WE HAVE recently seen two youngsters whose presenting complaints were highly suggestive of spinal cord disease but whose lesions were far removed from this area. We believe this deserves emphasis.
The first patient was seen initially when he was 14½ years old, complaining of vague pains in his night knee and thigh. This pain was intermittent, slightly worse at night, but did not interfere with the patient's activities. Physical examination was entirely negative. There was no local tenderness, limitation of motion or limp. Roentgenograms of the knee, thigh and hip were interpreted as negative, and the patient was advised to limit activity temporarily.
Although he was subsequently seen for minor respiratory infections, there was no further mention of pain. Eighteen months later, the patient's mother called to say that she had just noticed that the right leg was thinner than the left.
When seen, however, the patient, now 16 years old, reported that pain in the leg had continued during the 18-month period. There was no specific localization of the pain; it was worse at night and responded to heat, massage and aspirin. He had pain occasionally during the day and had limped for the preceding several months. This however did not stop him from playing football and baseball. He reported further that he first became aware of the thinness of the right leg about 4 months previously but had not told anyone. Furthermore, he reported an 11-lb weight loss during this 4-month period.
On examination, there was marked atrophy of the entire right leg, as shown in Figure 1.
- Copyright © 1961 by the American Academy of Pediatrics