case_images: PMC10831270_01
case_images: Case 1 clinical photographs and imaging. A, Scattered thin papules and plaques with excoriation and mild scale on the occipital scalp. B, MRI of the cervical spine demonstrated disc degeneration and spondylolisthesis contributing to multilevel stenosis, worst at C5-C6 where a disc herniation was associated with severe central canal stenosis and abnormal cord signal. Sagittal short tau inversion recovery (STIR) sequence is shown. C, Patient's scalp prior to GONB. D, Patient's scalp following the third GONB, which was performed 3 months after the first procedure. GONB, Greater occipital nerve block.
case_images: gr1.jpg
case_images: PMC10831270_01_gr1.jpg
case_images: fig1
case_images: Physical examination revealed scattered thin papules and plaques with excoriation and mild scale on the occipital scalp (Fig 1, A). Cervical magnetic resonance imaging (MRI) demonstrated disc degeneration and spondylolisthesis contributing to multilevel cervical stenosis (Fig 1, B). After repeated procedures, the patient had resolution of lesions (Fig 1, C and D).
case_images: Schematic of GONB technique. The patient's occipital protuberance and bilateral mastoid processes were identified as landmarks. The left injection site was located one-third of the distance from the occipital protuberance to the left mastoid process. Using a fanning technique, 1 mL of 0.25% bupivacaine was injected with the needle directed superiorly, 1 mL with the needle directed slightly medially, and 1 mL with the needle directed slightly laterally. The procedure was then repeated on the right side.
case_images: gr2.jpg
case_images: PMC10831270_02_gr2.jpg
case_images: fig2
case_images: The patient opted to receive a bedside bilateral GONB with bupivacaine as described above (Fig 2).
case_images: Improvement in patient-reported itch severity. Illustrated are the daily patient-reported WI-NRS scores for Case 1 (left) and Case 2 (right), beginning 5 days prior to the first GONB. Day 0 denotes the date of the first GONB, while black arrows indicate the date of the second GONB. WI-NRS, Worst Itch Numeric Rating Scale; GONB, greater occipital nerve block.
case_images: gr3.jpg
case_images: PMC10831270_02_gr3.jpg
case_images: fig3
case_images: The procedure was then repeated, leading to sustained itch reduction with WI-NRS as low as 3/10 over the next 3 to 4 weeks (Fig 3).
case_images: PMC10831270_02
case_images: Schematic of GONB technique. The patient's occipital protuberance and bilateral mastoid processes were identified as landmarks. The left injection site was located one-third of the distance from the occipital protuberance to the left mastoid process. Using a fanning technique, 1 mL of 0.25% bupivacaine was injected with the needle directed superiorly, 1 mL with the needle directed slightly medially, and 1 mL with the needle directed slightly laterally. The procedure was then repeated on the right side.
case_images: gr2.jpg
case_images: PMC10831270_02_gr2.jpg
case_images: fig2
case_images: The patient opted to receive a bedside bilateral GONB with bupivacaine as described above (Fig 2).
case_images: Improvement in patient-reported itch severity. Illustrated are the daily patient-reported WI-NRS scores for Case 1 (left) and Case 2 (right), beginning 5 days prior to the first GONB. Day 0 denotes the date of the first GONB, while black arrows indicate the date of the second GONB. WI-NRS, Worst Itch Numeric Rating Scale; GONB, greater occipital nerve block.
case_images: gr3.jpg
case_images: PMC10831270_02_gr3.jpg
case_images: fig3
case_images: The procedure was then repeated, leading to sustained itch reduction with WI-NRS as low as 3/10 over the next 3 to 4 weeks (Fig 3).
case_images: Case 2 clinical photograph. Numerous excoriations on the left occipital and parietal scalp.
case_images: gr4.jpg
case_images: PMC10831270_02_gr4.jpg
case_images: fig4
case_images: Physical examination revealed numerous excoriations on the left occipital and parietal scalp (Fig 4).