Central pruritus (CP) following CNS damage (Tables 5.1 and 5.2) has not received adequate recognition as part of the spectrum of CP (while it is well known as a consequence of PNP). Pruritus can blend with pain or dysesthesias or present singly (note that pain-insensitive patients are also itch-insensitive: ). Most likely, patients may complain of itching, but the treating physician may dismiss it until scratching makes the problem visible. Pruritus tends to be continuous, but may also present in paroxysms or bouts. Both brain and cord lesions have been described. In the brain, stroke is the main trigger, while in the cord, intramedullary masses are mainly responsible. Central pruritus is also commonly observed in multiple sclerosis, but also in neuromyelitis optica [39–41].
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