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Hernandez NS, Rogers JL, Pham MH. 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. Asian J Neurosurg 2024; 19:101-104. [PMID: 38751391 PMCID: PMC11093638 DOI: 10.1055/s-0043-1772760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Brachioradial pruritis (BRP) is a rare form of dermatomal pruritis that appears to be caused both by cervical radiculopathy and exposure to ultraviolet-light, although the exact pathophysiology for the manifestation of these symptoms remains to be determined. A diagnosis of BRP is typically confirmed with the "ice-pack" test and evidence of cervical spine pathology using magnetic resonance imaging. Treatment options consist of application of ice, reduction in sun exposure, and topical capsaicin, antiepileptics, or tricyclic antidepressants. Patients with refractory symptoms and cervical spine pathology may be candidates for surgical decompression, particularly at the C5 and C6 levels. However, there are currently no established guidelines to treat BRP, or surgical procedures that have shown to be superior. Here, we report two cases of cervical disc herniations after traumatic events that presented as BRP. Both cases were successfully treated with anterior cervical discectomy and fusion with complete resolution of symptoms.
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Affiliation(s)
| | | | - Martin H. Pham
- Address for correspondence Martin H. Pham, MD Assistant Professor of Neurological Surgery9300 Campus Point Drive, MC7893, La Jolla, CA 92037United States
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Shields LB, Iyer VG, Zhang YP, Shields CB. Brachioradial Pruritus: Clinical, Electromyographic, and Cervical MRI Features in Nine Patients. Cureus 2022; 14:e21811. [PMID: 35291549 PMCID: PMC8896843 DOI: 10.7759/cureus.21811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/05/2022] Open
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Disabling Pruritus in a Patient With Cervical Stenosis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:JAAOSGlobal-D-19-00178. [PMID: 32440634 PMCID: PMC7209791 DOI: 10.5435/jaaosglobal-d-19-00178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/11/2020] [Indexed: 11/18/2022]
Abstract
Brachioradial pruritus is a rare condition characterized by chronic localized itching of the dorsolateral upper extremities. Although the exact pathophysiology is still unknown, cervical nerve compression is thought to be a cause. We present the case of a 56-year-old man with a 6-year history of disabling chronic bilateral upper extremity pruritus and pain as well as concurrent neck pain. The patient presented to our office after multiple inconclusive diagnostic evaluations (dermatology, rheumatology, neurology, and psychiatry) and unsatisfactory multimodal conservative treatment attempts. His symptoms markedly impeded his ability to get restful sleep. Imaging of the cervical spine revealed multilevel cervical spondylosis, spinal stenosis with cord compression, and multilevel foraminal stenosis. The patient underwent successful multilevel anterior cervical decompression and fusion and was instantly symptom-free. The present case highlights that patients complaining of itching of the dorsolateral forearms of seemingly unknown etiology should undergo a workup of the cervical spine. If conservative treatment fails, surgical decompression may be considered in select patients.
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Weinberg BD, Amans M, Deviren S, Berger T, Shah V. Brachioradial pruritus treated with computed tomography-guided cervical nerve root block: A case series. JAAD Case Rep 2018; 4:640-644. [PMID: 30094306 PMCID: PMC6080634 DOI: 10.1016/j.jdcr.2018.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Brent D Weinberg
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Matthew Amans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Sibel Deviren
- Department of Orthopedics, University of California, San Francisco, California
| | - Timothy Berger
- Department of Dermatology, University of California, San Francisco, California
| | - Vinil Shah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
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Wachholz PA, Masuda PY, Pinto ACVD, Martelli ACC. Impact of drug therapy on brachioradial pruritus. An Bras Dermatol 2017; 92:281-282. [PMID: 28538902 PMCID: PMC5429128 DOI: 10.1590/abd1806-4841.20175321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/01/2016] [Indexed: 12/03/2022] Open
Abstract
Few studies have described therapeutic options in brachioradial pruritus. We
describe a cross-sectional study of brachioradial pruritus patients treated in
an outpatient unit. We reviewed medical records and interviewed brachioradial
pruritus patients without indication for decompressive surgery, in order to
access the perceptions of intensity of pruritus prior to treatment and response
to therapy. We found that antidepressants and anticonvulsants were the most
frequently prescribed drugs. Best reductions in pruritus were associated with
its highest intensities prior to treatment, and with longer periods of
therapy.
