EpistemisHyperesthesia
Specialty: Neurology.
Why it occurs
- Acute compressive radiculopathy in the irritative phase (disc herniation that generates exquisite hypersensitivity in the affected dermatome)
- Complex regional pain syndrome (CRPS)
- Postherpetic neuralgia in acute phase
- Bacterial or viral meningitis (generalized cutaneous hyperesthesia associated with meningism)
- Incomplete spinal cord injury (Brown-Séquard syndrome with contralateral hyperesthesia)
Initial workup
Superficial tactile exploration by gently rubbing the skin (brush or cotton) comparing dermatomal symmetry; Spinal MRI if acute root compression is suspected; urgent lumbar puncture if associated with febrile syndrome and suspicion of meningitis.
red flags
Generalized and severe cutaneous hyperesthesia associated with high fever, intense headache, neck stiffness, photophobia and altered sensorium, pathognomonic of acute meningitis.
Standard management
- Pregabalin — 75-300 mg/day
- Amitriptyline — 10-25 mg at night
- Topical 5% lidocaine in patches if the hyperesthesia is located in a delimited area of skin
- Systemic corticosteroids if there is severe root inflammation confirmed by imaging.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 4