The lumbar type of intermittent claudication / by J. Ramsay Hunt.

  • Hunt, James Ramsay, 1872-1937.
Date:
1912
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Licence: In copyright

Credit: The lumbar type of intermittent claudication / by 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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    vessels and diminishes the flow of blood to the parts, with a result- ing ischemia, which is the direct cause of the symptoms. The two chief factors, angiosclerosis and angioneurosis, are therefore usually combined, although Oppenheim recognizes a benign, purely functional type due to vascular spasm. Once the symptom complex was established in the lower ex- tremity (leg type), it was but natural that other groups of cases should be differentiated and described as special types, correspond- ing to different portions of the arterial tree. Oppenheim3 called attention to its occurrence in the upper extremity (arm type), and not a few cases of this kind have been described. In one case, in which both legs and an arm were affected, the tongue was similarly involved (Determann4). Of great clinical importance are the various visceral types of the disease, such as occur with lesions of the coronary artery (angina pectoris of Potain) and of the mesenteric arteries (Ortner5). It has also been observed in the central artery of the retina (Rosenfeld6). Such a case has come under my own observation, in which the arterial spasm and resulting pallor could be seen with the ophthalmoscope. The condition is by no means infrequent in the cerebral arteries, often as a symptom and precursor of thrombosis. Dejerine7 has recently given a graphic picture of intermittent claudication of the vessels of the spinal cord, with pain, weakness, and paresthesia? of the lower extremities coming on during exertion and accom- panied by exaggerated tendon reflexes, ankle clonus, and the Babinski reflex, all symptoms objective as well as subjective disappearing during rest. The Lumbar Type of Intermittent Claudication. The type to which I desire to call attention may from its location in the lower portion of the back be termed the lumbar type of intermittent claudication. The nature of the symptoms and their intermittent character, occurring regularly during activity, ceasing always after a short rest, would exclude all other organic conditions save one of vascular origin. It may be that some of the painful backs occurring in and after middle life, and regarded usually as rheumatic, may have a similar origin, cases in which the intermittent character of the symptoms is less clearly defined than the one which has come under my observation. Case Report. Mr. M. G., aged fifty-one years, unmarried, a stockbroker by occupation, was referred to me from the Roosevelt Hospital in November, 1910. He is American born and has always lived in New York. For many years he has indulged exces- * Deut. Zcit. f. Nervenheilkunde, 1900, Band xvii. * Wien. klin. Woch., 1906. 7 Rev. Neurologique, 1906, No. 8. « Ibid., 1907, Band xcii, S. 154. • Deut. med. Woch., 1906.