A C-fiber-mediated neuropathic brachioradial pruritus.
A 56-year-old man presented to the outpatient clinic with a 3-year history of itch within the innervation territory of C-6 of the left arm. Sudden neck movements induced intermittent paresthesias in the same dermatome. No dermatological diseases, allergies, or trauma to the affected extremity or the spine or a history of familial pruritus were reported. Neurological physical examination and electromyography revealed normal findings. Quantitative sensory testing demonstrated selective C-fiber dysfunction at C6-8 on the left, and cervical MR imaging revealed multilevel degenerative cervical spine pathology with neuroforaminal stenoses. Brachioradial neuropathic pruritus caused by cervical neuroforaminal stenosis was the final diagnosis. Treatment consisted of 2 cervical epidural steroid applications that resulted in clinical disappearance of the itch and improvement in C-fiber function on quantitative sensory testing.
De Ridder
Dirk
D
Brain Research Centre Antwerp for Innovative & Interdisciplinary Neuromodulation and Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium.
Hans
Guy
G
Pals
Philippe
P
Menovsky
Tomas
T
D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001132:Arm / Q000294:innervation*; D001917:Brachial Plexus / Q000503:physiopathology*; D020516:Brachial Plexus Neuropathies / Q000188:drug therapy / Q000503:physiopathology*; D002574:Cervical Vertebrae / Q000503:physiopathology; D004359:Drug Therapy, Combination; D006801:Humans; D007268:Injections, Epidural; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000503:physiopathology*; D036421:Nerve Fibers, Unmyelinated / Q000502:physiology*; D009460:Neurologic Examination; D010292:Paresthesia / Q000188:drug therapy / Q000503:physiopathology*; D011537:Pruritus / Q000188:drug therapy / Q000503:physiopathology*; D011826:Radial Nerve / Q000503:physiopathology*; D013130:Spinal Stenosis / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D008012:Lidocaine; D008775:Methylprednisolone