Intractable pruritus after traumatic spinal cord injury.
BACKGROUND
This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm.


METHODS
Case report.


RESULTS
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.
Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195-6490, USA. dacrane@u.washington.edu
Deborah A
DA
Crane
Kenneth M
KM
Jaffee
Anjana
A
Kundu
D000293:Adolescent; D005260:Female; D005542:Forearm / Q000503:physiopathology; D006801:Humans; D011537:Pruritus / Q000209:etiology* / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000628:therapy