ERNEST-CHARLES LASÈGUE
Ernest-Charles Lasègue (5 September,1816 – 20 March,1883) ([Figure 1 ]) was a French physician, epidemiologist, internist, neurologist, and psychiatrist
at the Hçpital Pitié-Salpêtrière in Paris[1 ],[2 ],[3 ].
Figure 1 Ernest-Charles Lasègue.Source: http://psychiatrie.histoire.free.fr/pers/bio/lasegue.htm
The young Lasègue showed an extraordinary intelligence, although he was considered
an irremediable student. He was interested in philosophy and rhetoric, spoke fluent
Latin, and translated Greek texts. He received his doctoral degree in 1846. After
obtaining his agrégation in 1853, he prospered and became one of the most brilliant physicians of the 19th century, known as “the universal specialist”[1 ].
Lasègue wrote about vertigo, epilepsy, general paralysis, catalepsy, migraine and
onanism, among other subjects, publishing a total of 115 articles. In 1876, he was
elected member of the Academy of Medicine. He passed away at the age of 66 from diabetes[4 ].
Lasègue has traditionally been considered the mastermind behind the test that bears
his name. In the wards of l’Hçpital de la Pitié-Salpêtrière, he would perform the straight leg raise test routinely, emphasizing to his pupils
its diagnostic significance as a sign constantly present in sciatica. However, Lasègue
never published a word about this sign[3 ]. The description was given to him by his pupil J.J. Forst, in his doctoral thesis
Contribuition a l’êtude Clinique de la Sciatique. Thèse pour le Doctorat en Médecine,
Paris; Faculté de Médecine de Paris, 1881
[5 ]. This work clearly explains the examination technique. The patient lies in the supine
position, and the involved lower extremity is raised with the knee extended. The maneuver
is repeated, with the leg flexed on the knee while the thigh is flexed on the pelvis
([Figure 2A ] and [B ]). The sign is present if the first maneuver evokes sciatic pain and the second does
not.
Figure 2 First maneuver; elevation with straight leg (A). Second maneuver, the control test.
The leg is flexed on the thigh (B)[5 ].
Robert Wartenberg, one of the most vehement critics of the untruthful authorship of
medical articles, wrote in 1941: “Since Lasègue described this phenomenon in 1861,
many modifications of his maneuver have been introduced”[6 ]. Remarkably, he later lurched to the contrary, considering that “it is highly embarrassing
to state the plain fact that all authors who quoted Lasègue’s article of 1864 as a
source of Lasègue’s sign did not read the article”[1 ].
Some authors believe that a possible source of the uncertainty concerning Lasègue
and the famous sciatica sign is his article entitled Considérations sur la Sciatique , published in Archives Générales de Médecine (1864)[7 ]. Since this piece became a classic, it was natural that all and sundry would promptly
assume, without questioning, that Lasègue discovered this renowned sign.
Forst and Lasègue mistakenly concluded that the sharp pain produced by raising the
involved lower extremity with the knee extended was due to muscle mass compression
of the sciatic nerve.
“… the sensation of pulling is very probably due to compression of the sciatic nerve
by muscular contraction. …We consider this sign to be pathognomonic of sciatica, for
we have not found it in any other affliction of that region.”[5 ]
LAZAR K. LAZAREVIĆ
Lazar K. Lazarević (13 May,1851 – 10 January,1891) was born in Šabac, a city in the
administrative center of the Mačva District, western Serbia.
Lazarević ([Figure 3 ]) was a physician, scientist, writer, and translator in the field of Neurology. After
completing high school in 1867, he entered law school, during which time he realized
Medicine was his true passion[8 ]. He traveled to Berlin in 1872 to study Medicine but returned to Serbia during the
Serbian-Turkish war (1876-1877) and was awarded the medal of devotion to service[9 ]. He returned to Berlin after the war to continue his education, obtained his PhD,
and eventually came back to Serbia.
Figure 3 Lazar K. Lazarević.Source: http://wannabemagazine.com/srecan-rodendan-laza-lazarevic/
He dedicated his short professional life (11 years of medical and literary work from
1879 to 1890), to reforming Serbian Medicine and became one of the most distinguished
medical scientists of his time. Lazarević published 72 articles in national and international
journals, many of them about neurological diseases.
In the article Ischiac postica cotunnii: one contribution to its differential diagnosis , first published in Serbian in the Serbian Archives of Medicine in 1880, and republished in German in 1884, based on six patients from his medical
practice, Lazarević correctly considered that stretching the sciatic nerve was the
cause of pain during the straight leg raising test. He died prematurely from tuberculosis
in 1891[9 ].
In 1884, based on experiments on a cadaver, Lucien de Beurmann elegantly suggested
that the real cause of the famous signal is the stretching of the sciatic nerve itself
rather than a sciatic muscular compression[10 ]. He exposed the trunk of the sciatic nerve on the posterior aspect of the thigh
between the biceps femorus and semitendinosus muscles. Part of the nerve was resected
and replaced by a rubber tube of the same length. He observed that, on performing
the straight leg raise, the length of the rubber tube increased from 11 cm to 18 cm
by maximal flexion of the straight leg toward the pelvis. Modern neuroimaging suggests
that displacement of the medulla and conus medullaris can play a role in this sign[11 ]. Apart from the pure mechanical effect, sensitization at the dorsal root ganglion
and posterior horn secondary to the nerve compression lowers the pain threshold[12 ].
Since the original publication in 1880, several modifications of the classic maneuver
have been introduced to improve the test performance, including additional dorsiflexion,
supination of the foot, dorsiflexion of the big toe, and adduction with inward rotation
of the leg[6 ]. A false sign frequently observed in malingerers may be detected by having the patient
lying prone with the affected leg close and parallel to the edge of the bed. If the
leg drops, there is stretching of the sciatic nerve and consequent pain, which is
absent in the faux cases[2 ]. The crossed straight leg raising test may be more reliable for disc protrusion
as it indicates more severe compression and centrally located prolapse[13 ].
The Lazarević-Lasègue sign, also known as the Lasègue test, Lazarević’s sign, or straight
leg raise test, has been used extensively in the evaluation of patients with sciatica.
Next to the Babinski and Romberg signs, the Lazarević-Lasègue remains one of the most
popular and relevant signs in Neurology[1 ].
