Intermittent claudication

Introduction Intermittent claudication refers to the patient's walking from the beginning, or after a long walk (usually hundreds of meters), unilateral or bilateral back pain, leg weakness, even numbness, but a little kneeling or sitting down After a while, the symptoms can be quickly relieved or disappeared, and the patient can continue to walk. After a while, the symptoms will reappear. Because in this process, limp is intermittent, it is called intermittent limp.

Cause

The occurrence of intermittent claudication is mainly due to the increased pathological load of the vertebral body and nerve roots due to the narrow pathology of the lumbar spinal canal, and the relaxation and contraction of the lower extremity muscles during walking further promotes the spinal canal Cortical physiologic congestion of the nerve roots of the corresponding spinal ganglia, followed by venous stasis and nerve root traction, the corresponding part of the microcirculation is blocked and the ischemic radiculitis occurs, resulting in waist and leg pain, lower limb numbness, weakness and other symptoms, When the patient is kneeling down, sitting down or lying down, the pressure load on the nerve root is reduced, the source of stimulation during muscle activity is eliminated, and the spinal cord and nerve root ischemia state is improved, so the symptoms are also reduced and disappeared. When walking again, the above symptoms reappeared, rested again, and the symptoms were relieved again. This repeated and alternated, forming intermittent claudication.

an examination

Related inspection

Brain CT examination

The most important diagnostic criteria is to observe the patient's symptoms first. The state of his walking can clearly show intermittent claudication; the second is to make a guess about the cause of the patient's symptoms, and to make relevant guesses such as X-rays. Examination of ultrasound, etc. If the lumbar spinal stenosis is found, it can be helpful for diagnosis. MRI is currently used as a screening method for screening patients with low back pain or sciatica.

Differential diagnosis

Lumbar spinal stenosis manifests as neurological intermittent claudication, which is different from vascular intermittent claudication (such as thromboangiitis obliterans). The differences are mainly as follows:

(1) The neurological intermittent claudication of the dorsal artery of the foot is good, and the vascular intermittent claudication of the dorsal artery is weakened or disappeared.

(2) Neurological intermittent claudication The lower extremity may have a segmental sensory disturbance, and the vascular intermittent crotch behavior is a sore-type sensory disturbance.

(3) The intermittent walking distance of the nerve is gradually shortened with the prolongation of the disease course, and the intermittent vascular claudication is not obvious.

(4) If necessary, angiographic examination is feasible, the neurological intermittent claudication arteries are good, and the intermittent vascular claudication can show the narrow region of the arterial cavity.

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