inability to adduct the eye (look nasally) on the
   same side as the lesion.  The opposite eye will have nystagmus during
   abduction.  Convergence is spared, and eye position at rest is normal.