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Affiliation(s)
- Patrick Alexander Wachholz
- Department of Public Health, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) - São Paulo (SP), Brazil
| | - Paula Yoshiko Masuda
- Department of Dermatology, Instituto Lauro de Souza Lima (ILSL) - Bauru (SP), Brazil
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Atış G, Bilir Kaya B. Pregabalin treatment of three cases with brachioradial pruritus. Dermatol Ther 2017; 30. [DOI: 10.1111/dth.12459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/26/2016] [Accepted: 11/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Güldehan Atış
- Department of Dermatology; Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Başak Bilir Kaya
- Department of Physical Medicine and Rehabilitation; Dr. Siyami Ersek Thorax and Cardiaovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Sheu SL, Wang KC. Pruritus and Dermatitis in the Elderly. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ward RE, Veerula VL, Ezra N, Travers JB, Mousdicas N. Multilevel symmetric neuropathic pruritus (MSNP) presenting as recalcitrant “generalized” pruritus. J Am Acad Dermatol 2016; 75:774-781. [DOI: 10.1016/j.jaad.2016.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 05/11/2016] [Accepted: 05/19/2016] [Indexed: 11/29/2022]
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Skelton F, Frontera JE. Brachioradial Pruritus as a Harbinger of Syrinx in Chronic Spinal Cord Injury: A Case Report. PM R 2016; 9:311-313. [DOI: 10.1016/j.pmrj.2016.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 08/03/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
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Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease. J Am Acad Dermatol 2016; 74:215-28; quiz 229-30. [DOI: 10.1016/j.jaad.2015.04.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/06/2015] [Accepted: 04/22/2015] [Indexed: 02/01/2023]
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Halvorsen JA, Ørstavik K. En kvinne i 60-årene med kløe på armene. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1459-61. [DOI: 10.4045/tidsskr.15.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Prurit brachioradial révélant un astrocytome médullaire cervical et traité par patchs de capsaïcine à 8 %. Ann Dermatol Venereol 2014; 141:374-5. [DOI: 10.1016/j.annder.2014.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 12/29/2013] [Accepted: 01/10/2014] [Indexed: 11/21/2022]
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Lucaciu OC, Connell GP. Itch sensation through transient receptor potential channels: a systematic review and relevance to manual therapy. J Manipulative Physiol Ther 2014; 36:385-93. [PMID: 23896168 DOI: 10.1016/j.jmpt.2013.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 12/14/2012] [Accepted: 12/27/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Patients may present with a complaint of "itchiness" or an "odd sensation" that can be relieved by manual therapy treatment options, which demonstrates the relevance of transient receptor potential (TRP) channels. There are studies that identify the role of various TRP channels as modulators of the itch sensation; however, discrepancies in the literature exist with respect to the overall neural pathway of the itch sensation, musculoskeletal implications, and decisive therapeutic implications. The purpose of this study was to review the literature and rate the quality of published articles regarding the role of TRP channels in the itch sensation. METHODS A systematic search of relevant literature that was published in English by a peer-reviewed journal between January 2000 and June 2012 was performed in PubMed. Studies that met the predetermined inclusion criteria regarding the relationship between TRP channels and itch were identified and then evaluated for methodological quality by the Downs and Black Quality Index score system and were summarized. RESULTS Nine studies were identified that met the inclusion criteria, all of which had fair methodological quality from the perspective of the modified Downs and Black Quality Index. TRPA1, TRPM8, and TRPV1-4 were indicated as key channels responsible for the transmission of the itch sensation. TRPV1 channels convey histamine-dependent itch, and TRPA1 channels convey histamine-independent itch. Temperature, nerve growth factor, and substance-P were also described as important itch modulators. There are similarities between the neural pathways responsible for itch, pain, and temperature, which explain the ability of noxious temperature to suppress the desire to scratch. Although transcutaneous electrical nerve stimulation, innocuous vibration, and cutaneous field stimulation have demonstrated relatively weak attenuation of itch, the use of topical capsaicin, noxious heat, and noxious cold have been demonstrated as effective therapies. CONCLUSIONS The findings of this review show that studies have assessed the function of TRP channels and itch, rather than identifying the relationship between itch and effective noninvasive treatment options. Therefore, TRP channels could serve as important, complex clinical targets for manual therapists.
