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  • Is L'Hermitte's Sign an Indicator of Cord Compression?

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    Old 12-15-2006, 08:24 PM   #1
    Suzy-Q
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    Is L'Hermitte's Sign an Indicator of Cord Compression?

    Hello,
    I am quite sure I have developed L'Hermitte's sign in the last 3 months. I've only learned of this 'sign' in the last 2 days. I have emailed my NS about this but I don't see him to talk about it until next Tuesday. It is a bit complicated...
    I am recovery from a second attempt to fuse L4-5 due to spondylithesis with severe stenosis. My first surgery was in 3-'05 and the revision surgery was in June of this year. My recovery has been, once again, quite rocky. At 4 months there still was no sign of fusion.
    Just before my June surgery, i had an MRI for a suddenly worsening neck problem. Sure enough, I have a herniation at C5-6 and spondylosis in that area as well. I have been in PT for this and I have had 2 epis since Aug that seemed to help quite a bit.
    But just after the first epi I suffered from some new and strage problems - sudden onset of severe heart palpitations and vertigo. Part of the vertigo was a very ***arre sensation that accompanies head movement. I couldn't get a handle on it. I wasn't sure if it was painful or just what the heck it was. But it went away in early Nov so I just wished it good riddance. But now it is back again and along with it I am having horrific cramps all over my upper torso. I mean I am having cramps in my ribcage, my biceps, and am armpit to say nothing of the severe cramps (spasms?) I have had across my neck and back. And now when my old funny feeling hits me as I move my head, I find it is like an electrical jolt that goes right down my arms, spinal cord, and into my legs (calves most often but also my feet).
    Internet research suggests this is L'Hermitte's Sign and a common problem for people with cervical spondylosis. OK, so I think I know what it is. But I don't know whether it is seen in just nerve root compression cases or only spinal cord compression cases?
    I am loathe to face another surgery. I would like to hope that it might not be that serious a symptom. I understand that cord compression is nothing to fool around with. But I think I and everyone I know would just flip at the prospect of another surgery. Cart before the horse, I'm sure. thanks for the comments... Suzy-Q

     
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    Old 12-18-2006, 08:04 AM   #2
    humantunigfork
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    L'hermitte's sign is an indicator of cord compression and perhaps in my case one of the most disturbing symptoms...The shocking sensation that pulsed up and down my spine and through my arms and hands was abated to some extent after my surgery C-5C-6 w/hardware...6-23...I had severe cord compression...However after my surgery I still experienced L'hermitte's sign off and on for about 3 months or so...I rarely feel it today...I have inquired on this board before about this troubling symptom and have garnered little response...My sense is that in my case given the spinal cord injury...the myleopathy incurred creates all sorts of neurological symptoms...and some of these may be resolved with time and some may not...I also know that some of those who suffer from MS...also experience this symptom...As you may know the surgery does nothing but get the disk off of the cord...it does nothing for the cord itself...Until we make some progress with stem cell technology our cords must heal themselves for the most part...good luck...HTF

     
    Old 12-26-2006, 02:45 PM   #3
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    I'm not sure if L'Hermitte's is what I'm feeling though after reading HTF's description I very well may be. The feeling for me is constant, though revs up sometimes even more so...it makes me feel horrible. It feels like every nerve in my arms and legs is vibrating, it's terrible. My reflexes are all very strong and even more so when this buzzing feeling is at its strongest. After a large c6-7 herniation (no surgery) and 4-5 months into it all (mind you this all started 15 months ago), this symptom started along with oh so many other neuro symptoms. I have been dealing with this for way too long with no answers. I am pushing for more help and testing, we'll see. Suzy Q...they say I just have mass effect on the c-7 nerve root; though they do note canal narrowing as well. Anyway....I'm still trying to get figured out...I feel horrible, tons of awful neuro symptoms, neck pain etc...it feels all about my neck which they are not really validating at this point...what do I know, I'm just the patient. Good luck.

    Last edited by monarog; 12-26-2006 at 02:53 PM.

