Brachial neuritis caused by varicella-zoster diagnosed by changes in brachial plexus on MRI

Ayoub, Tariq; Raman, Vivek; Chowdhury, Muhammad Abdul Baker

doi:10.1007/s00415-009-5266-4

Cited by 28 publications

(20 citation statements)

References 13 publications

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“…Autoimmune and inflammatory mechanisms have been postulated as the major pathogenesis, but several preceding events, such as trauma, infection, viral disease, surgery and immunization have been described in some cases [4,17]. In our patient, all possible causes of brachial plexopathies were excluded.…”

Section: Discussionmentioning

confidence: 87%

Magnetic resonance imaging in bilateral brachial neuritis with pure sensory involvement

2011

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Brachial neuritis is characterized by shoulder and arm pain followed by weakness and atrophy of affected muscles and sensory loss in the arm. Isolated sensory involvement of the brachial plexus is very rare. Diagnosis of brachial neuritis is usually based on clinical history and examination, with the confirmation by electrodiagnostic tests. A 72-year-old woman presented with numbness and tingling in the bilateral upper extremities. While nerve conduction examination revealed only sensory abnormalities of the bilateral upper extremities, magnetic resonance imaging (MRI) showed thickening and hyperintensity of the bilateral brachial plexus. We report a case of bilateral brachial neuritis with clinical and electrophysiological pure sensory involvement diagnosed using brachial plexus MRI. Although electrophysiological examination is thought to be the best diagnostic technique in the diagnosis of brachial neuritis, its findings sometimes indicate a distal lesion, while the involvement of the whole brachial plexus can be seen in MRI.

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Section: Discussionmentioning

confidence: 87%

Magnetic resonance imaging in bilateral brachial neuritis with pure sensory involvement

2011

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“…Electrophysiological analysis revealed partial degeneration of the superior, medial and inferior truncus in the brachial plexus similar to our case. In 2010 [8], MRI images of a patient with weakness, sensory loss and atrophy due to brachial plexus involvement secondary to herpes zoster showed inflammatory changes in the brachial plexus. Brachial MRI showed no involvement in our patient.…”

Section: Discussionmentioning

confidence: 99%

Acute monoplegia secondary to herpes zoster infection: a case report

Aksoy

Altan

Solum

2017

The European Research Journal

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Brachial plexopathy with motor involvement secondary to herpes zoster infection is very rare. Also known as shingles, herpes zoster occurs as a result of reactivation of varicella zoster virus in the dorsal root ganglia. We present a 69-year-old male patient with right upper extremity monoplegia secondary to herpes zoster infection. Physical examination showed scars from rash on his right antecubital fossa. Electroneuromyography showed a low amplitude motor response of the right median nerve, while having no sensation response at digits 1 and 3. Right ulnar and radial nerve sensation responses were lower in amplitude compared to the left side. Herpes zoster should be considered in the differential diagnosis of acute monoparesis. It is very important in avoiding unnecessary tests and treatments.Eur Res J 2017;3(1):90-93

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“…Brachial plexopathy is a very rare condition with an annual incidence of 1.64 cases per 100.000 persons (2). The associated motor neuropathy was probably due to an intense inflammatory demyelinating process and post-infectious immune-mediated motor root damage (7,10).…”

Section: █ Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The most common complication of HZ is post-herpetic neuralgia (PHN), a syndrome characterized by neuropathic pain and allodynia in the affected region, persisting for months or even years after the rash has healed. However, motor involvement is rare, and brachial plexus neuritis is also very rare (2,3,6,7,10,11).The main components of therapy of motor paresis or neuritis due to HZ are antiviral agents, pain therapy, and physiotherapy. Some studies have showed that the use of corticosteroids in combination with antiviral agents reduces pain and accelerates the healing process (8,9,11,14).…”

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Herpes zoster brachial plexopathy: direct steroid injection

Araz

Askin²,

Yilmaz³

2015

Turkish Neurosurgery

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ABSTRACTwhich started 2 weeks after HZ skin eruption affecting to the left C4 and C6 dermatomes. In the patient's history, the pain started with skin lesions and resolved at the end of the second weeks with oral acyclovir therapy. The patient did not define any pain at the admittance and he had no signs of cranial nerve or meningeal involvement. The skin lesions of HZ were extinguished and widely settled to periarticular region of the left shoulder, lateral surface of the left proximal arm and the left upper back. Motor strength examination of the left upper extremity revealed that motor power was 2/5 on shoulder abduction, external rotation and elbow flexion, 3/5 on elbow extension and 4/5 on wrist and fingers. There were no pathological findings except for mild hypoesthesia at the periarticular area of left shoulder.Patient's routine biochemical tests were within normal limits. Brain, diffusion-weighted brain and cervical magnetic resonance imaging (MRI) studies were normal at this time. Electrodiagnostic studies (EDS) revealed a brachial plexopathy affecting the upper, middle and lower trunks, but dominantly the upper trunk. The median, radial and ulnar nerves had slow conductivity whereas upper extremity muscles showed intensive degenerative properties in EDS. Moreover, brachial plexus MRI was performed and contrast media enhancement was observed at the left brachial plexus (Figures 1, 2).█ INTRODUCTION H erpes zoster (HZ) is a viral disease, caused by an exclusively human alpha herpes virus and is characterized by segmental painful skin rash and sensory symptoms. The most common complication of HZ is post-herpetic neuralgia (PHN), a syndrome characterized by neuropathic pain and allodynia in the affected region, persisting for months or even years after the rash has healed. However, motor involvement is rare, and brachial plexus neuritis is also very rare (2,3,6,7,10,11).The main components of therapy of motor paresis or neuritis due to HZ are antiviral agents, pain therapy, and physiotherapy. Some studies have showed that the use of corticosteroids in combination with antiviral agents reduces pain and accelerates the healing process (8,9,11,14). We present a case with motor involvement of shoulder due to HZ and its treatment with brachial plexus injection by interscalene approach with local anesthetic with low concentration and triamcinolone. █ CASE REPORTA previously healthy 69-year-old male patient was referred to our clinic with the history of progressive left arm weakness Herpes zoster (shingles) is a viral disease, characterized by painful skin eruptions and neuropathic sensory symptoms. Motor involvement and brachial plexus involvement in herpes zoster are rare conditions. Together with antiviral medication and pain therapy, palliative and supportive modalities take an important role in the treatment of herpes zoster. It is well documented in previous reports that oral or intravenous steroid administrations may be additive in management. In this case report, positive effects of direct steroid injecti...

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Brachial neuritis caused by varicella-zoster diagnosed by changes in brachial plexus on MRI

Cited by 28 publications

References 13 publications

Magnetic resonance imaging in bilateral brachial neuritis with pure sensory involvement

Magnetic resonance imaging in bilateral brachial neuritis with pure sensory involvement

Acute monoplegia secondary to herpes zoster infection: a case report

Herpes zoster brachial plexopathy: direct steroid injection

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