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• W2478638887 abstract "HomeStrokeVol. 30, No. 3Poststroke Pruritus Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBPoststroke Pruritus Arash Kimyai-Asadi and Hossein C. Nousari Taghi Kimyai-Asadi Fatemeh Milani Arash Kimyai-AsadiArash Kimyai-Asadi Department of Dermatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland Search for more papers by this author and Hossein C. NousariHossein C. Nousari Department of Dermatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland Search for more papers by this author Taghi Kimyai-AsadiTaghi Kimyai-Asadi Department of Neurology, The George Washington University School of Medicine, Washington, DC Search for more papers by this author Fatemeh MilaniFatemeh Milani Department of Rehabilitation Medicine, National Rehabilitation Hospital, Washington, DC Search for more papers by this author Originally published1 Mar 1999https://doi.org/10.1161/01.STR.30.3.692Stroke. 1999;30:692–693To the Editor: Although poststroke pain is a well-known phenomenon, poststroke pruritus is a generally under-recognized poststroke symptom. We have found only 10 reported cases of poststroke pruritus in the literature.12 We present 2 cases of poststroke pruritus and briefly discuss its etiology and management.Case 1: A 74-year-old female with a long-standing history of hypertension and hypercholestrolemia developed left-sided pruritus several weeks after a right thalamic stroke. The pruritus was episodic, affecting various localized areas of her left trunk and extremities while sparing the right side. The patient had no history of renal, liver, endocrine, hematologic, or skin diseases, and laboratory findings were unremarkable. Physical examination was significant for an erythematous excoriated area on the left side of the chest. Topical therapy with moisturizers and emollients helped alleviate each episode of pruritus, but the patient continued to have episodic, intense, localized pruritus on various regions of her left side. The patient refused oral medications in order to simplify her medication regimen.Case 2: A 69-year-old male with a long-standing history of hypertension developed intense pruritus of the left thigh several days after cerebral infarction in the right middle cerebral artery distribution. The pruritus was localized and unremitting, interfering with sleep. The patient had no history of renal, liver, endocrine, hematologic, or skin diseases, and laboratory findings were unremarkable. Physical examination revealed left-sided hemiplegia and hemiparesis, and an erythematous excoriated left anterior thigh. Treatment with amitriptylene 50 mg a day resulted in resolution of the pruritus within a week.Although the exact neuroanatomy and neurophysiology of itch perception has not been clarified, it is suggested that itch perception utilizes many of the same neural pathways used in pain sensation.2 Localized pruritus may be a symptom of any focal neurological phenomenon, such as brain tumors,3 multiple sclerosis,4 cerebral vascular aneurysms,5 and peripheral nerve entrapments.6It is important for physicians caring for stroke patients to be aware of poststroke pruritus and to avoid ignoring the symptoms or pursuing unnecessary work-up for other etiologies. The syndrome consists of excessive localized or generalized pruritus, primarily in the side of the body contralateral to the cerebral lesion. As in poststroke pain, the onset may be from days to weeks after the stroke, and the symptoms respond to medications such as amitriptylene and carbamazepine, although topical emollients may suffice in many cases.1 References 1 Massey EW. Unilateral neurogenic pruritus following stroke. Stroke.1984; 15:901–903.CrossrefMedlineGoogle Scholar2 Shapiro PE, Braun CW. Unilateral pruritus after a stroke. Arch Dermatol.1987; 123:1527–1530.CrossrefMedlineGoogle Scholar3 Andreev VC, Petkov I. Skin manifestations associated with tumours of the brain. Br J Dermatol.1975; 92:675–678.CrossrefMedlineGoogle Scholar4 Yamamoto M, Yabuki S, Hayabara T, Otsuki S. Paroxysmal itching in multiple sclerosis: a report of three cases. J Neurol Neurosurg Psychiatry.1981; 44:19–22.CrossrefMedlineGoogle Scholar5 King CA, Huff FJ, Jorizzo JL. Unilateral neurogenic pruritus: paroxysmal itching associated with central nervous system lesions. Ann Intern Med.1982; 97:222–223.CrossrefMedlineGoogle Scholar6 Eisenberg E, Barmeir E, Bergman R. Notalgia paresthetica associated with nerve root impingement. J Am Acad Dermatol.1997; 37:998–1000.CrossrefMedlineGoogle ScholarstrokeahaStrokeStrokeStroke0039-24991524-4628Lippincott Williams & WilkinsResponseWayne