Clinical, electrophysiologic, and imaging features of zoster‐associated limb paresis

Jones, Lyell K.; Reda, Haatem; Watson, James C.

doi:10.1002/mus.24141

Cited by 43 publications

(49 citation statements)

References 26 publications

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“…Functional improvement occurs between 1 and 2 years in most cases [10]. Our patient showed a remarkable improvement pattern 4 months after the onset.…”

Section: Discussionsupporting

confidence: 52%

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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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“…Functional improvement occurs between 1 and 2 years in most cases [10]. Our patient showed a remarkable improvement pattern 4 months after the onset.…”

Section: Discussionsupporting

confidence: 52%

“…In a study which evaluated 49 patients with zoster associated limb paralysis in 2014, Jones et al [10] reported that the mean age of onset was 71 years; the duration between rash and weakness was approximately 5.8 days; and 11% of patients had diabetes mellitus. The mean duration of paralysis was days.…”

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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“…Acute rash is often preceded by pain in the corresponding dermatome. Diffuse lumbosacral plexus involvement may occur in approximately 20% of lumbosacral region reactivations 5. Motor neuropathy and paresis secondary to either plexopathy or single neuropathy occurs in 1%–20% of confirmed VZV reactivations 1…”

Section: Discussionmentioning

confidence: 99%

“…There are few published case reports and series describing zoster associated lower limb plexopathy,5 likely due to the rarity of the condition. As such, there is no consensus guideline for the long-term management of the condition, especially with respect to reducing the risk of long-term neuralgia.…”

Section: Discussionmentioning

confidence: 99%

Varicella zoster lumbosacral plexopathy: a rare cause of lower limb weakness

Archer¹

2018

BMJ Case Reports

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This is a rare case of Varicella zoster virus (VZV) lumbosacral plexopathy in an 84-year-old women presenting with lower limb weakness and rash. Contrast-enhanced MRI showed enhancement of the left L3-L5 descending nerves and left lumbosacral plexus consistent with inflammatory/infectious aetiology. Cerebrospinal fluid PCR confirmed VZV DNA and cerebrospinal fluid serological testing was positive for VZV immunoglobulin (Ig)M and IgG antibodies. The patient was treated with intravenous acyclovir but this was complicated by the development of acute renal failure attributed to acyclovir-induced nephropathy, requiring dose adjustment. After a prolonged course of oral acyclovir and inpatient rehabilitation, the patient made a partial neurological and functional recovery.

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“…Weakness associated with HZ has been recognized since the 19th century and can affect bulbar, limb, or truncal muscles. 7 The incidence of SMP may increase with EDX studies revealed that subclinical motor involvement is more prevalent in patients with zoster infection. However, plexopathy presenting with severe motor paralysis due to zoster infection has been rarely described.…”

mentioning

confidence: 99%

Segmental Limb Paresis Due to Zoster Plexopathy: Case Report

Arslan¹,

Uyaroğlu²,

Öcek³

et al. 2016

Turkiye Klinikleri J Neur

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68erpes zoster (HZ) is the reactivation of dormant varicella zoster virus (VZV) in the dorsal root ganglia. The commonly involved nerve segments are thoracic, lumbar and trigeminal.1,2 It may also spread to involve the nerve roots adjacent to the dorsal root ganglia causing a plexitis or neuritis.3,4 Postherpetic neuralgia is the most common complication of HZ affecting more than 40% of patients. In contrast, the motor complications of herpes zoster are rare and their true incidence is unknown. Review of the literature suggests that motor involvement occur between 1-Segmental Limb Paresis Due to Zoster Plexopathy: Case Report A AB BS S T TR RA AC CT T Segmental zoster paresis (SZP) is focal, asymmetric and a rare cause of neurogenic weakness that may occur in a limb caused by herpes zoster (HZ). It typically occurs 2-3 weeks after the herpetic rash and usually affects the myotome that corresponds to the dermatomal distribution. HZ plexopathy may be overlooked in the acute period, or the motor paresis may be mistakenly diagnosed as another cervical or lumbar pathology after the vesicular lesions have disappeared. Three zoster plexopathy cases; two brachial and one lumbar were presented in this article. Electrophysiological study (EDX) findings, limb paresis, pain and erupted skin lesions with positive VZV antibodies indicated HZ plexopathy. EDX revealed patchy involvement of brachial and lumbar plexus. Antiviral treatment and physiotherapy improved muscle strength to mild paresis. An accurate and early diagnosis is vital for total recovery of muscle strength.K Ke ey y W Wo or rd ds s: : Brachial plexus neuropathies; electromyography; herpes zoster; acyclovir; sacral plexopathy Ö ÖZ ZE ET T Segmenter zoster parezisi (SZP) fokal, asimetrik, herpes zoster (HZ) nedeniyle tek ekstremitede oluşabilen nadir bir nörojenik güçsüzlüktür. Tipik olarak herpetik döküntüden 2-3 hafta sonra meydana gelir ve genellikle dermatomal dağılıma karşılık gelen miyotomu etkiler. HZ pleksopati akut dönemde gözden kaçabilir veya lezyonlar kaybolduktan sonra motor pareziye yanlışlıkla diğer servikal ve lomber patoloji tanıları konulabilir. Bu makalede iki brakial ve bir lomber pleksopati olmak üzere üç HZ pleksopati olgusu sunuldu. Elektrofizyolojik çalışma (EDX) bulguları, ekstremite parezisi, ağrı ve kabuklanmış cilt lezyonları ile birlikte pozitif VZV antikorları HZ pleksopatiye işaret etti. EDX bulguları brakial ve lomber pleksusun yamalı tutulumu ile uyumluydu. Antiviral tedavi ve fizyoterapi tüm olgularda kas gücünü hafif pareziye geriletti. Akut fazda doğru ve erken tanı kas gücünün total geri dönüşü için gereklidir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Brakiyal pleksus nöropatileri; elektromiyografi; herpes zoster; asiklovir; sakral pleksopati T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J N Ne eu ur r 2 20 01 16 6; ;1 11 1( (2 2)

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Clinical, electrophysiologic, and imaging features of zoster‐associated limb paresis

Abstract: ZALP is associated with considerable weakness. It typically lasts at least several months, localizes to plexus or peripheral nerve in 63%, and is associated with high rates of PHN.

Cited by 43 publications

References 26 publications

Acute monoplegia secondary to herpes zoster infection: a case report

Acute monoplegia secondary to herpes zoster infection: a case report

Varicella zoster lumbosacral plexopathy: a rare cause of lower limb weakness

Segmental Limb Paresis Due to Zoster Plexopathy: Case Report

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