Intractable Pruritus After Traumatic Spinal Cord Injury

Abstract

Background: This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm. Method: Case report. Findings: Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture. Conclusions: Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective.

Brachioradial pruritus treated with computed tomography-guided cervical nerve root block: A case series

“… 6 Reports of cervical spine degenerative changes or spinal cord masses involving the symptomatic dermatome suggest that compressive neuropathy may play a role in disease pathogenesis. 7 , 8 , 9 BRP is likely a result of a complex combination of factors, 10 including light exposure, trauma, 11 and nerve injury. 12 …”

A Case Report of Refractory Notalgia Paresthetica Treated with Lidocaine Infusions

“…The patient described in our case exhibited evidence of mild spinal cord atrophy on magnetic resonance imaging at the thoracic level corresponding to the notalgia location. A spinal cord injury in association with neuropathic itch has been described previously [ 17 ] but attributing it as a cause of NP in our case remains speculative. Spinal cord atrophy does not explain why the pruritic patch is unilateral despite causing bilateral sublesional neuropathic pain.…”

Brachioradial Pruritus: Clinical, Electromyographic, and Cervical MRI Features in Nine Patients

“…While it is unclear whether cervical radiculopathy is the major causative factor in BRP [1,3,18,19], increased rates of cervical spine disease from C5-C8 have been described in BRP [3,4,9]. BRP has been reported in patients with cervical disc herniation, osteophytes, neural foraminal stenosis, spinal neoplasms such as ependymoma, post-traumatic syringomyelia, and following an incomplete traumatic cervical spinal cord injury (C6 motor and sensory level bilaterally) with C6-7 posterior instrumentation and fusion [1,14,[19][20][21][22]. In Marziniak et al's study of 41 patients with BRP, 33 (80.5%) patients had stenosis of the intervertebral foramen or protrusions of the cervical disc that led to nerve compression [19].…”