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Hi everyone,


I saw a patient last in the university clinic 2 days ago that left me slightly confused with her presenting symptoms. The patient is a 55 year old female with a 35 year history of smoking but has since weaned down to 1 cigarette a day, down from 20. She has no medical history and known allergies and not no drug history. She does not engage in physical exercise but is up and about throughout the day doing household chores etc

She presented with elongated nails with a sore and painful ingrown on the right hallux. She also complains of having really tired and dull ache in her lower limbs that makes her unable to walk more than 200m without taking a rest. Her skin on the lower limb feels really sensitive to touch and complains that it stings upon palpation. Her skin gets itchy and red at times. She also complains of having significant oedema 3 months back during a long haul flight to the US and that "her legs do not feel the same after then" as the ache start developing significantly then. At night, she experiences a tingling and aching sensation to her feet and it is relieved by hanging her leg off the edge of the bed. Right limb is more severe than left limb on all accounts.

Upon examination and assessment, there is hair and nail growth on both feet with skin temperature being warm and colour healthy pink. There were no haemosiderin, varicosities or oedema present bilaterally. DP and PT pulses were diminished. Dopper tracings of PT pulses show monophasic waveforms bilaterally. ABI undertaken had a value on 1.31 on the right and 1.18 on the left. We did not have time to undertake a neuroassessment as the patient had to leave for a meeting. We wrote a referral letter to her GP for further testing and assessment of suspected PVD.

What is your take on this? Is this an atypical presentation of PVD? Patient's presenting complains show strong indication of PVD but assessment findings, besides the monophasic dopper tracings indicate otherwise. ABI appears elevated. Could she possibly have diabetes that is not known. Appreciate your thoughts. Thanks.

 

Restless Leg Syndrome

 

Hi Craig,

Thanks for your reply. Is there something in her presenting symptoms that definitively indicates to you that it is likely to be restless leg syndrome? If so, what further steps can we take to manage this patient?

Thank you.

 

This:

See the advice in the thread I linked .... difficult to manage.