Síndromes comunes de prurito neuropático
Common neuropathic itch syndromes.
Oaklander AL.
Acta Derm Venereol. 2012 Mar;92(2):118-25. doi: 10.2340/00015555-1318.
Abstract
Patients with chronic itch are diagnosed and treated by dermatologists. However, itch is a neural sensation and some forms of chronic itch are the presenting symptoms of neurological diseases. Dermatologists need some familiarity with the most common neuropathic itch syndromes to initiate diagnostic testing and to know when to refer to a neurologist. This review summarizes current knowledge, admittedly incomplete, on neuropathic itch caused by diseases of the brain, spinal cord, cranial or spinal nerve-roots, and peripheral nerves.
http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1318
Prurito neuropático
Neuropathic itch.
Oaklander AL.
Semin Cutan Med Surg. 2011 Jun;30(2):87-92. doi: 10.1016/j.sder.2011.04.006.
Abstract
Chronic itch can be caused by dysfunctions of itch-sensing neurons that produce sensory hallucinations of pruritogenic stimuli. The cellular and molecular mechanisms are still unknown. All neurological disease categories have been implicated, and neurological causes should be considered for patients with otherwise-unexplained itch. The same neurological illnesses that cause neuropathic pain can also or instead cause itch. These include shingles (particularly of the head or neck), small-fiber polyneuropathies, radiculopathies (eg, notalgia paresthetica and brachioradial pruritis), and diverse lesions of the trigeminal nerve, root, and central tracts. Central nervous system lesions affecting sensory pathways, including strokes, multiple sclerosis, and cavernous hemangiomas, can cause central itch. Neuropathic itch is a potent trigger of reflex and volitional scratching although this provides only fleeting relief. Rare patients whose lesion causes sensory loss as well as neuropathic itch can scratch deeply enough to cause painless self-injury. The most common location is on the face (trigeminal trophic syndrome). Treating neuropathic itch is difficult; antihistamines, corticosteroids, and most pain medications are largely ineffective. Current treatment recommendations include local or systemic administration of inhibitors of neuronal excitability (especially local anesthetics) and barriers to reduce scratching.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139924/pdf/nihms305676.pdf
Prurito intratable después de trauma medular
Intractable pruritus after traumatic spinal cord injury.
Crane DA, Jaffee KM, Kundu A.
J Spinal Cord Med. 2009;32(4):436-9.
Abstract
BACKGROUND: This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm. METHOD: Case report. FINDINGS: Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture. CONCLUSIONS: Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830685/pdf/i1079-0268-32-4-436.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Common neuropathic itch syndromes.
Oaklander AL.
Acta Derm Venereol. 2012 Mar;92(2):118-25. doi: 10.2340/00015555-1318.
Abstract
Patients with chronic itch are diagnosed and treated by dermatologists. However, itch is a neural sensation and some forms of chronic itch are the presenting symptoms of neurological diseases. Dermatologists need some familiarity with the most common neuropathic itch syndromes to initiate diagnostic testing and to know when to refer to a neurologist. This review summarizes current knowledge, admittedly incomplete, on neuropathic itch caused by diseases of the brain, spinal cord, cranial or spinal nerve-roots, and peripheral nerves.
http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1318
Prurito neuropático
Neuropathic itch.
Oaklander AL.
Semin Cutan Med Surg. 2011 Jun;30(2):87-92. doi: 10.1016/j.sder.2011.04.006.
Abstract
Chronic itch can be caused by dysfunctions of itch-sensing neurons that produce sensory hallucinations of pruritogenic stimuli. The cellular and molecular mechanisms are still unknown. All neurological disease categories have been implicated, and neurological causes should be considered for patients with otherwise-unexplained itch. The same neurological illnesses that cause neuropathic pain can also or instead cause itch. These include shingles (particularly of the head or neck), small-fiber polyneuropathies, radiculopathies (eg, notalgia paresthetica and brachioradial pruritis), and diverse lesions of the trigeminal nerve, root, and central tracts. Central nervous system lesions affecting sensory pathways, including strokes, multiple sclerosis, and cavernous hemangiomas, can cause central itch. Neuropathic itch is a potent trigger of reflex and volitional scratching although this provides only fleeting relief. Rare patients whose lesion causes sensory loss as well as neuropathic itch can scratch deeply enough to cause painless self-injury. The most common location is on the face (trigeminal trophic syndrome). Treating neuropathic itch is difficult; antihistamines, corticosteroids, and most pain medications are largely ineffective. Current treatment recommendations include local or systemic administration of inhibitors of neuronal excitability (especially local anesthetics) and barriers to reduce scratching.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139924/pdf/nihms305676.pdf
Prurito intratable después de trauma medular
Intractable pruritus after traumatic spinal cord injury.
Crane DA, Jaffee KM, Kundu A.
J Spinal Cord Med. 2009;32(4):436-9.
Abstract
BACKGROUND: This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm. METHOD: Case report. FINDINGS: Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture. CONCLUSIONS: Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830685/pdf/i1079-0268-32-4-436.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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