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Widespread pruritus and denervation
I have an odd case I would love the experts here on AANEM Connects help with. A 70 yo male patient presented initially with diagnosis of Notalgia Paresthetica over a year ago of which pruritus was the main complaint, and responded to steroid injection for quite a qhile (8+months). Then the pruritus returned with a vengence and more widespread including the extensor forearms. He was referred to me for possible brachioradial pruritus. Considering he had the pruritus also over the entire peri-scapular/ thoracic region and arms (more extensor surface) I was dubious of this diagnsosis.
Physical exam shows no significant weakness in upper limbs, relatievly normal sensory exam, normal reflexes.
Suprisingly EMG did show small amplitude PSW and Fibs in multiple muscles on both sides, most notable in biceps, triceps, brachioradialis, FDI bilaterally. I reviewed MRI of the cervical/thoracic spine which had been done just prior to seeing me and they were relatively benign.
Other things to note:
-70lb weight loss in last 6 months, but has been on wegovy during that time.
-Has complained of generalized mild weakness, but he attributed it to losing muscle mass with weight loss
-No new sensory complaints
Any ideas or other things you would check? Could this be a weird para-neoplastic presentation? Thank you in advance!
See NCS chart below
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