Urgent considerations
See Differentials for more details
When evaluating patients with pruritus, it is important to remember that this symptom could (although rarely) be the first sign of various severe conditions, including HIV infection/AIDS, malignant solid tumors, hematologic malignancies, and brain injury.[2][33][34] Delay in the diagnosis of the underlying cause may lead to significant deterioration of the patient's condition. The most urgent disease that may be accompanied by pruritus and that requires rapid diagnosis and treatment is stroke.
Brain injury (stroke)
Stroke can rarely be accompanied by pruritus.[35][36][37][38] It usually occurs in capsular infarctions or in middle cerebral artery-distribution vascular lesions. The underlying mechanism is probably damage of the neuronal pathway responsible for transmitting pruritic stimuli. Pruritus occurring during brain injury is usually unilateral and severe, and can be general or localized. If pruritus due to brain injury is suspected, the patient will require a neurologic consultation and/or imaging of the central nervous system.
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