Leg Numbness and Pain with Low Blood Pressure: A Cardiovascular Perspective

Numbness and tingling in the legs accompanied by low blood pressure?

Hello Doctor, my father is 63 years old.
A year ago, he experienced numbness and tingling in his legs, and an orthopedic surgeon performed surgery for "lumbar disc nerve adhesion." However, his symptoms did not improve post-surgery; in fact, they worsened! The severity and extent of the numbness and tingling in his lower limbs increased, accompanied by low blood pressure (92 systolic / 58 diastolic / 92 heart rate) and orthostatic hypotension.
Within just six months, he became unable to walk! Currently, there is a dark purple appearance in the microvasculature of his legs, and the numbness and low blood pressure worsen when sitting or standing, while lying down alleviates the symptoms (the numbness persists 24 hours a day, making it impossible to sleep, with variations in severity based on position).
The hospital tests showed no signs of the three highs (hypertension, hyperglycemia, hyperlipidemia), but the LAMBDA LIGHT CHAIN levels were elevated.
I would like to ask the doctor if this could be related to lower limb venous thrombosis or cardiac valve insufficiency? Thank you.

JHD, 30~39 year old female. Ask Date: 2021/08/10

Dr. Li Han reply Cardiology

Hello, regarding your inquiry about your father's condition of having dark purple microvascular changes in his feet, experiencing tingling and exacerbated hypotension while sitting or standing, but relief of symptoms when lying down, could this be indicative of "lower extremity venous embolism or cardiac valve insufficiency?" Generally speaking, lower extremity venous diseases typically present with obstructed blood return, commonly resulting in lower limb edema, which tends to improve when the limbs are elevated, contrary to your father's symptoms.
However, there can be cases of deep vein thrombosis with subtle symptoms.
As for the possibility of orthostatic hypotension or cardiac valve insufficiency, further evaluation is needed.
I recommend consulting your attending physician or family doctor nearby, and if necessary, they can refer you to a specialist.
Best wishes from the Ministry of Health and Welfare Changhua Hospital.

Reply Date: 2021/08/10

More Info

Understanding leg numbness and pain, particularly in the context of low blood pressure, requires a comprehensive evaluation of various cardiovascular and neurological factors. Your father's symptoms, including persistent leg numbness and pain, low blood pressure, and the presence of dark purple discoloration in the lower extremities, suggest a complex interplay of vascular and possibly neurological issues.

Firstly, the low blood pressure readings (92/58 mmHg) and the mention of orthostatic hypotension (a drop in blood pressure upon standing) indicate that your father may be experiencing inadequate blood flow to the lower extremities. This can lead to symptoms such as numbness, tingling, and pain. The fact that symptoms improve when lying down suggests that gravity may be exacerbating the issue, potentially due to compromised venous return or arterial insufficiency.

The surgical history related to "intervertebral disc nerve adhesion" raises the possibility of nerve involvement. However, if the surgical intervention did not alleviate symptoms and they have worsened, it is essential to consider other underlying causes. Persistent numbness and pain could be indicative of nerve compression or irritation, possibly from adjacent structures or due to vascular insufficiency.

The presence of dark purple discoloration in the legs could suggest venous insufficiency or even venous thrombosis. In cases of venous thrombosis, blood clots can obstruct normal blood flow, leading to swelling, pain, and discoloration. While your father has been evaluated for common cardiovascular risk factors (the "three highs" - hypertension, hyperlipidemia, and diabetes), the elevated lambda light chain could indicate a plasma cell disorder or other hematological issues, which may also contribute to vascular problems.

To address your specific concerns regarding the possibility of deep vein thrombosis (DVT) or valvular heart disease, it is crucial to conduct further diagnostic tests. An ultrasound of the lower extremities can help assess for DVT, while echocardiography can evaluate heart valve function and detect any abnormalities that may contribute to low blood pressure and poor circulation.

In summary, your father's symptoms warrant a multidisciplinary approach. A thorough cardiovascular evaluation, including Doppler studies of the lower extremities and echocardiography, is essential to rule out venous obstruction and valvular heart disease. Additionally, a neurological assessment may be necessary to evaluate for any nerve-related issues that could be contributing to his symptoms. Given the complexity of his condition, it is advisable to consult with both a cardiologist and a neurologist to develop a comprehensive management plan tailored to his needs.

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