A Case of Herpes Zoster Presented with Lower Limb Paresis

Choi, Young Rak; Oh, Chi Hoon; Choi, Won-Chul

doi:10.7759/cureus.2923

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…Skin lesions generally precede the neurologic symptoms by several days to one week. Some studies reported that in some rare incidents, neurologic symptoms occurred before skin lesions [1][2][3][6][7][8] . The patient in our case also experienced neuralgia followed by skin lesions occurring one week later.…”

Section: Discussionmentioning

confidence: 99%

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Segmental Zoster Paresis with Late-Onset Skin Rash Mimicking a Herniated Cervical Disc: A Case Report

Jeong

Kim

2022

Nerve

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Segmental zoster paresis (SZP) of the limbs, characterized by focal weakness of the extremity, is recognized as a rare complication of herpes zoster that can lead to a misdiagnosis of other radiculopathies or musculoskeletal problems. Here, we present a rare case where the patient experienced severe pain and weakness of the right upper extremity caused by SZP. A 58-year-old man came to the hospital with severe right upper extremity radicular pain. Cervical magnetic resonance imaging of the spinal cord showed disc protrusion at the C5-6 level with a high signal change. Anterior cervical discectomy and fusion was performed. On the first and second postoperative days, the patient’s symptoms showed slight improvements. However, on the fourth postoperative day, the patient experienced a right shoulder drop along with exacerbated radicular pain and presented a herpetic rash on the right extremity. The patient showed a dramatic improvement in pain and weakness after taking antiviral medication and undergoing a fluoroscopic-guided right C6 selective nerve root block. He fully recovered from his symptoms after 12 weeks of rehabilitation and physical therapy. This rare case involved SZP which was misunderstood as a herniated cervical disc. If a patient complains of severe pain with motor weakness inconsistent with radiologic findings, SZP should be discriminated from other possible diagnosis.

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Section: Discussionmentioning

confidence: 99%

“…Herpes zoster (HZ) commonly presents with vesicular eruption due to the reactivation of varicella-zoster virus (VZV), especially in elderly patients [1][2][3][4][5]9) . Approximately 50% of HZ in the United States occurs in people 50 or older.…”

Section: Introductionmentioning

confidence: 99%

Segmental Zoster Paresis with Late-Onset Skin Rash Mimicking a Herniated Cervical Disc: A Case Report

Jeong

Kim

2022

Nerve

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“…The involvement of C3-C5 motor nerves could lead to diaphragmatic paresis and induce the clinical manifestations, including dyspnea and pulmonary dysfunction (42,43). The affected ganglion segments and possible clinical manifestation are summarized in Table 1 (3,7,28,34,(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63).…”

Section: Clinical Characteristics Of Szpmentioning

confidence: 99%

“…In addition to EMG, MRI examination also has relatively high sensitivity in detecting the involved nerves and muscles. Various previous studies have described the widening of the affected nerve and T2-weighed highsignals (63,69). The enhanced scanning through gadolinium (Gd)-contrast agents could also help to detect the inflammation levels of the involved nerve roots 9).…”

Section: Diagnosis and Auxiliary Examinations Of Szpmentioning

confidence: 99%

Segmental Zoster Paresis: A Literature Review

et al. 2021

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Background: Herpes zoster is an acute infectious skin disease that is induced by the re-activation of the virus incubated in nerve ganglions following initial infection with varicella-zoster virus in childhood. Herpes zoster mainly affects sensory nerves, resulting in severe acute pain, which is also the most common reason for medical intervention in this patient group. The concurrent involvement of motor nerves could induce the symptoms of segmental zoster paresis, which is manifested by localized asymmetric myasthenia, whose range generally follows the distribution of myomere with skin rashes. Due to the low incidence and unspecific clinical manifestations, segmental zoster paresis has not been sufficiently recognized by clinicians, and can easily be misdiagnosed. Objective: To summarize the previous studies on segmental zoster paresis and analyze the pathogeneses, diagnosis, and treatment of this disease, as well as stress the challenges in current treatment, which could provide useful evidence for the clinical diagnosis and better the treatment of patients with segmental zoster paresis in the future. Study Design: We conducted a narrative review. Setting: Hospitals, neurology departments, pain departments, and private practices. Methods: We searched PubMed and Chinese CNKI libraries using the terms “herpes zoster,” “muscle paresis,” “segmental zoster paresis,” and “motor nerve.” Clinical trials, reviews, and case reports were collected and reviewed. Results: As a rare complication following varicella-zoster virus infection, segmental zoster paresis has not been sufficiently recognized by clinicians, and there are still no guidelines available to guide the clinical treatments. The exact mechanism of segmental zoster paresis is still unclear. Electromyographic and magnetic resonance imaging examinations could be used as auxiliary diagnostic methods for segmental zoster paresis. Early regular anti-viral therapy could substantially decrease the risk of herpes zoster related complications. Combined application of glucocorticoids and some other physical therapy may also be useful in certain patients. The general prognosis of segmental zoster paresis is relatively good, with 67% patients achieving complete or almost complete recovery of the muscle function. Limitations: More clinical trials are needed to clarify the exact mechanisms and best treating methods. Conclusion: As the symptom in most segmental zoster paresis patients is self-limited, and the patients’ prognosis is generally good, early diagnosis of the disease is especially important, due to the avoidance of unnecessary diagnostic procedures and incorrect treatments. Standard treatment guidelines regarding the functional rehabilitation are still needed for patients with refractory segmental zoster paresis. Key words: Herpes zoster, postherpetic neuralgia, segmental zoster paresis, muscle strength, motor nerve, spinal dorsal ganglion, zoster infection, muscle paresis

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Herpes zoster-induced acute urinary retention, limb paresis, and constipation in two immunocompetent patients

Fang

Xiao

2022

Clin Auton Res

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A Case of Herpes Zoster Presented with Lower Limb Paresis

Cited by 3 publications

References 16 publications

Segmental Zoster Paresis with Late-Onset Skin Rash Mimicking a Herniated Cervical Disc: A Case Report

Segmental Zoster Paresis with Late-Onset Skin Rash Mimicking a Herniated Cervical Disc: A Case Report

Segmental Zoster Paresis: A Literature Review

Herpes zoster-induced acute urinary retention, limb paresis, and constipation in two immunocompetent patients

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