[Clinical thinking and decision-making in practice. A nurse with low back pain radiating to both legs].
A 50-year-old nurse with chronic back pain developed painful paraesthesia in the legs and saddle region during walking. Because pain in the legs could not be provoked by standing erect, the orthotic-lordotic cauda syndrome or neurogenic intermittent claudication (spinal canal stenosis) became unlikely and vascular intermittent claudication likely. The femoral pulses were absent. Angiography showed severe stenosis of the distal aorta which was successfully treated by percutaneous transluminal angioplasty.
Hoogenraad
T U
TU
Afd. Neurologie, Academisch Ziekenhuis, Utrecht.
Mastenbroek
G G
GG
van Reedt Dortland
R W
RW
D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000175:diagnosis* / Q000628:therapy; D002420:Cauda Equina; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis; D017116:Low Back Pain / Q000209:etiology*; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis; D010292:Paresthesia / Q000209:etiology*; D011128:Polyradiculopathy / Q000209:etiology; D011187:Posture / Q000502:physiology
Klinisch denken en beslissen in de praktijk. Een verpleegster met pijn onder in de rug uitstralend in beide benen.