     
    Old 12-26-2006, 04:11 PM   #4
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    HTF...Are you out there? Your posting name has so caught my eye as it describes how I feel 24/7 - I can't even associate it as positional, though sometimes it kicks in harder than others. I feel absolutely awful...I describe it as all my nerves are "plugged in" - this is the worst of all the myriad of neuro issues I have going on. I guess I'm looking for advice. I had a c6-7 herniation 15 months ago (no surgery). 4-5 months after that all the horrible neuro stuff, numbness, tingling, twitching, dizziness, periodic balance/gait issues, hyper reflexes - you name it. I ended up in the ER 9 months ago...c6-7 herniation still there, "but improving," no cord compression noted etc. I have been through the mill with this, bloodwork, Brain MRI w/ contrast, spinal tap, EMG/NVC - all results "normal." My neck/arm kill me 24/7 and all the neuro stuff is constant. My question...can the MRI somehow not show what is really going on or what other testing can be done to pursue this more? My last MRI was in the ER 9 months ago...my symptoms are very real and they've not been able to find any other cause/disease at this point. My neck and arm pain worsened then the neuro stuff hit and is unrelenting. Any advice from anyone would be appreciated. I keep posting on this board just to vent. I'm trying to stay positive, but I am struggling doing so. This has been hard on my marriage. It is not uncommon for me to be a pile, crying about how bad I feel and knowing something is "terribly wrong," but with no diagnosis or plan to abate these terrible symptoms. My husband is really supportive, but I know this is really tough on him as well. Thanks for advice and for "listening." Mona

     
    Old 12-26-2006, 06:11 PM   #5
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    Hi Mona and HTF,
    Thanks for the replies. Turns out I don't have L'Hermitte's. I still don't have any definite answers but I have more clues. I had a new Cervical MRI done on 12/19 - it shows the same c5-6 herniation but now there is slight spinal cord compression. Also, I had abnormal finger reflexes that my NS says is unequivical for cord compression.
    But I have been having severe nausea and the head sensation is really hard to track down. Thing is I can make myself have the same inner stroblight effect just by moving my eyes - no need to turn my head an inch. So, my NS referred me to a neuro cuz he says all this just doesn't add up. Since I left his office on the 19th I have had the worst nausea. I've been on meclizine just to control the vomitting! It just made toast of all the holidays, too.
    But I got lucky and they found me a neuro and I will be seen on this Thursday. Of course, the nausea and head sensation has let up a lot tonight! Isn't it always the way? But I will see the neuro and hopefully learn what might explain all this horrible vertigo-like stuff.
    I can tell you nausea and a swimming head are no fun but I can't say I envy you, either! I wish you the best of luck - Suzy-Q

     
    Old 12-26-2006, 07:55 PM   #6
    PearlDoves
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    Well, hmmm... If the flow of the spinal fluid is being disrupted by the herniation that could be causing some problems as well. It might be possible that the herniation is worse than what is showing up on the MRI? Not sure on that one, but I suppose anything is possible - especially if how you move about or certain neck and head possitions aggitate your symptoms more somehow... again, I'm not real clear on how things play out as far as those factors go...

    But what I would be interested in is an MRI of the head perhaps with and without contrast so as to not miss anything, I might be off on saying this, but I just feel really suspicious of your head. I'd also perhaps see if an MRA of the head and neck would be good, so as to make sure nothing is going on with the arteries. You could also ask if an MRI of the neck with contrast might show more as well.

    Has anybody ever ordered an EMG nerve study on you? This might be something your neruologist ends up doing to see if you have any nerve damage, this could potentially be a factor as well. If the neurologist suspects something with pressure in the head or infection he could have a spinal tap done.

    On another note, I should ask if you've been around people with cold or flu like symptoms or have you been sick recently, even if its been a month or more since you were? If you have a severe sinus infection or a middle ear infection, this can cause many problems if its bad enough. A middle ear infection could be causeing the vertigo, which could in turn make you nauseated and vomit. A Cat scan of the head could confirm a sinus infection and in some cases an ear infection it appears, In one study, xrays picked up that people had a sinus infection a little over half the time that people had them, so cat scan would be better. If you think you may have an infection, you can get started on Sudafed and Guaifenesin- both available over the counter and could be located be located by a pharmasist for you. But I would be sure to speak with your primary doc to see what else could be done or to see if you should see an ENT. Otherwise the only other things I can think of to ask is if you ever get migraines, but this is could ultimatly lead me to say that an MRI of your head might be a good idea.

    Last edited by PearlDoves; 12-26-2006 at 08:21 PM.