Massey E., MD031999pruritisstrokeThis letter emphasizes the poststroke pruritis that can occur in patients with cerebral infarction or hemorrhage. Although not common, we continue to see several cases yearly. Although initially described in capsular infarctions, it also seems to occur in middle cerebral artery distribution vascular lesions as well. When unilateral, contralateral, and poststroke, it is easier to diagnose the cause. Obviously, there are many other causes of pruritis.When it is localized to the lateral thigh, such as in case 2, one must consider other options such as meralgia paresthetica.I agree that treatment with tricyclics and, more recently, neurontin, can help. Often the symptoms resolve over weeks. Conventional antipruritis treatment, orally or topically, may sometimes help.Perhaps the greatest challenge is what Latin term to give to this poststroke symptom! Previous Back to top Next FiguresReferencesRelatedDetailsCited By Furlanetti L, Hasegawa H, Hulse N, Morris-Jones R and Ashkan K (2021) Chronic itch induced by thalamic deep brain stimulation: a case for a central itch centre, Journal of Translational Medicine, 10.1186/s12967-021-03110-y, 19:1, Online publication date: 1-Dec-2021. Soo Y, Leung H and Wong L (2019) What are this patient's problems? A problem-based approach to the general management of stroke Warlow's Stroke, 10.1002/9781118492390.ch11, (481-578) Canavero S and Bonicalzi V (2018) Central Pruritus Central Pain Syndrome, 10.1007/978-3-319-56765-5_5, (151-166), . Franz P (2015) Juckreiz — eine neurologische Krankheit?, NeuroTransmitter, 10.1007/s15016-015-5376-4, 26:12, (33-39), Online publication date: 1-Dec-2015. Zeidler C, Raap U and Ständer S (2015) Pruritus im Alter: Jeder Fünfte ist betroffen, MMW - Fortschritte der Medizin, 10.1007/s15006-015-2544-1, 157:5, (54-60), Online publication date: 1-Mar-2015. Zeidler C, Raap U and Ständer S (2015) Dermatose oder Symptom einer inneren Erkrankung?, hautnah dermatologie, 10.1007/s15012-015-1862-4, 31:4, (38-44), Online publication date: 1-Jul-2015. Dhand A and Aminoff M (2013) The neurology of itch, Brain, 10.1093/brain/awt158, 137:2, (313-322), Online publication date: 1-Feb-2014., Online publication date: 1-Feb-2014. Garibyan L, Chiou A and Elmariah S (2013) Advanced aging skin and itch: addressing an unmet need, Dermatologic Therapy, 10.1111/dth.12029, 26:2, (92-103), Online publication date: 1-Mar-2013. Panuganti B and Tarbox M (2013) Evaluation and Management of Pruritus and Scabies in the Elderly Population, Clinics in Geriatric Medicine, 10.1016/j.cger.2013.01.009, 29:2, (479-499), Online publication date: 1-May-2013. Zylicz Z and Krajnik M (2011) Itch complicating malignant diseases Supportive Oncology, 10.1016/B978-1-4377-1015-1.00020-5, (200-210), . Cohen O, Chapman J, Lee H, Nitsan Z, Appel S, Hoffman C, Rosenmann H, Korczyn A and Prohovnik I (2010) Pruritus in familial Creutzfeldt–Jakob disease: a common symptom associated with central nervous system pathology, Journal of Neurology, 10.1007/s00415-010-5694-1, 258:1, (89-95), Online publication date: 1-Jan-2011. Grundmann S and Ständer S (2010) Evaluation of chronic pruritus in older patients, Aging Health, 10.2217/ahe.09.84, 6:1, (53-66), Online publication date: 1-Feb-2010. Marziniak M, Pogatzki-Zahn E and Evers S (2010) Other Neurological Causes of Itch Pruritus, 10.1007/978-1-84882-322-8_26, (163-164), . Fleuret C and Misery L (2010) Neurogenic Pruritus with Cerebral and/or Medullary Abnormalities Pruritus, 10.1007/978-1-84882-322-8_23, (144-149), . Ward J and Bernhard J (2005) Willan's itch and other causes of pruritus in the elderly, International Journal of Dermatology, 10.1111/j.1365-4632.2004.02553.x, 44:4, (267-273), Online publication date: 1-Apr-2005. Lonsdale-Eccles A and Carmichael A (2003) Treatment of Pruritus Associated with Systemic Disorders in the Elderly, Drugs & Aging, 10.2165/00002512-200320030-00004, 20:3, (197-208), . Etter L and Myers S (2002) Pruritus in systemic disease: mechanisms and management, Dermatologic Clinics, 10.1016/S0733-8635(02)00011-6, 20:3, (459-472), Online publication date: 1-Jul-2002. Krajnik M and Zylicz Z (2001) Understanding Pruritus in Systemic Disease, Journal of Pain and Symptom Management, 10.1016/S0885-3924(00)00256-6, 21:2, (151-168), Online publication date: 1-Feb-2001. March 1999Vol 30, Issue 3 Advertisement Article InformationMetrics Copyright © 1999 by American Heart Associationhttps://doi.org/10.1161/01.STR.30.3.692 Originally publishedMarch 1, 1999 Keywordsprurituspost-stroke syndromesPDF download Advertisement" @default.
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