An Itch beyond the Skin: Syringomyelia Revealed by Localized Neuropathic Pruritus

Abstract

A 67-year-old man presented with an eight-month history of persistent pruritus accompanied by a burning sensation in the left upper limb. Neurological examination revealed a pattern of hypoesthesia in the left upper limb that was inconsistent with a peripheral nerve or spinal root lesion; subsequent involvement of the right lower limb was also noted. The pruritus proved refractory to multiple therapeutic options. Neurophysiological studies showed no abnormalities. Magnetic resonance imaging of the cervicothoracic spinal cord revealed an intramedullary cystic lesion consistent with syringomyelia.

Neuropathic pruritus may result from peripheral or central sensory dysfunction, particularly within the spinothalamic tract, thalamus, or somatosensory cortex. As illustrated in this case, it may represent the predominant manifestation of syringomyelia, underscoring the importance of considering structural spinal cord causes in patients presenting with persistent and unexplained pruritus.