Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome

Abstract

Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-yearold woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries.

Treatment of Brachioradial Pruritus: A Systematic Review

“…5,18 Historically, topical steroids such as hydrocortisone, triamcinolone, and fluocinonide have been tried for BRP without much success. 1,5,6,15,16,19,20 The use of topical steroids, doxepin cream, and local anesthetics has been described in one retrospective study. Of patients treated with topical steroids (n=22), 18% noted complete resolution of symptoms and 27% reported improvement.…”

“…The most commonly cited oral medication for BRP treatment is gabapentin with eight articles (three retrospective studies, one case series, four case reports; n=26) reporting on gabapentin efficacy. 4,5,10,19,[21][22][23][24] Effective doses range from 300 mg once daily to six times daily. 19,[21][22][23] However, side effects such as sedation and gastrointestinal upset may limit the upper limit of dosing in some patients.…”

Brachioradial Pruritus Caused by Cervical Disc Herniation Precipitated by Trauma Treated with Anterior Cervical Discectomy and Fusion: Report of Two Cases and Review of the Literature

“…A case of BRP has been described in a patient suffering simultaneously from cervical disc herniation and Parsonage-Turner syndrome, raising the question of the particular mechanism that activates neuropathic itch in BRP. 6 However, cervical canal stenosis, foraminal stenosis, and disc protrusion or herniation remain to be the strongest clinical and anatomic correlates to BRP.…”

“…[1][2][3][4] Binder published a seminal report on a case of neuropathic BRP caused by cervical disc herniation, 5 with several groups since publishing similar case reports. [6][7][8] Treatment of BRP includes ice application, physical therapy, topical corticosteroids, oral antihistamines, and antiepileptics. [9][10][11] In rare cases, surgical management of BRP is considered.…”