Herpes zoster segmental paresis in an immunocompromised breast cancer woman

Rastegar, Shirvan; Mahdavi, Sadegh Baradaran; Mahmoudi, Farhad; Basiri, Keivan

doi:10.4103/2277-9175.162547

Cited by 12 publications

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The elderly and immunocompromised patients are most susceptible to VZV [ 1 , 9 , 19 ]. Due to the immunosenescence in aged people, HZ infection frequently occurs [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

A retrospective case series of segmental zoster paresis of limbs: clinical, electrophysiological and imaging characteristics

Liu

et al. 2018

BMC Neurol

View full text Add to dashboard Cite

BackgroundSegmental zoster paresis (SZP) of limbs, characterized by focal weakness of extremity, is recognized as a rare complication of herpes zoster (HZ). The following study analyzes the clinical characteristics and data from electromyography and MRI scans in patients with motor weakness after zoster infection.MethodsOne thousand three hundred ninety-three patients from our database (Shandong Provincial Qianfoshan Hospital) suffering from HZ were retrospectively reviewed from June 2015 to July 2017. Patients who fulfilled the diagnostic criteria for SZP were included in the analysis. The clinical characteristics, as well as electromyography findings and MRI scans were analyzed.ResultsSZP was present in 0.57% of patients with HZ (8/1393). The average age of symptom onset in 8 SZP patients was 69 years old (SD: 13, range 47–87). The severity of muscle weakness ranged from mild to severe. The electrophysiological testing revealed the characteristics of axonopathy. Radiculopathy (2/8), plexopathy (2/8), radiculoplexopathy (3/8) and combined radiculopathy and mononeuropathy (1/8) were also identified. MRI revealed hyperintensity of the affected spinal dorsal horns, nerve roots or peripheral nerves.ConclusionsSZP is associated with obvious limb weakness, nerve axons lesions and localization to nerve roots, plexus or peripheral nerves.

show abstract

“…The elderly and immunocompromised patients are most susceptible to VZV [ 1 , 9 , 19 ]. Due to the immunosenescence in aged people, HZ infection frequently occurs [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

A retrospective case series of segmental zoster paresis of limbs: clinical, electrophysiological and imaging characteristics

Liu

et al. 2018

BMC Neurol

View full text Add to dashboard Cite

show abstract

“…The upper limb HZ, particularly involving C6 or C7 segments, was strongly connected with the incidence of limb weakness. Segmental zoster paresis occurrence on the upper extremities seemed to be higher than lower extremities in several case reports in the literature (Yoleri et al, 2005;Rastegar et al, 2015;Teo et al, 2016;Chen et al, 2020;Patel et al, 2022). Liu et al (2018) found that limb weakness occurred in 6 out of 8 with upper limbs HZ.…”

Section: Discussionmentioning

confidence: 90%

Risk factors and nomogram-based prediction of the risk of limb weakness in herpes zoster

Feng

2023

Front. Neurosci.

View full text Add to dashboard Cite

BackgroundLimb weakness is a less common complication of herpes zoster (HZ). There has been comparatively little study of limb weakness. The aim of this study is to develop a risk nomogram for limb weakness in HZ patients.MethodsLimb weakness was diagnosed using the Medical Research Council (MRC) muscle power scale. The entire cohort was assigned to a training set (from January 1, 2018 to December 30, 2019, n = 169) and a validation set (from October 1, 2020 to December 30, 2021, n = 145). The least absolute shrinkage and selection operator (LASSO) regression analysis method and multivariable logistic regression analysis were used to identify the risk factors of limb weakness. A nomogram was established based on the training set. The discriminative ability and calibration of the nomogram to predict limb weakness were tested using the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA). A validation set was used to further assess the model by external validation.ResultsThree hundred and fourteen patients with HZ of the extremities were included in the study. Three significant risk factors: age (OR = 1.058, 95% CI: 1.021–1.100, P = 0.003), VAS (OR = 2.013, 95% CI: 1.101–3.790, P = 0.024), involving C6 or C7 nerve roots (OR = 3.218, 95% CI: 1.180–9.450, P = 0.027) were selected by the LASSO regression analysis and the multivariable logistic regression analysis. The nomogram to predict limb weakness was constructed based on the three predictors. The area under the ROC was 0.751 (95% CI: 0.673–0.829) in the training set and 0.705 (95% CI: 0.619–0.791) in the validation set. The DCA indicated that using the nomogram to predict the risk of limb weakness would be more accurate when the risk threshold probability was 10–68% in the training set and 15–57% in the validation set.ConclusionAge, VAS, and involving C6 or C7 nerve roots are potential risk factors for limb weakness in patients with HZ. Based on these three indicators, our model predicted the probability of limb weakness in patients with HZ with good accuracy.

show abstract

“…[ 13 ] Immunocompromization, smoking, and diabetes are associated with neurological complications that follow VZV infection. [ 14 , 15 ] Our patient was 72-year-old with a smoking history (smoked >1 pack per day for >30 years, but quit 10 years before the onset of this disease) and had no systemic disease other than hypertension and coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

Segmental zoster paresis of unilateral upper extremity

et al. 2020

View full text Add to dashboard Cite

Rationale: Segmental zoster paresis (SZP) is a relatively rare neurologic complication of herpes zoster (HZ), and is characterized by focal asymmetric motor weakness in the myotome that corresponds to skin lesions of the dermatome. The upper extremities are the second most commonly involved regions after the face, and predominantly involve proximal muscles. The pathogenesis of SZP remains unclear; however, most of the reports indicate that it is the inflammation because of the spread of the herpes virus. Patient concerns: A 72-year-old man without trauma history of the left shoulder joint developed weakness of the left proximal upper extremity 10 days after vesicular eruption of HZ. Diagnoses: His left shoulder girdle paresis was diagnosed with the upper truncus of the brachial plexus as a HZ complication according to a series of tests, including cervical magnetic resonance imaging (MRI), cerebral fluid analysis, sonography, and electrophysiological studies. Interventions: Acyclovir and prednisolone were administered during hospitalization to treat SZP. Meanwhile, analgesics and gabapentin were administered to control the patient's neuralgic pain. He also received inpatient (daily) and outpatient (3 times per week) physical therapy along with range of motion and strengthening exercises. Outcomes: Partial improvement of the strength of the left shoulder girdle, and no improvement of the left deltoid muscle was observed 2 months after the interventions. Lessons: This case emphasizes that HZ infections may be complicated by segmental paresis and they should be considered in the differential diagnosis of acute paresis in the upper limb. Awareness of this disorder is important because it avoids unnecessary invasive investigations and interventions, leading to suitable treatments with favorable prognosis.

show abstract

Herpes zoster segmental paresis in an immunocompromised breast cancer woman

Cited by 12 publications

References 21 publications

A retrospective case series of segmental zoster paresis of limbs: clinical, electrophysiological and imaging characteristics

A retrospective case series of segmental zoster paresis of limbs: clinical, electrophysiological and imaging characteristics

Risk factors and nomogram-based prediction of the risk of limb weakness in herpes zoster

Segmental zoster paresis of unilateral upper extremity

Contact Info

Product

Resources

About