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

Archer, Timothy Michael

doi:10.1136/bcr-2017-223947

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Also, if the MRI is not available, electrodiagnostic studies combined with the clinical presentation and history of painful blistering rash should be diagnostic for VZV plexopathy. There are case reports that showed positive VZV DNA polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) even four weeks after the initial blistering rash [ 4 ]. Also of diagnostic importance, the presence of anti-VZV immunoglobulin (Ig) G antibody in the CSF is more sensitive than VZV DNA [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging-Negative Varicella Zoster Virus Plexopathy in a Young Patient: A Case Report

Gül¹,

Ahmed²,

McGraw³

et al. 2023

Cureus

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Varicella zoster virus (VZV)-associated plexopathy mainly occurs in patients over 60 years old. Postherpetic neuralgia is a well-known complication of herpes zoster (HZ); however, segmental zoster paresis secondary to HZ was reported in 1-20% of cases in the literature. Magnetic resonance imaging (MRI) findings may be positive in up to 70% of the patients. We describe a 43-year-old male patient with a history of grade two left frontal oligodendroglioma, which was treated with two partial resections, radiation treatment and procarbazine/lomustine, who presented with left upper extremity pain and developed a blistering rash in a dermatomal pattern in the left proximal upper extremity two weeks after the initial symptoms. He was diagnosed with shingles and treated with steroids and acyclovir with minimal improvement. Six weeks after the initial symptoms, a physical exam revealed left deltoid, supraspinatus and infraspinatus weakness with normal muscle stretch reflexes and decreased sensation on the C5 dermatome. Electromyography (EMG) revealed absent left lateral antebrachial cutaneous sensory nerve action potentials (SNAP) amplitude and a small left radial SNAP amplitude compared to the right side. Evidence of ongoing denervation with reinnervation was seen in the left upper trunk-supplied muscles. MRI of the brachial plexus was negative for any abnormalities. The patient was diagnosed with VZV-associated plexopathy, which improved with pregabalin and physical therapy. Our patient was significantly younger than expected in the HZ group. MRI usually shows T2 hyperintensities and thickening of the nerve roots in patients with VZV-associated plexopathy. However, the presentation, onset of symptoms, characteristics of the rash, and clinical course were diagnostic of HZ, and the weakness pattern, supported by the EMG findings, was diagnostic of VZV-associated plexopathy.

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Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging-Negative Varicella Zoster Virus Plexopathy in a Young Patient: A Case Report

Gül¹,

Ahmed²,

McGraw³

et al. 2023

Cureus

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“…A comprehensive literature search revealed only 2 other cases of abnormal nerve and/or lumbosacral plexus enhancement in a patient with confirmed zoster lumbosacral plexopathy. 6,7 Nerve enhancement is, therefore, likely a transient finding in the acute phase of herpes zoster neuropathy.…”

Section: Discussionmentioning

confidence: 99%

Acute Herpes Zoster Radiculopathy of the Lower Extremity With Dermatomal Rash and Lumbar Nerve Enhancement on MRI

Bhushan

Dominguez

Shirazi

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Herpes zoster is a frequent cause of neuralgia and dermatomal vesicular rash secondary to reactivation of latent varicella zoster virus. However, it rarely presents with acute lumbar radiculopathy and the diagnosis can be quite challenging in such cases. Nerve signal abnormalities on magnetic resonance imaging are well recognized in herpes zoster neuropathy or plexopathy affecting the extremities, although gadolinium enhancement is characteristically absent. In this article, we describe a case of acute herpes zoster lumbosacral radiculopathy with characteristic vesicular dermatomal rash and second ever reported finding of gadolinium enhancement of the lumbar nerve on magnetic resonance imaging.

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“…PHN is the most common complication, however dVZV can also affect lungs, liver and brain [ 9 ]. Other rare and important complication that should be considered is VZV plexopathy, which is more common in the brachial than the lumbosacral plexus [ 10 , 11 ]. VZV plexopathy usually presents as an asymmetrical limb weakness, as in our patient, and may be mistaken for degenerative diseases causing radiculopathy.…”

Section: Discussionmentioning

confidence: 99%

“…VZV plexopathy usually presents as an asymmetrical limb weakness, as in our patient, and may be mistaken for degenerative diseases causing radiculopathy. Differential diagnosis for plexopathy include idiopathic, diabetic neuropathy, CNS malignancy, radiation therapy, trauma, autoimmune and inflammatory [ 10 ]. However, in a patient with a vesiculopustular dermatomal rash and plexopathy, an infection cause including VZV plexopathy must be immediately considered.…”

Section: Discussionmentioning

confidence: 99%

Disseminated herpes zoster with cauda equina symptoms

Steinberg

Moody

Yenior

et al. 2020

IDCases

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Highlights Herpes zoster results from the reactivation of dormant varicella zoster virus. Risk factors include older ages and immunosuppression. Lumbosacral plexopathy is a complication of disseminated herpes zoster. Early treatment even in immunocompetent patients can decrease morbidity. Awareness of the complications is crucial to provide early treatment.

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

Cited by 8 publications

References 15 publications

Magnetic Resonance Imaging-Negative Varicella Zoster Virus Plexopathy in a Young Patient: A Case Report

Magnetic Resonance Imaging-Negative Varicella Zoster Virus Plexopathy in a Young Patient: A Case Report

Acute Herpes Zoster Radiculopathy of the Lower Extremity With Dermatomal Rash and Lumbar Nerve Enhancement on MRI

Disseminated herpes zoster with cauda equina symptoms

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