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Affiliation(s)
- Octavian C Lucaciu
- Department of Anatomy, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
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Mirzoyev S, Davis M. Brachioradial pruritus: Mayo Clinic experience over the past decade. Br J Dermatol 2013; 169:1007-15. [DOI: 10.1111/bjd.12483] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S.A. Mirzoyev
- Mayo Medical School; Mayo Clinic; 200 First Street SW Rochester MN 55905 U.S.A
| | - M.D.P. Davis
- Department of Dermatology; Mayo Clinic; 200 First Street SW Rochester MN 55905 U.S.A
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Masuda PY, Martelli ACC, Wachholz PA, Akumatsu HT, Martins ALGP, Silva NM. Brachioradial pruritus -- descriptive analysis of Brazilian case series. J Dtsch Dermatol Ges 2013; 11:530-5. [PMID: 23280069 DOI: 10.1111/ddg.12009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/30/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND The epidemiology and clinical features of brachioradial pruritus are variably described in the literature. We sought to analyze these features in a large group of Brazilian patients. PATIENTS AND METHODS In a descriptive, observational study, we identified all patients with a final diagnosis of brachioradial pruritus seen over a one-year period and re-trospectively reviewed their records. The diagnosis was made after clinical-laboratory investigation had ruled out other causes of chronic pruritus. Demographic and clinical variables were collected along with pruritus characteristics, and analyzed using des-criptive statistics. RESULTS Forty-three patients were identified; their mean age was 55.9 years, with predominance of women (81.4%) and Caucasians (86%). In 52%, the pruritus worsened with heat and sun exposure; 58.1% had intermittent complaints; the ice-pack sign was present only in 20.9%. The arms involving dermatomes C5-C6-C7-C8 (62.8%) were the most affected sites, while psychoactive drugs were the most frequently prescribed therapy. CONCLUSIONS Although uncommon, brachioradial pruritus should not be neglected in dermatological diagnosis. This case series analysis indicated that Brazilian patients from a tropical climate show characteristics similar to those described in other series from more temperate regions.
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Affiliation(s)
- Paula Y Masuda
- Dermatology Service of Instituto Lauro de Souza Lima, Brazil
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Beuscher L, Reeves G. Brachioradial Pruritus: Approach to the Patient With Enigmatic Forearm Pruritus. J Nurse Pract 2012. [DOI: 10.1016/j.nurpra.2012.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marchalik D, Lipsky A, Petrov D, Harvell JD, Milgraum SS. Dermatologic Presentations of Orthopedic Pathologies. Am J Clin Dermatol 2012; 13:293-310. [DOI: 10.2165/11595880-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Brachioradial pruritus as a result of cervical spine pathology: The results of a magnetic resonance tomography study. J Am Acad Dermatol 2011; 65:756-762. [DOI: 10.1016/j.jaad.2010.07.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 07/15/2010] [Accepted: 07/22/2010] [Indexed: 11/18/2022]
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Ko JH, Shih PY, Huang YH. Brachioradial pruritus in a young man presenting with transverse myelitis. DERMATOL SIN 2010. [DOI: 10.1016/s1027-8117(10)60026-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Pruritus remains a significant problem facing dermatologists and can be associated with various dermatoses and systemic derangements. At times, one can treat the underlying cutaneous or systemic process to alleviate itch. However, it is frequently challenging to identify the cause of a patient's itch and, in this situation, even more difficult to manage the symptom effectively. In this article, the authors discuss the approach to a patient with generalized pruritus without clinically obvious dermatoses. They also addresses mechanisms and management modalities of itch in common systemic diseases, including cholestasis, uremia, and neuropathic dysfunction.
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Affiliation(s)
- Jamison D Feramisco
- Department of Dermatology, University of California at San Francisco, 1701 Divisadero Street, 3rd floor, San Francisco, CA 94115, USA
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De Ridder D, Hans G, Pals P, Menovsky T. A C-fiber-mediated neuropathic brachioradial pruritus. J Neurosurg 2010; 113:118-21. [PMID: 19817537 DOI: 10.3171/2009.9.jns09620] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Dirk De Ridder
- Brain Research Centre Antwerp for Innovative & Interdisciplinary Neuromodulation and Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium
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Binder A, Koroschetz J, Baron R. Disease mechanisms in neuropathic itch. ACTA ACUST UNITED AC 2008; 4:329-37. [PMID: 18461071 DOI: 10.1038/ncpneuro0806] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 03/04/2008] [Indexed: 12/26/2022]
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