     
    Old 12-26-2006, 10:05 PM   #7
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    Thanks Pearl for all your input and ideas. When all this neuro stuff hit me like a brick wall 9 months ago...I did have an MRI of my head...w/ contrast...looking for MS stuff (it came out "normal"). I wonder if a closer look into my head woud be helpful as I'm so messed up. Is there another type of MRI that should be done do you think? I will ask about the MRA...I see my PCP tomorrow AM to push for more testing as this waiting around is really not working for me - I'm really too sick. I did have a spinal tap as well and an EMG/NVC - both were supposedly "normal." No real viral type illnesses and...this crazy neuro stuff is 9 months long now, with no relief (no real virus stuff prior to the onset either). I know it's easy for me to think it's my neck as I have so much pain (which still seems strange to me since it's been 15 months since herniation) but I do understand it could be something totally unrelated. I just really want someone to help me get to the bottom of this. I guess my worst fear is this is my "new normal" with no relief. I just can't accept living with this horrible "plugged in" nerve feeling, I can't do it. Even if I can't get to the bottom of it (which I would prefer) I need something to help control the symptoms. At this point, I'll accept masking the problem...I just can't handle these symptoms for much longer. The pain I can take, the over-active nerves...not so much. Thanks again Pearl, you've given me more ideas to discuss with my PCP tomorrow. Mona

     
    Old 12-26-2006, 11:22 PM   #8
    PearlDoves
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    Quote:
    Originally Posted by monarog
    Is there another type of MRI that should be done do you think? I will ask about the MRA...

    The MRA is basicly an MRI, but the difference is, at some point you are given "contrast" to make your arteries show up amoung other things. When I had one done of my neck, its was pretty cool because when I looked at my films, I could see part of my heart too. But going back to MRI's, you could have an MRI with contrast on your neck to see if there are anything that is being missed with just a regular MRI.

    If you are seeing your PCP, perhaps ask about getting an Internal Medicine doc on your case. These docs are usually brought in when a case is difficult to solve because they look at the BIG PICTURE and might look into other things with you that could get missed by other docs. Internal medicine docs you will usually see in specialized catagories like Rheumatology, but if you could get a straight out Internal Medicine doc to see or consulted on your case, you may benifit in some way. Good Luck to you and many blessings, I hope something is found soon. Don't give up, stay strong, you can perservere, just hang on while the docs try to get it figured it out.

    Have they tried giveing you any medications or injections to help with the symptoms?

    Another kind of test they could do for your neck is a discogram... I think we may have talked about this before and I can't remember what came of that, but if you think it could help, it might be worth mentioning as well to see if the problem can be found from one of your discs in the spine.

    What do you mean when you say its a plugged up nerve feeling? Can it be described?

    Last edited by PearlDoves; 01-12-2007 at 07:38 PM.

     
    Old 12-27-2006, 08:13 AM   #9
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    I'm going to my PCP in one hour...so I will be discussing some of this with him - the MRA idea on my brain and/or MRI on the cervical spine with contrast. I will also inquire about a Internal Medicine Doc. My PCP is holding great expectations when I see the Physiatrist the middle of the month...but, I'm not so sure after talking to a couple of people who have been that route. I have read about a discogram, that too I will bring up. I've also read about a myelogram in conjunction with a CT scan...another idea I will discuss. I don't want to be over the top with requesting tests...yet at the same time I feel so terrible with no answers I really want to get figured out. I know it's not "normal" to have hyper reflexes and then this sudden onset of high BP - when it was always low - I believe these should be red flags that something really is going on. It's hard, as outwardly I look relatively normal...yet I've never felt so terrible, strange.

    At the time of my herniation...they described it as "very large." My NS said no PT as he didn't want it aggravated any further. I know most people have canal narrowing naturally as we age (I'm 45). I just know mine is 9mm or less where my herniation is...I guess I have to trust docs that this isn't problematic...but, something is causing all of this!

    This plugged in feeling...the best way I can describe it...it feels like all of my nerves in my legs and arms are almost vibrating just charging and active all the time - don't know how else to describe it. It's always there, but sometimes comes on really strong, which is the worst...that is when I will sometimes tremor (hands and/or legs). I've had 2-3 times where when I would lay down I had an internal vibration feeling that was visible, my whole body was vibrating, though I only had it a couple of times, and haven't had this for about 6-7 months.

