Title: Leriche Syndrome –A Case with an Unusual Presentation

Authors: Harharpreet Kaur, Richa Verma, Kiranjit Kaur, Navneet Singh

 DOI: https://dx.doi.org/10.18535/jmscr/v7i6.43

Abstract

Leriche syndrome is caused by an atherosclerotic occlusion of the aortoiliac arteries which produces vascular insufficiency in the pelvic region .This can produce ischemia of neural structures with symptoms of neuropathy causing the diagnosis to be overlooked especially in diabetics .Our patient was a 61 year old diabetic whose presenting  symptoms were acute pain and  paresthesias in the back which  radiated down the right lower limb and suggestive of a degenerative disc disease. The patient did not recover with the conventional treatment for the same and was reviewed. The symptoms appeared on walking and subsided on rest. This history prompted a complete vascular evaluation which established the diagnosis. The pain due to the disc disease takes time to heal but our patient made an unexpectedly rapid recovery after medical measures to improve circulation were instituted. Presumably the oxygen tension in the nerve trunk was lowered during exercise as a simultaneous increase in the blood supply through the vasa nervorum was prevented due to the aortoilliac disease. The extensive collaterals help in normalizing life in some cases as ours who sought medical help only when the radiculopathy due to a relatively mild disc disease was precipitated by the compromised circulation.

Keywords: Leriche syndrome; Radiculopathy.

References

  1. Leriche, R; Morel, A (February 1948). "The Syndrome of Thrombotic Obliteration of the Aortic Bifurcation". Annals of Surgery. 127 (2): 193–206.
  2. Parke WW, Watanabe R. The Intrinsic vasculature of the lumbosacral spinal nerve roots. Spine 1985; 10:508-515
  3. Evans JG. Neurogenic intermittent claudication. Brit. med. J., 1964, 2, 985-987
  4. Blau, J. N., and Logue, V. (1961). Lancet, 1, 1081
  5. Akhaddar A, Eljebbouri B, Saouab R, Boucetta M. Acute paraplegia revealing Leriche syndrome. Intern Med. 2012;51:981–982
  6. Yoon DH, Cho H, Seol SJ, Kim T.Right Calf Claudication Revealing Leriche Syndrome Presenting as Right Sciatic Neuropathy Ann 2014.Rehabil Medv 38(1);
  7. Wang YC, Chiu YS, Yeh CH. Leriche's syndrome presenting as sciatica. Ann Vasc Surg. 2010;24:694.e1–694.e3
  8. Victor G. Dewolfe, Fay A.et al Intermittent Claudication of the Hip and the Syndrome of Chronic Aorto-Iliac Thrombosis; Circulation 1954; no 1

Corresponding Author

Dr Harharpreet Kaur

Professor Medicine, MM Medical College, Kumarhatti, Distt. Solan, Himachal Pradesh, India