Unilateral neurogenic pruritus: Paroxysmal itching associated with central nervous system lesions
Although pruritus has been associated with spinal cord lesions, to our knowledge there are no reports of lesions rostral to the brainstem associated with pruritus and altered pain perception. We present such a case. This patient presented several months after surgical treatment of her basilar artery aneurysm with a chief symptom of pruritus. Her skin showed excoriations and the papulonodular lesions of prurigo. These are secondary cutaneous lesions, in this case due to scratching, as opposed to spontaneously arising primary lesions. This type of pruritus without a primary cutaneous eruption usually should lead to a differential diagnosis of possible underlying medical disorders. In this patient, the unilateral pruritus associated with contralateral central nervous system lesions, with the exclusion of history, physical examination, and appropriate laboratory studies of other causes of pruritus without a primary cutaneous eruption, led to the diagnosis of neurogenic pruritus.