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Cranial Nerves

Multiple Sclerosis

February 15th, 2021
On this page:Lhermitte's Sign


  • Signs of Multiple Sclerosis

  • Signs of optic neuritis - reduced visual acuity, central visual loss, optic disc atrophy
  • Internuclear ophthalmoplegia - inability to adduct one eye, with nystagmus in the other eye
  • Lhermitte's sign - electric sensation in the limbs on neck flexion
  • Upper motor neuron weakness - increased tone, reduced power, hyperreflexia
  • Dorsal column (vibration / proprioception) sensory loss
  • Signs of cerebellar involvement - ataxia, dysarthria, dysmetria, dysdiadochokinesis, nystagmus

Lhermitte's Sign

  • How to Perform

  • Flex the patient's neck and ask them about any symptoms in their back, arms or legs.
  • Interpretation

  • Lhermitte's sign is present if there is an electric shock-like sensation through the back and down the upper / lower limbs.
  • Significance

  • Classically a sign of multiple sclerosis, though can occur with other myelopathies, chemotherapy or radiotherapy.
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