A case of neuropathic brachioradial pruritus caused by cervical disc herniation

Abstract

Background A 64-year-old woman presented to an outpatient clinic with a 2-year history of itch, burning sensation and intermittent paresthesias within the innervation territory of the sixth cervical nerve root on the right dorsal forearm. No dermatological diseases, trauma to the affected extremity or the spine, or familial pruritus were reported.

Investigations Dermatological examination, skin biopsy, laser Doppler imaging, neurological physical examination and cervical MRI scan.

Diagnosis Brachioradial pruritus caused by cervical disc herniation.

Management Ventral spinal fusion with cage implantation.

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Figure 1: Laser Doppler images of the affected right forearm in a patient with brachioradial pruritus.
Figure 2: MRI scan of the cervical spine in a patient with brachioradial pruritus.

References

  1. 1

    Rolke R et al. (2006) Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 123: 231–243

    CAS  Article  Google Scholar 

  2. 2

    Waisman M (1968) Solar pruritus of the elbows (brachioradial summer pruritus). Arch Dermatol 98: 481–485

    CAS  Article  Google Scholar 

  3. 3

    Goodkin R et al. (2003) Brachioradial pruritus: cervical spine disease and neurogenic/neuropathic pruritus. J Am Acad Dermatol 48: 521–524

    Article  Google Scholar 

  4. 4

    Wallengren J et al. (2005) Neuroanatomy and neurophysiology of itch. Dermatol Ther 18: 292–303

    Article  Google Scholar 

  5. 5

    Walcyk PJ et al. (1986) Brachioradial pruritus: a tropical dermopathy. Br J Dermatol 115: 177–180

    CAS  Article  Google Scholar 

  6. 6

    Knight TE et al. (1994) Solar (brachioradial) pruritus—response to capsaicin cream. Int J Dermatol 33: 206–209

    CAS  Article  Google Scholar 

  7. 7

    Kavak A and Dosoglu M (2002) Can a spinal cord tumor cause brachioradial pruritus? J Am Acad Dermatol 46: 437–440

    Article  Google Scholar 

  8. 8

    Cohen AD et al. (2003) Brachioradial pruritus: a symptom of neuropathy. J Am Acad Dermatol 48: 825–828

    Article  Google Scholar 

  9. 9

    Wallengren J and Sundler F (2005) Brachioradial pruritus is associated with a reduction in cutaneous innervation that normalizes during the symptom-free remissions. J Am Acad Dermatol 52: 142–145

    Article  Google Scholar 

  10. 10

    Wallengren J and Sundler F (2004) Phototherapy induces loss of epidermal and dermal nerve fibers. Acta Derm Venereol 84: 111–115

    CAS  Article  Google Scholar 

  11. 11

    Bernhard JD and Bordeaux JS (2005) Medical pearl: the ice-pack sign in brachioradial pruritus. J Am Acad Dermatol 52: 1073

    Article  Google Scholar 

  12. 12

    Wallengren J and Dahlbäck K (2005) Familial brachioradial pruritus. Br J Dermatol 153: 1016–1018

    CAS  Article  Google Scholar 

  13. 13

    Savk E et al. (2001) Open pilot study on oxcarbazepine for the treatment of notalgia paresthetica. J Am Acad Dermatol 45: 630–632

    CAS  Article  Google Scholar 

  14. 14

    Crevits L (2006) Brachioradial pruritus—a peculiar neuropathic disorder. Clin Neurol Neurosurg 108: 803–805

    CAS  Article  Google Scholar 

  15. 15

    Bueller HA et al. (1999) Gabapentin treatment for brachioradial pruritus. J Eur Acad Dermatol Venereol 13: 227–228

    CAS  Article  Google Scholar 

  16. 16

    Winhoven SM et al. (2004) Brachioradial pruritus: response to treatment with gabapentin. Br J Dermatol 150: 786–787

    CAS  Article  Google Scholar 

  17. 17

    Baron R (2006) Mechanisms of disease: neuropathic pain—a clinical perspective. Nat Clin Pract Neurol 2: 95–106

    Article  Google Scholar 

Download references

Acknowledgements

A Binder, J Koroschetz, M Stengel and R Baron were supported by the Federal Ministry of Education and Research, the German Research Network on Neuropathic Pain (grant 01 EM 0504) and an unrestricted educational grant from Pfizer, Germany. Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Correspondence to Andreas Binder.

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Competing interests

A Binder has received honoraria from Pfizer, Allergan and Grünenthal. R Baron has acted as a consultant and received honoraria and grant support from Genzyme, Grünenthal and Pfizer, and has acted as a consultant and received honoraria from Allergan, Medtronic, Mundipharma and Sanofi Pasteur MSD. The other authors declared no competing interests.

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Binder, A., Fölster-Holst, R., Sahan, G. et al. A case of neuropathic brachioradial pruritus caused by cervical disc herniation. Nat Rev Neurol 4, 338–342 (2008). https://doi.org/10.1038/ncpneuro0807

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