An unusual case of 'itchy paralysis': neuromyelitis optica presenting with severe neuropathic itch.

Zhao, Sizheng ORCID: 0000-0002-3558-7353, Mutch, Kerry, Elsone, Liene, Miller, James and Jacob, Anu (2015) An unusual case of 'itchy paralysis': neuromyelitis optica presenting with severe neuropathic itch. Practical neurology, 15 (2). pp. 149-151.

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Abstract

Pruritus, better known as itch, is ‘an unpleasant cutaneous sensation provoking the desire to scratch’.1 It is typically caused by pruritogens that activate nerve endings in cutaneous and transitional tissues (eg, conjunctivae, anal mucosa) and serves a protective function against noxious stimuli. Itch can also occur with diseased or malfunctioning pruritogenic neurones in the absence of a pruritogen—a symptom termed neuropathic pruritus or neuropathic itch.2 Neuropathic pruritus is a well described but under-recognised symptom of neurological disorders. The site of involvement may be (i) peripheral nerve and root, (ii) spinal cord or (iii) brain. It may accompany a variety of peripheral and central neurological disorders, including postherpetic neuralgia, peripheral neuropathy, trigeminal neuralgia, traumatic nerve injury, complex regional pain syndrome, multiple sclerosis and stroke.3 Neuromyelitis optica is a relapsing inflammatory astrocytopathic disorder affecting predominantly the optic nerves and spinal cord. It is associated with antiaquaporin-4 immunoglobulin G (AQP4-IgG) in up to 70% of patients. Spinal cord involvement typically presents as a longitudinally-extensive transverse myelitis with associated sensorimotor and sphincter dysfunction. Sensory symptoms such as numbness, dysaesthesia, pain and tonic spasms are common.4 This report highlights neuropathic pruritus as an under-recognised feature of neuromyelitis optica.

Item Type:	Article
Uncontrolled Keywords:	Humans, Neuromyelitis Optica, Paralysis, Pruritus, Immunoglobulin G, Middle Aged, Female, Aquaporin 4
Depositing User:	Symplectic Admin
Date Deposited:	01 Feb 2016 12:10
Last Modified:	17 Dec 2022 01:33
DOI:	10.1136/practneurol-2014-000936
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/2049508