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Resolution of a Focal Pruritic Rash Following Neurosurgical Decompression in an Adolescent With Chiari I and Syringomyelia.
- Source :
-
Pediatric neurology [Pediatr Neurol] 2023 Aug; Vol. 145, pp. 115-118. Date of Electronic Publication: 2023 May 19. - Publication Year :
- 2023
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Abstract
- Background: Chiari I malformation (Chiari I) is defined by the downward displacement of one or both cerebellar tonsils below the foramen magnum of the skull with crowding altering cerebrospinal fluid flow. It can be associated with the development of a fluid-filled cavity within the spinal cord, syringomyelia. Neurological deficits or symptoms can occur at the level of anatomic involvement of syringomyelia.<br />Case Presentation: A young man presented to dermatology clinic for evaluation of a pruritic rash. Recognizing a unique left "cape-like" distribution of neuropathic itch leading to prurigo nodularis, he was referred for further evaluation by neurology in the local emergency department. After additional history and neurological exam, a magnetic resonance imaging confirmed Chiari I with an associated syringobulbia and a syrinx extending to T10/11 of the spinal cord. Anteriorly the syrinx extended into the left parenchyma of his spinal cord involving the dorsal horn, a lesion explaining his neuropathic itch. The sensation of itch and rash resolved after posterior fossa craniectomy and C1 laminectomy with duraplasty.<br />Conclusion: Neuropathic itch, in addition to pain, can be a symptom of Chiari I with syringomyelia. Focal pruritus without an obvious cutaneous trigger should prompt providers to consider a central neurological pathology. While many patients with Chiari I are asymptomatic, the presence of neurological deficits and syringomyelia, are indications for neurosurgical evaluation.<br /> (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Subjects :
- Male
Humans
Adolescent
Magnetic Resonance Imaging
Pruritus etiology
Decompression, Surgical methods
Treatment Outcome
Syringomyelia complications
Syringomyelia diagnostic imaging
Prurigo complications
Prurigo surgery
Arnold-Chiari Malformation complications
Arnold-Chiari Malformation surgery
Exanthema complications
Exanthema surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1873-5150
- Volume :
- 145
- Database :
- MEDLINE
- Journal :
- Pediatric neurology
- Publication Type :
- Academic Journal
- Accession number :
- 37329859
- Full Text :
- https://doi.org/10.1016/j.pediatrneurol.2023.05.009