Back to Journals » Vascular Health and Risk Management » Volume 8

Lift the quilt in case of atrial fibrillation and disc prolapse

Authors Bastovansky A, Ziegler K, Stöllberger C, Finsterer J

Received 23 February 2012

Accepted for publication 9 March 2012

Published 22 June 2012 Volume 2012:8 Pages 389—392

DOI https://doi.org/10.2147/VHRM.S31156

Review by Single-blind

Peer reviewer comments 2

Adam Bastovansky,1 Kathrin Ziegler,2 Claudia Stöllberger,2 Josef Finsterer3

1Department of Radiology, 2Medical Department, Krankenanstalt Rudolfstiftung, Vienna, Austria; 3Danube University Krems, Krems, Austria

Background: Peripheral embolism to the lower extremities may mimic disc prolapse with severe consequences.
Case report:  A 71-year-old male with a history of chronic alcoholism developed low back pain radiating to both lower extremities in a nonradicular distribution and bilateral dysesthesias of the distal lower legs after lifting a heavy weight. Given that magnetic resonance imaging (MRI) of the lumbar spine showed disc herniation in L3/4 and L4/5, he was scheduled for laminectomy but was unable to undergo surgery due to thrombocytopenia. After transfer to another hospital, persistence of symptoms and signs, absent pulses on the distal lower legs, and rhabdomyolysis with temporary renal insufficiency, peripheral embolism with compartment syndrome was suspected. Magnetic resonance angiography revealed occlusion of the right superficial femoral artery and long high-grade stenosis of the left superficial and profound femoral arteries and distal arteries. He successfully underwent embolectomy and fasciotomy.
Conclusions: If lumbar pain is not radicular, peripheral pulses are minimally palpable, and distal limbs are cold and show livid decolorization, peripheral embolism is much more likely than disc herniation, particularly if the patient's history is positive for atrial fibrillation. MRI of the lumbar spine must be interpreted in conjunction with clinical presentation.

Keywords: embolism, compartment syndrome, neurosurgery, embolectomy, fasciotomy, rhabdomyolysis

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Readers of this article also read:

The neutrophil to lymphocyte ratio is associated with severity of rheumatic mitral valve stenosis

Baysal E, Burak C, Cay S, Aksu T, Altıntaş B, Yaylak B, Sevük U, Bilge Ö

Journal of Blood Medicine 2015, 6:151-156

Published Date: 13 May 2015

Acquired hemophilia A: emerging treatment options

Janbain M, Leissinger CA, Kruse-Jarres R

Journal of Blood Medicine 2015, 6:143-150

Published Date: 8 May 2015

Attention-deficit/hyperactivity disorder in postsecondary students

Nugent K, Smart W

Neuropsychiatric Disease and Treatment 2014, 10:1781-1791

Published Date: 26 September 2014

Dissociative symptoms reflect levels of tumor necrosis factor alpha in patients with unipolar depression

Bizik G, Bob P, Raboch J, Pavlat J, Uhrova J, Benakova H, Zima T

Neuropsychiatric Disease and Treatment 2014, 10:675-679

Published Date: 25 April 2014

Limitations of real-world treatment with atorvastatin monotherapy for lowering LDL-C in high-risk cardiovascular patients in the US

Marrett E, Zhao C, Zhang NJ, Zhang Q, Ramey DR, Tomassini JE, Tershakovec AM, Neff DR

Vascular Health and Risk Management 2014, 10:237-246

Published Date: 25 April 2014

Blood pressure and blood viscosity are not correlated in normal healthy subjects

Salazar Vázquez BY

Vascular Health and Risk Management 2012, 8:1-6

Published Date: 30 December 2011

Does plasmin have anticoagulant activity?

Jane Hoover-Plow

Vascular Health and Risk Management 2010, 6:199-205

Published Date: 26 March 2010