The ischemic lumbago : a further contribution to the lumbar type of intermittent claudication / J. Ramsay Hunt.

  • Hunt, James Ramsay, 1872-1937.
Date:
1914
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Licence: In copyright

Credit: The ischemic lumbago : a further contribution to the lumbar type of intermittent claudication / J. Ramsay Hunt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    intermittent claudication resembling lumbago in location and character of pain, but which is evidently vascular from its intermittent character, the ischemic lumbago. Case 1.—Severe unilateral lumbar pains, occurring only on exertion, of the ischemic type.” in a woman aged 66, who has suffered from intermittent claudication of both loicer extremities for ten years. The unilateral lumbar pains were always relieved by a brief period of rest and presented the typical character of the intermittent claudication. Tlie patient has been under my care for intermittent claudi- cation of both lower extremities for the past ten years. Her symptoms are typical of the disease and the case has been fully described in a previous paper.2 The left leg is more affected than the right and there are the characteristic painful cramps, paresthesias and rigidity on exertion which disappear after a brief period of rest. The femoral and popliteal arteries pulsate equally on the two sides; but the pulsation in the right dorsalis pedis is thread-like and is often not palpable, and there is only a feeble pulsation in the left posterior tibia 1. The left dorsalis pedis and the right posterior tibial show good strong pulsations. Since my original report there has been practically no change in the condition of the lower extremities. The patient, however, has developed symptoms of diabetes in a mild degree which are readily controlled by diet. The ninount of sugar varies from 0.3 to 1 per cent. Heart shows hypertrophy of left ventricle. Marked accentuation of aortic second sound. Systolic blood-pressure, 200 mm. General neurologic exam- ination is negative. Onset of Lumbar Symptoms.—In April, 1912, the patient first noticed pain in the lumbar region of the left side when very tired and after muscular exertion. This was described as an aching and throbbing sensation and it gradu- ally increased in severity and in frequency. It is strictly limited to the left side of the vertebral column, below the ribs and above the crest of the ilium. When very severe there is a tendency for the pain to extend somewhat laterally, but never beyond the midaxillary line. At times the pain is quite sharp and knife-like in character, or as if an iron claw were gripping her in the loin. There is also at times a bursting sensation. These subjective symptoms are accompanied by a distinct feeling of weakness in the left side of the lumbar region after prolonged muscular effort. She says that the muscles do not feel as if in cramp or spasm, but there is often a swollen sensation as if there were “something there like an abscess.” I have never been able, however, to make out any 2. Hunt. .1. Rnmsav : Intermittent Claudication and Allied Syn- dromes due to Angiosclerosls of the Extremities, Med. Rec., New York, May 27, 1905.