Lhermitte’s sign is seen in:

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

Lhermitte's sign is a classic, though not exclusive, symptom of Multiple Sclerosis (MS).
It is characterized as a transient, electric shock-like sensation that runs down the back and into the limbs upon flexion of the neck.
The underlying cause is the demyelination of the dorsal columns in the cervical spinal cord, which are responsible for carrying sensory information.
This demyelination, a hallmark of MS, makes the nerve fibers hyperexcitable and sensitive to stretching during neck movement.

Option A: Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease that can have neurological manifestations, but Lhermitte's sign is not a typical or common feature.
Option B: Myasthenia Gravis is a disorder of the neuromuscular junction where antibodies block acetylcholine receptors, leading to fatigable muscle weakness. It does not involve the sensory tracts of the spinal cord.
Option D: Guillain–Barré Syndrome (GBS) is an acute inflammatory polyneuropathy affecting the peripheral nervous system. Lhermitte's sign is a central nervous system sign.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Association of Lhermitte's sign with neurological disorders as background academic context rather than a clinical decision trigger.
Recognizing Lhermitte's sign is crucial for nurses as it can be an early indicator of Multiple Sclerosis, prompting timely referral to a neurologist.
During a neurological assessment, a nurse should specifically ask patients with suspected MS if they have experienced this sensation when bending their head forward.
Patient education is important. The nurse should explain that while the sensation is unpleasant, it is typically brief and not dangerous, but it signifies underlying nerve damage that requires management.

How to Approach the Question

First, identify the key term in the question stem: 'Lhermitte’s sign'.
This is a factual recall question. Access your knowledge about the definition and common causes of this specific neurological sign.
Recall that Lhermitte's sign is an electric shock-like sensation with neck flexion, indicating a problem in the cervical spinal cord's dorsal columns.
Evaluate the options based on their primary site of pathology:
Systemic Lupus Erythematosus: Systemic autoimmune, can affect CNS, but not the classic cause.
Myasthenia Gravis: Affects the neuromuscular junction.

Concept Tested & Keywords

QoS69iuUGeGjHF-0lY8rut

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 1540-1542, 1710-1712

E6 Medicine Davidson Principles Practice 24e p. 1160-1162

Practise the full DSSSB - 28 August 2019 (Shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.