Short Communications: Unilateral Neurogenic Pruritus Following Stroke

Case Material Nine patients with pruritus following stroke have been seen at Duke University Medical Center Rehabilitation Unit (table 1). Six were male and three female. Four were transferred from another facility and five had been in our hospital since occurrence of the stroke. During rehabilitation, from 3-6 weeks post stroke, these patients developed excoriations of the involved side. Their rehabilitation progress was not different from other patients. In five of our patients lesions involved the deep structures including thalamus and subcorical regions contralateral to the pruritic side. Motor and sensory involvement was variable. Computerized tomography in each patient defined the anatomic location (table 1). The lesions were secondary cutaneous lesions due to scratching. Underlying medical disorders, which should be considered in pruritus without a primary cutaneous eruption, were excluded by history, physical examination and appropriate laboratory evaluation. Possible medications causing itching were discontinued. A seizure focus as the cause of paroxysmal pruritus was not identified on electroencephalogram. No lymphoma, renal failure, jaundice, anemia, or infectious cause could be found. All patients have been followed for at least three months. Treatment included glycerine and olive oil local therapy in some and required Amitriptyline or Carbamazepine in five patients. Pruritus lessened in all patients over time and excoriations resolved. D.S., C 24373, was a 67 year old white female who developed a deep neck infection with subsequent erosion of the superior right internal carotid artery requiring surgical intervention. Post-operatively she had a left hemiplegia and hemianesthesia. Head CT scan (fig. 1) revealed an infarct in the distribution of the right middle cerebral artery with extension into the