Can cervical radiculopathy cause bilateral itching?

Can Cervical Radiculopathy Cause Bilateral Itching?

Yes, cervical pathology can cause bilateral upper extremity itching, though this is an atypical presentation that should prompt urgent evaluation for cervical myelopathy (spinal cord compression) rather than simple radiculopathy.

Understanding the Atypical Nature of This Presentation

Cervical radiculopathy typically presents with unilateral dermatomal pain, sensory loss, motor weakness, and reflex changes in the upper extremity 1, 2. Bilateral symptoms are a red flag that suggests more serious pathology—specifically cervical myelopathy from spinal cord compression rather than isolated nerve root compression 3.

The Connection Between Cervical Pathology and Itching

While extremely uncommon, cervical nerve compression can manifest as chronic localized itching of the dorsolateral upper extremities, a condition known as brachioradial pruritus 4. A documented case demonstrated complete resolution of disabling bilateral upper extremity pruritus after multilevel anterior cervical decompression and fusion in a patient with multilevel cervical spondylosis, spinal stenosis with cord compression, and multilevel foraminal stenosis 4.

Critical Red Flags Requiring Urgent Evaluation

Bilateral symptoms affecting the upper extremities mandate immediate MRI evaluation to rule out cervical myelopathy 3. The following features require urgent assessment:

• Bilateral radiculopathy (bilateral radicular pain, sensory disturbance, or motor weakness) 5, 3
• Progressive neurological deficits 3
• New changes in bladder or bowel function 3
• Loss of perineal sensation 3
• Gait disturbance or difficulty with fine motor tasks 6

Diagnostic Approach Algorithm

Step 1: Screen for myelopathy features

• Assess for long tract signs (hyperreflexia, positive Hoffman's sign, clonus, Babinski sign)
• Evaluate gait and coordination
• Check for bilateral upper and lower extremity involvement 3

Step 2: Obtain urgent MRI cervical spine without contrast

• This is the preferred imaging modality for evaluating atypical presentations 3, 6
• MRI provides superior soft tissue visualization for detecting disc herniations, nerve root compression, and spinal cord compression 3

Step 3: Consider comprehensive neurological workup

• Neurology consultation should be obtained for atypical presentations with bilateral symptoms 3
• MRI of both cervical and lumbar spine may be necessary if symptoms affect multiple levels 3
• Non-spinal causes such as multiple sclerosis or other neurological disorders should be considered 3

Management Based on Findings

If myelopathy is confirmed:

• Surgical decompression should be considered urgently, as progressive neurological deficits can occur 3, 6
• This is not a condition for prolonged conservative management

If isolated multilevel radiculopathy without myelopathy:

• Conservative management may be attempted initially, as 75-90% of cervical radiculopathy cases resolve with nonoperative therapy 3, 7
• However, surgical decompression may be considered in select patients with disabling symptoms that fail conservative treatment 4

Common Pitfalls to Avoid

Do not dismiss bilateral itching as a purely dermatologic problem without evaluating the cervical spine 4. The case literature demonstrates that patients with upper extremity pruritus of unknown etiology underwent multiple inconclusive evaluations by dermatology, rheumatology, neurology, and psychiatry before cervical pathology was identified 4.

Do not treat bilateral symptoms as simple radiculopathy—this presentation pattern indicates potential myelopathy requiring more urgent intervention 3. Bilateral radiculopathy places patients at risk for progression to cauda equina-like syndromes or complete myelopathy if cervical cord compression is present 5.