# Situation: A 29-year-old woman with relapsing-remitting multiple sclerosis (MS) is admitted to the medical ward with new weakness and numbness of both legs for 3 days. She lives in a hot, humid area and works in an office. She says that bending her head forward sends an electric-shock feeling down her back and into her legs. Which name does the nurse use to record this finding?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630416  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 29-year-old woman with relapsing-remitting multiple sclerosis (MS) is admitted to the medical ward with new weakness and numbness of both legs for 3 days. She lives in a hot, humid area and works in an office.

She says that bending her head forward sends an electric-shock feeling down her back and into her legs. Which name does the nurse use to record this finding?

## 보기

1. Uhthoff phenomenon
2. Lhermitte sign **✔ 정답**
3. Brudzinski sign
4. Kernig sign

**정답: 2**

## 해설

Lhermitte sign is an electric-shock sensation running down the spine, often into the limbs, when the neck flexes; it reflects demyelination in the cervical cord. Kernig and Brudzinski signs are signs of meningeal irritation, and Uhthoff phenomenon is temporary worsening of symptoms with heat.

## 심화 해설

Naming the finding
She describes an electric-shock feeling that runs down her back and into her legs when she bends her head forward. This is Lhermitte sign: an electric-shock sensation running down the spine, often into the limbs, when the neck flexes; it reflects demyelination in the cervical cord. The nurse records the finding as Lhermitte sign.

The mechanism
In multiple sclerosis (MS), immune-mediated inflammation strips myelin from nerve fibers in the brain and spinal cord. Demyelinated fibers in the posterior columns of the cervical cord become abnormally sensitive to mechanical stretch. Flexing the neck stretches the cord slightly, and these damaged fibers fire spontaneously, producing a brief, shock-like sensation that travels down the spine and limbs. Lhermitte sign is a sensory symptom elicited by the client's own movement, not a test of meningeal irritation. It is common in MS but can also occur with other cervical cord lesions.

| Sign or phenomenon | What happens | Meaning |
| --- | --- | --- |
| Uhthoff phenomenon | Symptoms temporarily worsen with heat | Heat slows conduction in demyelinated nerves |
| Lhermitte sign | Electric shock down spine on neck flexion | Cervical cord demyelination |
| Brudzinski sign | Hips and knees flex when neck is flexed passively | Meningeal irritation |
| Kernig sign | Pain and resistance on knee extension with hip flexed to 90 degrees | Meningeal irritation |

Why the other names are wrong
Uhthoff phenomenon is a temporary worsening of existing MS symptoms when body temperature rises, as with exercise, hot weather, or fever; it is relevant to this client who lives in a hot, humid area, but it does not describe a shock on neck flexion. Brudzinski sign is involuntary flexion of the hips and knees when the examiner flexes the neck passively, and Kernig sign is pain and resistance when the knee is extended with the hip flexed; both are meningeal signs seen in meningitis or subarachnoid hemorrhage, not features of MS.

Nursing application
The nurse documents the finding accurately, reassures the client that it is a recognized MS symptom, and teaches her to avoid sudden neck flexion if the sensation is distressing. New or worsening Lhermitte sign may accompany a relapse and is reported along with other new neurologic symptoms.

Exam takeaway
Key point Neck flexion with an electric shock down the spine is Lhermitte sign, a feature of MS. Kernig and Brudzinski signs are meningeal; Uhthoff is heat sensitivity.

## 임상 시나리오

Lhermitte Sign in Multiple SclerosisAn electric shock with neck flexion
Lhermitte sign is an electric-shock sensation down the spine and into the limbs when the neck flexes. It reflects demyelination of the cervical spinal cord.

It differs from Uhthoff phenomenon (heat-related worsening) and from Kernig and Brudzinski signs, which indicate meningeal irritation rather than MS.

CautionNew or worsening neurologic symptoms, including Lhermitte sign, may signal a relapse and should be reported.

## 핵심 개념

- **Lhermitte sign** — An electric-shock sensation down the spine on neck flexion, caused by cervical cord demyelination.
- **Demyelination** — Loss of the myelin sheath around nerve fibers, slowing or blocking nerve conduction.
- **Uhthoff phenomenon** — Temporary worsening of multiple sclerosis symptoms when body temperature rises.
- **Relapsing-remitting MS** — A form of multiple sclerosis with attacks of new symptoms followed by partial or complete recovery.

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