Scalp dysesthesia related to cervical spine disease

Laura A Thornsberry, Joseph C English
JAMA Dermatology 2013, 149 (2): 200-3

BACKGROUND: Scalp dysesthesia is characterized by abnormal sensations of the scalp in the absence of any other unusual physical examination findings. The pathogenesis of this condition is unknown but has been reported in the setting of underlying psychiatric disorders. Other localized pruritic syndromes, including brachioradial pruritus and notalgia paresthetica, have been associated with pathologic conditions of the spine and have been successfully treated with gabapentin.

OBSERVATIONS: Among 15 women identified in a retrospective review of medical records as having been seen with scalp dysesthesia, 14 patients had cervical spine disease confirmed by imaging. The most common finding on imaging was degenerative disk disease, with 10 of 14 patients having these changes at C5-C6. Other abnormal imaging findings included anterolisthesis, osteophytic spurring, lordosis, kyphosis, and nerve root impingement. A gabapentin regimen (topical or oral) had been recommended to 14 patients; of 7 patients who were followed up, 4 patients noted improvement in symptoms when taking gabapentin.

CONCLUSIONS: Patients with scalp dysesthesia also had abnormal cervical spine images. Chronic muscle tension placed on the pericranial muscles and scalp aponeurosis secondary to the underlying cervical spine disease may lead to the symptoms of scalp dysesthesia.

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