    I was given a beta-blocker (Atenolol) to see if that helped settle down the nerves - I haven't noticed much difference. I take Trazadone sometimes before bed, just to help me sleep. Other than that...Ibuprofen to help with neck/arm pain. I am going to question my PCP today about something to help with the terrible nerve symptoms until I get figured out - I need relief as I'm waiting on appt stuff. I get nervous about all these meds and getting addicted to something so I haven't pushed too much - but I need relief. Thanks again Pearl - I REALLY appreciate the time you take for your input and support. I'll keep you posted. Mona PS. How are YOU feeling post ACDF? You're about 6-7 weeks out, right? Bless you.

    Last edited by monarog; 12-27-2006 at 08:17 AM.

     
    Old 12-27-2006, 09:44 AM   #10
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    I can't help but think that the problem really is still with your neck, of course I'm not a doc, but just with what you've said, it just seem to me you need to find a doc who will be willing to do surgery on you based on your symptoms and quality of life. Your NS might be really conservative and not want to do it unless there is some technicality about it that he expects to see. Hyperflexia can be caused from what is going on from your neck, which in turn causes high blood pressure, esp when your bowl and bladder are full, but this is dangerous because the high blood pressure could cause you to stroke. Have they put you on a HBP medicine so as to help control it when it starts to arise?

    I know the fear of being addicted to narcotics can be intimidating, but to get you thru this, you may need to consider it for now. As long as you can stay rational about it, or if you start feeling like you NEED to take it, or that you NEED to take more, that's when you need to STOP, talk to your doc and swtich to something else. Its possible that your doc could also give you a stronger non-steroid NSAID which wouldn't be addictive at all. So something stronger than Ibuprofen might help, though this deals with inflamation and may not touch your nerve problems like Vicodin might could.

    A Myelogram and a Discogram are simular in that both have it to where dye is injected so as to see the discs better, however with the discogram they actually try to see which one is causing the pain and will try to trigger it. You will have this under a sedation so you may not even remember it after you come out of it.

     
    Old 12-27-2006, 09:47 AM   #11
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    I think I've been having some sinus problems amoung other things that were getting confused with problems from perhaps the surgery, such as vertigo and chest pain. I felt better after having took a steroid for a few days, but then symptoms were returning, so we've been trying to figure things out. I feel pretty good for the most part now that I started taking sinus meds, I just have to take it easy sometimes and not over do it, otherwise I can start to get a bit symptomatic again from things relating to my neck - such as turning my head too much repeditively... it just takes time to heal from everything in general I think. its just amazing how everything can relate or complicate another problem sometimes though. Its interesting, yet also frustrating!

    Last edited by PearlDoves; 12-27-2006 at 09:58 AM.

     
    Old 12-27-2006, 05:23 PM   #12
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    So...the PCP suggested I try Neurontin (sp?)...I'll give this a shot, mainly while I'm waiting for the other appts. He doesn't want to do more testing...he wants the physiatrist to assess me and then order whatever tests they think to clarify my situation. I have so much neck pain, so dizzy and out of sorts...it's going to be a long 3 weeks until I have the appt. I hope this RX helps with my crazy over-active nervous system - that's my biggest complaint. Thanks Pearl for your help and input.

     
    Old 12-27-2006, 09:17 PM   #13
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    Neurontin could help, hopefully it will, good luck on that. Give it time to work up in your system. Some drugs take time to build up before you notice a difference - not sure if this is one of those or not. But if you notice any other werid symptoms that are very bothersome or allergic reaction after takeing it, be sure to stop and call your pcp. Keep us posted. Hang in there!

     
    Old 12-28-2006, 10:43 AM   #14
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    Re: Is L'Hermitte's Sign an Indicator of Cord Compression?

    Quote:
    Originally Posted by PearlDoves
    it just seem to me you need to find a doc who will be willing to do surgery on you based on your symptoms and quality of life. Your NS might be really conservative and not want to do it unless there is some technicality about it that he expects to see.

    Going back to what I said before... after some more thought, its possible that also the initial herniation really did some bad stuff to your nerves and/or spinal cord, in which case it will take time for them to recover. Its even more difficult to heal when you are in pain all the time, so hopefully the new medication will help.

     
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