Martin Marziniak1, Ngoc Quan Phan2, Ulrike Raap3, Dorothee Siepmann2, Funda Schürmeyer-Horst2, Esther Pogatzki-Zahn4, Thomas Niederstadt5, Sonja Ständer6. 1. Department of Neurology, University Hospital Münster, Münster, Germany. 2. Competence Center Pruritus and Department of Dermatology, University Hospital Münster, Münster, Germany. 3. Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany. 4. Department of Anesthesiology and Intensive Care Medicine, University Hospital Münster, Münster, Germany. 5. Department of Clinical Radiology, University Hospital Münster, Münster, Germany. 6. Competence Center Pruritus and Department of Dermatology, University Hospital Münster, Münster, Germany. Electronic address: sonja.staender@uni-muenster.de.
Abstract
BACKGROUND: Brachioradial pruritus (BRP) describes a rare form of itching occurring at the dorsolateral part of the forearms. Recent case reports suggest that BRP may be attributed to cervical lesions or spine neoplasms. OBJECTIVE: We sought to determine the incidence of cervical spine changes in BRP and to correlate the localization of spinal lesions with the dermatomal presence of pruritus. METHODS: Magnetic resonance tomography (MRT) of the cervical spinal cord, a chest x-ray, and a skin biopsy were performed in 41 patients (28 female, 13 male; 59.0 ± 10.6 years) with BRP. Patients completed an itch questionnaire (NeuroDerm Questionnaire) that included a dermatome chart and the Northwick Park Neck Pain Questionnaire. RESULTS: The patients marked the locations C5 (90.2%) and C6 (100%) on the dermatome chart. All patients had detectable MRT changes. In 80.5% of the patients, stenosis of the intervertebral foramen or protrusions of the cervical disk led to nerve compression. The location of the nerve compression lesions correlated significantly with the dermatomal localization of the pruritus (Spearman correlation coefficient 0.893; P < .01). No spinal neoplasm was observed, and 19.5% of the patients had degenerative changes without significant correlation to the dermatomal localization of pruritus. LIMITATION: No healthy control group without pruritus was investigated. CONCLUSION: BRP may result from cervical nerve compression, and rarely, it may also stem from degenerative changes. Our findings suggest that even slight cervical changes detected on MRT may alter itch afferents and lead to BRP. Spinal cord tumors are rare and should be ruled out by a cervical spine MRT.
BACKGROUND: Brachioradial pruritus (BRP) describes a rare form of itching occurring at the dorsolateral part of the forearms. Recent case reports suggest that BRP may be attributed to cervical lesions or spine neoplasms. OBJECTIVE: We sought to determine the incidence of cervical spine changes in BRP and to correlate the localization of spinal lesions with the dermatomal presence of pruritus. METHODS: Magnetic resonance tomography (MRT) of the cervical spinal cord, a chest x-ray, and a skin biopsy were performed in 41 patients (28 female, 13 male; 59.0 ± 10.6 years) with BRP. Patients completed an itch questionnaire (NeuroDerm Questionnaire) that included a dermatome chart and the Northwick Park Neck Pain Questionnaire. RESULTS: The patients marked the locations C5 (90.2%) and C6 (100%) on the dermatome chart. All patients had detectable MRT changes. In 80.5% of the patients, stenosis of the intervertebral foramen or protrusions of the cervical disk led to nerve compression. The location of the nerve compression lesions correlated significantly with the dermatomal localization of the pruritus (Spearman correlation coefficient 0.893; P < .01). No spinal neoplasm was observed, and 19.5% of the patients had degenerative changes without significant correlation to the dermatomal localization of pruritus. LIMITATION: No healthy control group without pruritus was investigated. CONCLUSION: BRP may result from cervical nerve compression, and rarely, it may also stem from degenerative changes. Our findings suggest that even slight cervical changes detected on MRT may alter itch afferents and lead to BRP. Spinal cord tumors are rare and should be ruled out by a cervical spine MRT.
Authors: Ana Cecília Versiani Duarte Pinto; Patrick Alexander Wachholz; Paula Yoshiko Masuda; Antonio Carlos Ceribelli Martelli Journal: An Bras Dermatol Date: 2016 Jul-Aug Impact factor: 1.896