Complete recovery of herpes zoster radiculopathy based on electrodiagnostic study: A case report

Abstract

BACKGROUND Herpes zoster is a painful infectious disease caused by the varicella zoster virus. Herpes zoster radiculopathy, which is a type of segmental zoster paresis, can complicate the disease and cause motor weakness. This complication should be considered when a patient with a rash complains of acute-onset motor weakness, and the diagnosis can be verified via electrodiagnostic study. CASE SUMMARY A 64-year-old female with a history of asthma presented to the emergency department with stabbing pain, an itching sensation, and a rash on the right anterior shoulder that had begun 5 d prior. Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions. Because herpes zoster was suspected, the patient immediately received intravenous acyclovir. On the third hospital day, she complained of motor weakness in the right upper extremity. Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression. On the 12 th hospital day, electrodiagnostic study revealed right cervical radiculopathy, mainly in the C5/6 roots. Six months later, monoparesis resolved, and follow-up electrodiagnostic study was normal. CONCLUSION This case emphasizes that clinicians should consider the possibility of post-herpetic paresis, such as herpes zoster radiculopathy, and that electrodiagnostic study is useful for diagnosis and follow-up.

Analysis of Risk Factors and Construction of a Prediction Model of Motor Dysfunction Caused by Limb Herpes Zoster

“…[9][10][11][12][13] When varicella-zoster virus invades the anterior nerve root, patients experience decreased muscle strength and motor dysfunction, which usually occurs within a few weeks after the appearance of the rash. 14 Since Broadbent first reported a case of motor dysfunction caused by cervical herpes zoster in 1866, a number of cases have been reported, [15][16][17][18] including literature reporting that the incidence of motor dysfunction in patients with herpes zoster was only 0.3%-5.0%, but Mondelli et al found that more than half of the patients with herpes zoster had limb motor nerve involvement, indicating that a large number of patients were missed. 19 In our study, when MRC score rather than electromyography was used, the overall incidence of motor dysfunction reached 4.59% (58/1264), which may be underestimated.…”