Intermittent Claudication

INTERMITTENT CLAUDICATION, claudicatio ischaemica, dysbasia, or dyskinesia angiosclerotica intermittens (French: claudication intermittente), intermittent lameness, intermittent claudication, a syndrome characterized by the fact that during walking, pains or paresthesias in the form of a feeling of tension, heaviness, numbness, or crawling sensations periodically appear in one or, less frequently, in both lower extremities; these sensations are very unpleasant, sometimes difficult to tolerate. When they appear, the patient has to stop for some time, and then all symptoms quickly pass, only to reappear when walking continues. This peculiar disease is caused by vascular spasms and was first noted in horses in 1831 by Boulay, and in 1857 Charcot described it in humans. The disease usually develops in old age; it occurs significantly more often in men than in women (due to smoking). Family cases have also been described. - The etiology of the disease is very diverse: auto-intoxication (diabetes, gout, etc.), acute and chronic infections, chronic intoxications (alcohol and especially nicotine). In advanced cases, productive or obliterating endarteritis may be observed in the vessels. - The pathogenesis of the disease comes down to vascular spasms (similar to what happens in cardiac anginal phenomena, in mesenteric angina, and in other angioneuroses). At rest, the blood supply to the muscles is sufficient, but during muscle work, the blood supply becomes insufficient, which causes the onset of attacks (ischemia). At the moment of an attack, the pulse of the dorsal artery of the foot, and sometimes of the tibial and popliteal arteries, cannot be felt; in more severe cases, the pulse in them may be absent even outside of attacks. Arteriosclerosis of the corresponding vessels contributes to the development of the disease, which is confirmed by X-ray studies; arteriosclerotically altered and narrowed arteries are sometimes visible on X-ray plates. Insufficient blood supply sometimes leads to trophic disorders in the form of ulcers on the fingers and foot or even to gangrene. The following three types of intermittent claudication are distinguished: 1) peripheral (Charcot), 2) spinal (Dejerine), 3) cerebral (Grasset). The peripheral type, according to Curschmann, is caused by congenital narrowness of the arterial system; Mendel believes that intermittent claudication can be caused by the following reasons: 1) congenital constitutional weakness of peripheral vessels, 2) neuropathic constitution (neurovascular diathesis), 3) congenital constitutional weakness of vessels in combination with neurovascular diathesis. Phenomena similar to intermittent claudication can also be observed in the upper extremities (vascular diseases, extra ribs, etc.), as well as in the tongue (Erb, Determann). - Spinal intermittent claudication is usually a precursor to spinal cord diseases, most often myelitis. It develops as a result of sclerosis of the arterioles supplying the gray matter centers of the spinal cord. Foerster described intermittent claudication in arteriosclerosis of the spinal cord roots. Paresthesias can also be caused by pathological processes in the brain - hemorrhages, softening, neoplasms, as well as circulatory disorders in atheromatosis, syphilis, etc. The development of the disease is usually chronic, but acute cases occur in infections (typhoid fever; Dejerine). - Usually, diagnosis of the disease does not present difficulties due to the characteristic signs of the disease - the periodic appearance of symptoms during walking and their absence at rest. This makes it possible to distinguish the disease from sciatica, Raynaud's disease, etc. - The prognosis is unfavorable in most cases, the disease usually progresses, sometimes leading to gangrene. - Treatment is diverse depending on the etiology and form. Spinal and cerebral forms are usually caused by arteriosclerosis or syphilis, so treatment should be directed along these lines. The peripheral form is treated causally and symptomatically. Smoking should be absolutely forbidden in all cases, as well as alcohol consumption. In case of metabolic disorders - appropriate diet. From medications, iodine, diuretin, aspirin, Natrium nitrosum, injections of 10% sodium chloride 1 cm³ are used. A number of authors have noted good results from the use of insulin due to its inhibitory effect on adrenal secretion. Schle-singer saw good results from nitroscleran. From physical therapy measures, light massage, radioactive, sulfuric, and carbon dioxide baths in appropriate resorts, hot foot baths, two-chamber baths, diathermy, etc. are recommended. Schle-singer speaks against the use of heat, as it can cause a paradoxical reaction of the vessels. In severe, advanced cases, it is sometimes necessary to resort to surgical intervention in the form of sympathectomy according to Leriche, and in case of gangrene - to amputation.